Fungal Skin Infections

Clinical Presentation

Fungal skin infections can present as papular rashes, particularly in cases of invasive fungal infections and certain superficial mycoses, often found on the trunk and extremities 1
Candidiasis can develop single or multiple nodular skin lesions that appear as discrete pink to red papules, usually found on the trunk and extremities 1
Aspergillosis can present as erythematous papules that may progress to pustules and subsequently develop central ulceration with an elevated border covered by a black eschar, typically occurring on the extremities but can also appear on the face and trunk 2
Trichosporonosis can present with dermatologic manifestations that vary from multiple erythematous macules to maculopapular lesions 1
Mucormycosis/Zygomycosis can cause painful erythematous skin nodules that become necrotic 1
Cryptococcosis can appear as papules, nodules, or pustules, particularly in immunocompromised patients 3

Skin biopsy with fungal culture is indicated for definitive diagnosis, especially for atypical presentations 2
Blood cultures should be obtained in suspected disseminated fungal infections 1
Direct microscopy with potassium hydroxide preparation can aid in diagnosis

Systemic antifungal therapy is the mainstay of treatment for invasive fungal infections with cutaneous manifestations 2
Surgical debridement may be necessary for necrotic lesions or when local infection cannot be controlled with antifungal therapy alone 2
Topical antifungals may be sufficient for limited superficial infections

Misdiagnosis as bacterial infection can lead to inappropriate antibiotic treatment 1
Delayed diagnosis can result in high mortality from invasive fungal infections, particularly in immunocompromised patients 1
Inadequate sampling can miss deeper fungal elements, and proper biopsy technique is essential 1
Overlooking fungal superinfection can occur in papular rashes from other causes, such as EGFR inhibitor-induced rash 4

Immunocompromised patients, particularly those with neutropenia or those who have undergone transplantation, require aggressive evaluation and treatment for fungal skin infections 1, 3