Diagnosis and Treatment of Fungal Skin Infections

Diagnosis

Confirm diagnosis through microscopic examination with potassium hydroxide (KOH) preparation to visualize yeast or hyphae, as recommended by the Infectious Diseases Society of America 1
For Candida, look for white, thick, curd-like appearance with surrounding erythema, which is a characteristic feature of candidal skin infections 1

Polyenes (nystatin) are equally effective alternatives to topical azoles for the treatment of candidal skin infections, with complete cure rates of 73-100%, according to the Clinical Infectious Diseases guidelines 2, 3
For intertrigo (skin fold infections), keep the infected area dry in addition to antifungal treatment, and use topical azoles and polyenes as effective first-line treatments, as recommended by the Clinical Infectious Diseases guidelines 2, 3, 4
For candidal paronychia (infection around nails), drainage is the most important intervention, and combine with topical antifungal therapy, according to the Clinical Infectious Diseases guidelines 2, 3
For candidal onychomycosis (nail infection), topical agents alone are usually ineffective, and oral itraconazole is recommended, as stated in the Clinical Infectious Diseases guidelines 3

Oral terbinafine is generally preferred for dermatophyte infections, especially for tinea unguium (nail infections), according to the Clinical Infectious Diseases guidelines 3

For localized Candida skin infections, first-line treatment is topical azoles (clotrimazole, miconazole) or nystatin for 1-2 weeks, and keep affected areas dry, as recommended by the Clinical Infectious Diseases guidelines 2, 3

The British Journal of Dermatology recommends oral itraconazole as the first-line systemic treatment for candidal onychomycosis, with a dosage of 200 mg daily or pulse therapy (400 mg daily for 1 week each month) for a minimum of 4 weeks for fingernails and 12 weeks for toenails 5