Eczema is not a fungal infection. It is a chronic inflammatory skin condition. While both eczema and fungal infections can cause red, itchy patches, they originate from different causes and require distinct management approaches.
Understanding Eczema
Eczema, often referred to as atopic dermatitis, is a chronic inflammatory skin condition characterized by dry, itchy, and inflamed patches. It commonly appears on areas like the elbows, knees, hands, and face, particularly in infants. It tends to flare up periodically.
The underlying causes of eczema involve a complex interaction of genetic predisposition, immune system dysfunction, and environmental triggers. For instance, some individuals with eczema have a genetic variation affecting a protein called filaggrin, which is important for maintaining a healthy skin barrier. A weakened skin barrier allows moisture to escape and makes the skin more vulnerable to irritants and allergens, triggering inflammation. Common environmental triggers include certain cleaning products, fragrances, dust mites, pet dander, and even stress.
Eczema has several types, with atopic dermatitis being the most prevalent and chronic form. Other types include contact dermatitis, resulting from exposure to irritants or allergens, and dyshidrotic eczema, characterized by small, itchy blisters on the hands and feet. Nummular eczema presents as coin-shaped patches, while seborrheic dermatitis often affects oily areas like the scalp. Each type shares the common characteristic of skin inflammation but may have unique triggers and presentations.
Key Differences from Fungal Infections
Distinguishing eczema from fungal infections is important because their causes, appearances, and treatments differ. Eczema stems from immune system dysfunction and genetic factors, whereas fungal infections are caused by microscopic organisms like dermatophytes or yeasts. Fungal infections, such as ringworm or athlete’s foot, are contagious and can spread through direct contact with infected skin, animals, or contaminated objects. In contrast, eczema is not contagious.
While both conditions can cause redness, itching, and scaling, their rash presentations vary. Eczema patches tend to be dry, scaly, and can have ill-defined borders, appearing pink or red on lighter skin tones, and gray, brown, or violet on darker skin tones. Fungal infections, especially ringworm, frequently present as characteristic ring-shaped lesions with raised, scaly, and well-defined borders. These lesions can expand and spread to other areas of the body.
Diagnosis also differs between the two conditions. Healthcare providers diagnose eczema through a clinical examination, assessing the appearance of the rash and reviewing the patient’s medical history. For suspected fungal infections, a clinical examination is followed by a potassium hydroxide (KOH) test. This involves scraping a skin sample, dissolving skin cells in a KOH solution, and examining it under a microscope to identify fungal elements. The KOH test helps confirm the presence of fungi like dermatophytes or Candida, and is not performed for eczema.
How Eczema is Managed
Managing eczema focuses on reducing inflammation, repairing the skin barrier, and controlling symptoms rather than targeting an infectious agent. Eczema care involves regular moisturizing to maintain skin hydration and barrier function. Using fragrance-free and hypoallergenic moisturizers is recommended.
Topical treatments are an approach for eczema management. These include corticosteroids, which reduce inflammation and itching, and calcineurin inhibitors like tacrolimus and pimecrolimus, which modulate the immune response in the skin. Calcineurin inhibitors are useful for sensitive areas like the face and skin folds.
For more severe or persistent cases, systemic medications or phototherapy are considered. Systemic treatments, such as oral immunosuppressants, work throughout the body to control the immune system’s overactivity. Phototherapy, involving controlled exposure to specific wavelengths of ultraviolet light, can help reduce inflammation and improve symptoms. Lifestyle adjustments, such as avoiding identified triggers, managing stress, and using gentle skin care products, support eczema management.
When Fungi Complicate Eczema
While eczema itself is not a fungal infection, individuals with eczema are more susceptible to secondary infections. The compromised skin barrier in eczema makes it easier for microorganisms to penetrate and cause an infection.
Common fungi like Candida (a yeast) or dermatophytes (which cause ringworm) can complicate eczema, especially in warm, moist skin folds. When a fungal infection develops, it can worsen existing eczema symptoms or alter the appearance of the rash, sometimes making it more defined or circular. In such cases, the treatment strategy involves addressing both the underlying eczema and the new fungal infection. This means treating the fungal infection with antifungal medications in addition to continuing eczema management.