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Fungal Skin Infections

Gupta AK, MacLeod MA, Foley KA, Gupta G, Friedlander SF. Pediatr Rev. 2017 Jan;38(1):8-22


Candidal diaper dermatitis is the most common fungal infection of childhood. This yeast infection almost always secondarily invades diaper-area skin that has been damaged by an irritant contact dermatitis from maceration, urine, and/or stool. Children in the preschool-age group who no longer wear diapers are more likely to develop tinea infections, particularly tinea capitis. Tinea refers to dermatophyte infections in the epidermis and areas high in keratin, such as the hair and nails. In prepubertal children, tinea capitis and tinea corporis are most common; in adolescence, tinea pedis (TP), tinea cruris, and tinea unguium (onychomycosis) are more common. Yeast infections other than candidal diaper dermatitis, including pityriasis versicolor (PV) (formerly known as tinea versicolor) and mucocutaneous candidiasis (MC), may also occur. Chronic MC (CMC) is a rare, usually inherited disorder. PVis a common infection in adolescents and adults that usually affects the sebum-prone areas (face, chest, back). Fungal infections can be a substantial source of morbidity in the pediatric population, accounting for about 15% of pediatric outpatient visits in the United States. This article reviews the epidemiology and clinical presentations of tinea infections (capitis, corporis, pedis, cruris, unguium), PV, and MC in children. The differential diagnosis and methods for confirming diagnosis based on clinical presentation are discussed. Recommended treatment options for each type of infection are specified (Table 1). Of note, many recommendations are off-label, as the safety of many agents has not been established for children.

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