Dr. Aarti Bernett, MBBS, Trichy SRM Medical College Hospital & Research Center, Tiruchirappalli, Tamil Nadu, India and MD (DVL), Government Medical College, Tirunelveli, Tamil Nadu, India
Dr. Aarti Bernett, MBBS, Trichy SRM Medical College Hospital & Research Center, Tiruchirappalli, Tamil Nadu, India and MD (DVL), Government Medical College, Tirunelveli, Tamil Nadu, India

Could That Itchy Skin Be a Fungal Infection You Shouldn't Ignore? Dr. Aarti Bernett Clears It Up

Dr. Aarti Bernett shares her expertise on skin fungal infections, discussing their prevalence, symptoms, effective treatments, and prevention methods

In an engaging segment of "Docscopy" featured in MedBound Times, Dr. Nirainila Joseph interviews Dr. Aarti Bernett, focusing on the topic of fungal skin infections.

From her formative years (MBBS) at Trichy SRM Medical College Hospital & Research Center, Tiruchirappalli, Tamil Nadu, India to her postgraduate studies (MD) in Dermatology, Venereology, and Leprosy at Government Medical College, Tirunelveli, Tamil Nadu, India, Dr. Aarti has honed her skills and expertise, emerging as a beacon of clinical excellence in her field.

Having established her clinic in her hometown of Tirunelveli, Dr. Aarti diagnoses and treats a myriad of dermatological ailments. Among these, fungal skin infections stand as a prevalent concern, demanding both clinical insight and patient education. In this exclusive interview, she graciously shares her insights on fungal skin infections - their prevalence, symptoms, treatment modalities, preventive measures, follow-up protocols, and dispelling common myths.

Q

Dr. Nirainila Joseph: Please tell us about yourself, your educational background, and your journey in the field of dermatology.

A

Dr. Aarti Bernett: I am Dr. Aarti Bernett. I am 33 years old. My husband is a Physician and Intensivist. We have two daughters. After my schooling, I initially chose the engineering field which I didn’t like later. So after one and a half years in engineering college, I applied again and entered medicine. I did my MBBS degree in Trichy SRM Medical College, Tiruchirappalli. After my MBBS, due to marriage and going in the family way, I stayed at home for 4 years. After that, I prepared and wrote my PG entrance exam and I chose Dermatology at Government Medical College, Tirunelveli. I chose dermatology because I always believe in clinical examination and making a diagnosis. Dermatology is one such field where we can just use our hand-held lens/ dermatoscope to diagnose without sophisticated investigations. After my postgraduation, I set up my own clinic in my hometown, Tirunelveli.

The most common fungal skin infection that Dr. Aarti Bernett sees regularly is the Dermatophyte infection. (Wikimedia Commons)
The most common fungal skin infection that Dr. Aarti Bernett sees regularly is the Dermatophyte infection. (Wikimedia Commons)
Q

Dr. Nirainila Joseph: Your passion and dedication to dermatology is inspiring. Now, let's move on to our topic of discussion, skin fungal infections. While bacteria and viruses often dominate discussions about infectious diseases, fungi play a significant role as well, particularly in skin infections. How common are fungal skin infections in your experience?

A

Dr. Aarti Bernett: Fungal infections are very common. In daily OPD, 40 to 50% of patients have fungal infections of some kind. The most common one I see regularly is the Dermatophyte infection.

Q

Dr. Nirainila Joseph: Can you discuss the typical symptoms of common fungal skin infections? Are there any less common symptoms that people should be aware of?

A

Dr. Aarti Bernett: Dermatophyte infection can involve both skin, hair, and nails, of which skin is the most common. In the skin, it produces extremely itchy red or greyish-black patches with raised borders. These patches gradually increase in size and coalesce to form bigger patches. They are found usually in the groin, axilla, mammary area, and beneath the abdomen but can be found anywhere including the face. They produce severe itching. They spread from one person to another by direct contact or sharing objects like towels. The other common fungal infection is Pityriasis versicolor which is a milder one seen over the seborrheic areas of the body like the upper chest, shoulders, upper back, and face. They produce greyish-white/brown/black flat patches with no itching. This fungal infection does not spread from one person to another.

The other common fungal infection is Pityriasis versicolor which is a milder one seen over the seborrheic areas of the body like the upper chest, shoulders, upper back, and face. They produce greyish-white/brown/black flat patches with no itching. (Wikimedia Commons)
The other common fungal infection is Pityriasis versicolor which is a milder one seen over the seborrheic areas of the body like the upper chest, shoulders, upper back, and face. They produce greyish-white/brown/black flat patches with no itching. (Wikimedia Commons)
Q

Dr. Nirainila Joseph: You have clearly stated the different symptoms of common skin fungal infections. But, how do fungal skin infections differ from other types of skin conditions? How can people differentiate between them?

A

Dr. Aarti Bernett: Fungal infections can be differentiated by their peculiar locations, itching, and similar symptoms in family members since they spread very quickly.

Q

Dr. Nirainila Joseph: In light of the various factors affecting our skin health how do lifestyle and environmental factors contribute to the development of fungal skin infections?

A

Dr. Aarti Bernett: Food has no direct relation but obesity leads to increased body folds which may indirectly increase sweating and facilitates fungal growth. Bathing twice daily is recommended in tropical regions to keep the fungus out of bay. And people should avoid wearing tight clothing and should not share objects which come in direct contact with the body .

Q

Dr. Nirainila Joseph: As we know understanding the correct diagnosis is the first step to effective treatment. Can you describe the diagnostic process for identifying a fungal skin infection? Are there different diagnostic methods for different types of infections?

A

Dr. Aarti Bernett: They can be diagnosed by direct dermatoscopy. In case of doubt we can take scrapping of the fungal scales in a glass slide, place a drop of KOH 10% and visualize under the microscope where we can see fungal hyphae.

To diagnose a fungal infection, a scraping of the fungal scales is taken and placed on a glass slide. A drop of 10% KOH is added, and the slide is then visualized under a microscope, where fungal hyphae can be seen. (Representational image: Wikimedia Cmmons)
To diagnose a fungal infection, a scraping of the fungal scales is taken and placed on a glass slide. A drop of 10% KOH is added, and the slide is then visualized under a microscope, where fungal hyphae can be seen. (Representational image: Wikimedia Cmmons)
Q

Dr. Nirainila Joseph: Once diagnosed, what are the most effective treatments currently available for fungal skin infections?

A

Dr. Aarti Bernett: For Dermatophyte, oral antifungals like itraconazole and griseofulvin are very effective along with topical creams like luliconazole. For Pityriasis versicolor, topical anti-fungal like ketoconazole will suffice.

Q

Dr. Nirainila Joseph: When we speak of treatment options for any disease, It's important to address the unique considerations involved in patients with underlying systemic conditions, how do you approach the treatment of fungal skin infections in such patients?

A

Dr. Aarti Bernett: In patients with underlying systemic conditions, choice of oral antifungal matters. For example, itraconazole is avoided in Coronary Artery Disease, fluconazole and ketoconazole are avoided in hepatic dysfunction and griseofulvin in case of photosensitivity . Also, if patient is immunocompromised, treatment duration has to be prolonged.

Q

Dr. Nirainila Joseph: After initiating treatment for a fungal skin infection, how important is follow-up care after treatment for a fungal skin infection? What does typical follow-up involve?

A

Dr. Aarti Bernett: Patients should follow up at least once a month to make sure all fungal elements are destroyed. Skin scrapping is taken during the follow-up visits to ascertain that.

Q

Dr. Nirainila Joseph: Recurrent fungal skin infections can be particularly troublesome. How do you handle cases where fungal skin infections that keep coming back?

A

Dr. Aarti Bernett: Antifungals with different mechanisms of action can be given together and treatment duration can be prolonged. Patients should also be advised of lifestyle modifications.

Steroid and antifungal combinations sold as over the counter medicines (OTC) have contributed much to the antifungal resistance. It is emerging as a global epidemic in countries like India.
Q

Dr. Nirainila Joseph: Today, antifungal resistance is an increasingly recognized concern in the management of fungal skin infections. To begin, could you discuss the role of antifungal resistance in the treatment of these infections? How big of a problem is this?

A

Dr. Aarti Bernett: Steroid and antifungal combinations sold as over the counter medicines (OTC) have contributed much to the antifungal resistance. It is emerging as a global epidemic in countries like India.

Q

Dr. Nirainila Joseph: As our understanding of fungal skin infections continues to deepen, are there any emerging trends or advancements in the diagnosis and treatment of fungal skin infections?

A

Dr. Aarti Bernett: Oral vitamin A preparations like Acitretin can be combined along with oral antifungals for resistant cases.

Untreated fungal infections can rarely become a deep fungal infection which is called as Majocchi granuloma. (Wikimedia Commons)
Untreated fungal infections can rarely become a deep fungal infection which is called as Majocchi granuloma. (Wikimedia Commons)
Q

Dr. Nirainila Joseph: Now that we've discussed the treatment options for fungal skin infections, it's pertinent to consider the consequences of failing to treat these infections in a timely manner. Could you elaborate on the possible complications in such scenarios?

A

Dr. Aarti Bernett: It can spread all over the body. It can rarely become a deep fungal infection which is called as Majocchi granuloma.

Q

Dr. Nirainila Joseph: As we talk about the management of fungal skin infections, it's important to address prevention strategies. How can fungal skin infections be prevented, especially for individuals who are prone to them?

A

Dr. Aarti Bernett:

  1. Don’t share your clothing and towels.

  2. Avoid using public toilets.

  3. Don’t forget to shower after coming back from work or outside .

Dr. Aarti Bernett recommends showering after returning from work or being outside to prevent skin fungal infections. (Wikimedia Commons)
Dr. Aarti Bernett recommends showering after returning from work or being outside to prevent skin fungal infections. (Wikimedia Commons)
Q

Dr. Nirainila Joseph: With the availability of numerous home remedies and over-the-counter treatments, What is your opinion on using them for managing fungal skin infections?

A

Dr. Aarti Bernett: Home remedies or OTC medications can worsen fungal infections and make them to spread more. So kindly avoid them.

Q

Dr. Nirainila Joseph: What advice would you give to someone who suspects they might have a fungal skin infection? When is it important to see a dermatologist?

A

Dr. Aarti Bernett: It is advised to see a dermatologist when a suspicious patch arises.

Q

Dr. Nirainila Joseph: As a dermatologist, what are the misconceptions or myths surrounding fungal skin infections that you encounter frequently? 

A

Dr. Aarti Bernett: Applying home remedies like turmeric and salt is commonly encountered. Also using antiseptic solutions to rinse the affected area is commonly practiced.

According to Dr. Aarti Bernett, applying home remedies like turmeric and salt is a commonly encountered misconception for treating fungal infections. She advises against resorting to home remedies and instead recommends visiting a dermatologist for proper treatment. (Wikimedia Commons)
According to Dr. Aarti Bernett, applying home remedies like turmeric and salt is a commonly encountered misconception for treating fungal infections. She advises against resorting to home remedies and instead recommends visiting a dermatologist for proper treatment. (Wikimedia Commons)
Q

Dr. Nirainila Joseph: Recognizing the importance of dispelling misconceptions about fungal skin infections, how can public awareness be improved?

A

Dr. Aarti Bernett: It can be done by issuing pamphlets to people containing information about the symptoms and signs and also through mass media like television and radio.

Q

Dr. Nirainila Joseph: Thank you for taking the time to share your insights and expertise with us throughout this interview. As we conclude our discussion, I'd like to ask, what are the most important takeaways you want our readers to remember about fungal skin infections?

A

Dr. Aarti Bernett: Go to the dermatologist as soon as a single patch arises. Never sort to home remedies or OTC drugs.

MedBound Times expresses sincere gratitude to Dr. Aarti Bernett for sharing her valuable insights on our platform.

Dr. Aarti Bernett, MBBS, Trichy SRM Medical College Hospital & Research Center, Tiruchirappalli, Tamil Nadu, India and MD (DVL), Government Medical College, Tirunelveli, Tamil Nadu, India
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