Growing up, it was very common to have a fungal infection on the skin. Most children develop patches on their hair or skin at some point in primary school. You either had it or saw a friend with the dreaded "ringworm”. This sometimes came with social stigmatisation because of the visible hair loss and scaling on their scalp. Almost everyone will develop a superficial fungal infection at some point in their lives.

Superficial fungal infections, also known as dermatomycoses, are common infections that are estimated to affect around one billion people worldwide. These superficial infections frequently affect the skin, hair, and nails of humans. They are caused by three main groups of fungi: dermatophytes, non-dermatophyte mould, and yeasts.

There are over 100,000 species of fungi across the world. The superficial infections affecting humans are usually non-life threatening. People with low socio-economic status, crowded living conditions, close animal contact, and sub-optimal hygiene are at greater risk of contracting these diseases. It’s estimated that there are 138 million cases of the infection found among school-age children in Africa.

Dermatophytes can be classified into three groups based on their reservoir preference: anthropophilic, zoophilic, and geophilic—I will explain these terms. Anthropophilic dermatophytes prefer humans and spread via human-to-human contact, with household dust acting as a reservoir for spores. Zoophilic dermatophytes have an animal reservoir, such as cats, dogs, and rabbits, and spread through animal-to-human contact. Geophilic dermatophytes are fungi found in soil that sporadically infect humans but are highly virulent.

Recent research studies and estimates indicate that at least one billion people, potentially up to 20-25 per cent of the global population, have superficial fungal infections. The increased global spread of several fungi species is attributed to factors such as mass tourism, migration, and travel. The greatest burden of skin fungal diseases is observed among children aged one to five years old and the elderly, particularly in sub-Saharan Africa, and predominantly affects males.

Superficial fungal infections can be transmitted through human-to-human contact, human-to-animal contact, or through soil. Individuals living or working in crowded environments, especially in warm and humid climates, are at a significantly increased risk of contracting these infections. Those who live or work with domestic or stray animals are at an increased risk of contracting zoophilic dermatophytes. Additionally, poor hygiene habits, such as infrequent changes in clothing, are associated with a higher risk of infection.

Healthcare workers will usually classify superficial fungal infections into four categories under the name tinea. Tinea of the head or scalp mostly affects children, tinea of the body commonly known as ringworm, tinea of the foot commonly known as athlete’s foot and tinea of the groin. Although the name ringworm is attached to some of these conditions, worms are not involved in any of them. The infections are caused by fungi.

Signs and symptoms of superficial fungal infections include circular, ring-shaped sores on the body, which may be slightly red, scaly, and about one inch in diameter. These lesions are often itchy and uncomfortable. On the scalp, superficial fungal infections can cause itching, round-raised lesions, and hair loss in patches. Some cases may be confused with dandruff or cradle cap, and severe cases can develop into kerions, which are pus-filled sores due to an allergic reaction to the fungus.

Athlete’s foot, common in adolescents, causes itchy, red skin with cracking and flaking between the toes. Oral medications are needed to treat superficial fungus of the scalp, usually for 4 to 6 weeks, as applying treatments directly to the head may not be effective. Washing hair with a special shampoo can help prevent the infection from spreading. Over-the-counter creams and powders work well for other fungal infections, such as athlete's foot and body ringworm.

To prevent fungal skin infections, maintain good hygiene by keeping your skin clean and dry, especially after exercise or on hot days. Thoroughly dry areas like skin folds and between toes. Wear clean clothes and change out of sweaty clothes, socks, and shoes immediately. Change bedsheets regularly to prevent moisture buildup. Avoid sharing personal items like clothes, towels, combs, and bedsheets to prevent the spread of fungal spores.

For individuals who spend a lot of time in damp areas, using anti-fungal creams can be beneficial. And if you notice any signs of fungal infections such as itchiness or the appearance of a rash, it’s essential to seek medical attention promptly.

Dr Vincent Mutabazi is an applied epidemiologist.

X: @VkneeM