Is It Atopic Dermatitis, or Is It a Fungus?

Atopic dermatitis, often referred to as eczema, and fungal infections can look similar. This makes it hard to tell them apart sometimes. But they are different conditions.

What is eczema?

Eczema is a chronic condition characterized by red, itchy skin. Eczema typically first appears in early childhood and lasts into adulthood. But it also can first occur in adolescence or adulthood.¹

Eczema often occurs with asthma or hay fever. It tends to flare periodically, then clear up. Sometimes eczema can clear up for an extended period of time – even years. Symptoms of eczema can include all or any of the following:¹

• Dry skin
• Moderate-to-severe itchy skin, often worsening at night
• Red or brownish-gray patches on the skin
• Small, raised bumps on the skin that may leak fluid or crust over if scratched
• Thick, cracked, or scaly skin
• Skin sensitivity or swelling from over scratching

How is eczema diagnosed?

Doctors diagnose the condition through examination of the problem area and a discussion of medical history. There is no specific lab test for eczema, but doctors often conduct allergy or skin patch testing to find the cause or to rule out other skin conditions.¹

What causes atopic dermatitis?

Genetics is the most common cause of eczema. A gene difference, or variation, changes the ability of the skin to provide protection against environmental factors. These factors may include skin irritants and allergens. In some instances, food allergies may also play a role in causing eczema.¹

Preventing eczema flare-ups

There is no cure for eczema, but there are things you can do to prevent outbreaks, and treatments are available for when outbreaks happen.¹ For the prevention of atopic dermatitis, doctors recommend keeping the skin well moisturized. Shorter baths or showers with warm (not hot) water and gentle, eczema-friendly soaps are also recommended.¹

It also helps to pinpoint what might be triggering outbreaks, such as certain skin products or allergens. You can then avoid exposure to these triggers if possible.¹

Bleach baths

For severe cases of eczema, the American Academy of Dermatology (AAD) also recommends bleach baths to prevent flare-ups. Diluted bleach can decrease the bacteria on the skin. According to the AAD, you can add ½ cup of household (not concentrated) bleach to a 40-gallon bathtub filled with warm water.¹

Soak from the neck down for no more than 10 minutes, no more than twice a week. Talk to your doctor about the potential benefits of a bleach bath to prevent eczema flare-ups.¹

How is atopic dermatitis treated?

When outbreaks do occur, doctors may recommend creams, such as corticosteroids or calcineurin inhibitors, to prevent itching and allow the skin to heal. It is important to not overuse corticosteroid creams, so always follow your doctor's directions.¹

If a flare-up is severe, doctors may also prescribe steroid medicines, such as prednisone. If the skin becomes infected, doctors may prescribe antibiotic cream to treat the infection.¹

Dupixent

A newer treatment option that has been approved by the US Food and Drug Administration (FDA) is an injectable biologic called dupilumab. This drug is meant for people with severe eczema who do not respond well to other treatment options.¹

Wet wraps

Other treatments in severe cases might include wet dressings. Here, topical corticosteroids are applied and covered with wet bandages. They also include phototherapy, or light therapy. Phototherapy involves exposing the skin to controlled amounts of sunlight or artificial UVA/UVB rays.¹

Complications of atopic dermatitis

Atopic dermatitis is a chronic condition and can lead to complications such as asthma and hay fever, chronic skin symptoms, skin infections, or sleep problems. Work with your doctor to come up with prevention and treatment strategies for atopic dermatitis.¹

What is a fungal skin infection?

Fungal skin infections are different from eczema, though they can sometimes look similar. Fungal infections are not chronic or genetic conditions. Instead, they are caused by common fungi found in the environment.^1,2

These skin infections typically appear on moist areas of the body, such as:^1,2

• Between the toes
• Under the arms
• Under the breasts
• In the genital area

What are common fungal skin infections?

Common fungal skin infections are caused by yeast (such as a candida infection) or dermatophytes (such as ringworm). Fungal skin infections can be diagnosed from skin scrapings or skin cultures examined under a microscope. People who are over a healthy weight and people with diabetes tend to be more likely to develop fungal skin infections.^2,3

What do fungal infections look like?

Fungal skin infections often look like a rash. Doctors usually suspect a fungal infection when a red, irritated, or scaly rash appears in one of the commonly affected areas.^2-4

Fungal skin infections may appear in the shape of a scaly, raised, red, itchy ring. This is called ringworm. This rash can appear in other areas of the body, and is not always in the shape of a ring. It may go by other names when it appears on other areas of the body, such as athlete’s foot when it appears on the feet.^2-4

People also sometimes develop rashes on other parts of their body that are not infected by the fungus. A fungal foot infection may lead to a bumpy or itchy rash on the fingers, for example. These are usually due to an allergic reaction to the fungus, not from touching the infected area.^2,3

Are fungal infections contagious?

Unlike eczema, some forms of fungal skin infections, such as ringworm, are highly contagious. Some are not contagious, like candida fungal skin infections.^5,6

What causes fungal skin infections?

Fungal skin infections tend to be quite common and are caused by coming into contact with fungi in the environment. People who have a weakened immune system caused by other conditions may be at an increased risk for developing fungal skin infections. Certain medicines or vitamin deficiencies, as well as poor hygiene, can also be contributing factors.^1,2,7

How are fungal skin infections treated?

Fungal infections are typically treated with antifungal drugs, usually applied directly to the affected area. These can include creams, gels, lotions, solutions, or shampoos, depending on the affected area. Antifungal drugs may also be taken by mouth.²

In addition to medicine, people may use measures to keep the affected areas dry, such as applying powders or wearing open-toed shoes. These measures may also prevent the infection from coming back. For some infections, doctors may prescribe steroids to relieve inflammation and itching.²

Unlike eczema, fungal skin infections are not chronic, and therefore the prognosis is typically very good for a healthy person with a fungal skin infection. Still, antifungal resistance can occur in patients with compromised immune systems.⁷