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Is It Atopic Dermatitis or Is It a Fungus?

Atopic dermatitis (AD), often referred to as atopic eczema, is a chronic condition characterized by red, itchy skin.

What is atopic dermatitis?

Symptoms of AD 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 which may leak fluid or crust over if scratched
  • Thick, cracked, or scaly skin
  • Skin sensitivity or swelling from over scratching

AD typically first appears in early childhood and persists into adulthood, but it can also first occur later in adolescence or adulthood. It tends to flare periodically, then clear up, and often occurs with asthma or hay fever. Sometimes AD can clear up for an extended period of time—even years.1

Diagnosing atopic dermatitis

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

Causes of atopic dermatitis

Genetics is the most common cause of AD. A gene variation affects the ability of the skin to provide protection against environmental factors, such as skin irritants and allergens. In some instances, food allergies may also play a role in causing AD.1,2

How to prevent an eczema flare up

There is no cure for AD, but there are things you can do to prevent outbreaks, and treatments are available for when outbreaks happen.1 For the prevention of AD, doctors recommend that patients keep the skin well moisturized. It can also help to try and identify what might be triggering outbreaks, such as certain skin products or allergens, and avoid exposure if possible. Shorter baths or showers with warm water—not hot— and gentle, eczema-friendly soaps are also recommended.1

Bleach baths

For severe cases of AD, 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, patients can add ½ cup of household (not concentrated) bleach to a 40-gallon bathtub filled with warm water. Soaking from the neck down for no more than 10 minutes, no more than twice a week is recommended. Talk to your doctor about the potential benefits of a bleach bath to prevent AD outbreaks.1

How to manage eczema flare ups

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 the directions of your physician. If a flare-up is severe, doctors may also prescribe oral corticosteroids, such as prednisone. If the skin becomes infected, doctors may prescribe antibiotic cream to treat the infection.1

Biologics and wet wrap

A newer treatment option for AD has recently been approved by the Federal Drug and Administration (FDA). An injectable biologic called dupilumab is indicated for patients with severe AD who do not respond well to other treatment options. Other treatments in severe cases might include wet dressings—when topical corticosteroids are applied and covered with wet bandages—or light therapy—exposing the skin to controlled amounts of sunlight or artificial UVA/UVB rays.1

Complications of atopic dermatitis

AD is a chronic condition and can lead to complications such as asthma and hay fever, chronic skin symptoms, skin infections, or sleep problems.1 It’s important to work with your physician to come up with prevention and treatment strategies for AD.

What is a fungal skin infection?

Fungal skin infections are different from AD, though at first glance they can sometimes appear similar. Fungal infections are not chronic or genetic conditions; they are caused by common fungi found in the environment. These skin infections typically appear on moist areas of the body, such as between the toes, under the arms, under the breasts, or in the genital area.1,3

Common fungal skin infections

Common fungal skin infections are caused by yeast, such as a candida infection, or dermatophytes, like ring worm. People who are overweight or patients with diabetes tend to be more likely to develop fungal skin infections. With fungal infections, patients sometimes can develop rashes on other parts of the 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.3,4

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. Fungal skin infections may also appear in the shape of a scaly, raised, red, itchy ring, often 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—such as athlete’s foot when it appears on the feet—when it appears on other areas of the body.3-5

Are fungal infections contagious?

Unlike AD, some forms of fungal skin infections, such as ringworm, are highly contagious. Candida fungal skin infections, however, are not contagious.6,7 Fungal skin infections can be diagnosed from skin scrapings or skin cultures examined under a microscope.3

Fungal skin infection causes

Fungal skin infections tend to be quite common and are caused by coming into contact with fungi in the environment.1,3 Still, patients who are immunocompromised, or have a weakened immune system caused by other conditions, may be at an increased risk for developing fungal skin infections. Certain medications or vitamin deficiency, as well as poor hygiene, can also be contributing factors.8

Treatment for fungal skin infections

Fungal infections are typically treated with antifungal drugs, usually applied directly to the affected area and can include creams, gels, lotions, solutions, or shampoos—depending on the affected area. Antifungal drugs may also be taken by mouth. In addition to medication, people may use measures to keep the affected areas dry, such as applying powders or wearing open-toed shoes. These measures may also prevent reoccurrence. For some infections, doctors may prescribe corticosteroids to relieve inflammation and itching.3

Unlike AD, fungal skin infections are not chronic, and therefore the prognosis is typically very good for a healthy person receiving treatment for a fungal skin infection. Still, antifungal resistance can occur in patients with compromised immune systems.8

  1. Mayo Clinic. Atopic dermatitis (eczema). Accessed May 29, 2018.
  2. Faergemann J. Atopic dermatitis and fungi. Clin Microbiol Rev. 2002;14(4):545-563. Accessed May 29, 2018.
  3. Aaron DM. Merck Manual. Overiew of fungal skin infections. Accessed May 29,2018.
  4. Centers for Disease Control and Prevention. Fungal diseases. Accessed May 29, 2018.
  5. Centers for Disease Control and Prevention. Ringworm. . Accessed May 29, 2018.
  6. Mayo Clinic. Ringworm (body). Accessed May 29, 2018.
  7. National Institutes of Health. US National Library of Medicine. Accessed May 29, 2018.
  8. Gupta S, James WD. Mucosal candidiasis. Accessed May 29, 2018.