References
Fungal infections: community nursing approaches to skin and nail care
Abstract
Dermatophytes (ringworms) are possibly the most prevalent causes of human infection globally. At least 40 dermatophyte species infect humans. For example, onychomycosis, which is responsible for about half of abnormal nails, may: produce ridging, ingrown nails, bleeding and nail loss; make walking painful; and facilitate secondary bacterial infections. Several diseases increase the risk of onychomycosis caused by dermatophytes, including knee osteoarthritis and poorly controlled diabetes. This article focuses on nursing approaches to managing skin and nail dermatophyte infections. Topical antifungals are generally the first-line treatment for tinea corporis, cruris and pedis. Oral antifungals may be appropriate for tinea capitis, onychomycosis, extensive skin infections or if topical treatment does not resolve the infection. Antifungal resistance is becoming more common. However, community nurses should address poor adherence and other possible causes of treatment failure before assuming antifungal resistance. Community nurses should also ensure that patients are diagnosed and treated rapidly, and suggest lifestyle changes that reduce the risk of antifungal failure, infection and relapse.
Over the years, people have become used to the idea that bacteria colonise our skin, guts and genitalia, and recognise that changes to the microbiome cause or contribute to myriad conditions, such as atopic dermatitis, antibiotic-associated diarrhoea and bacterial vaginosis. However, fungi are often forgotten. Feet, for instance, potentially harbour almost 200 different fungal species (Casadevall and Desmon, 2024).
Worldwide, dermatophytes (ringworm) may be the most common causes of human infections, bacteria and viruses notwithstanding (White et al, 2014). It is important to adopt effective nursing approaches to manage dermatophytes, which infect skin, hair and nails, and can cause deep-tissue infections in immunosuppressed people (Dellière et al, 2024).
At least 40 dermatophyte species can infect humans by ‘sticking’ to the stratum corneum, the skin's outer layer (White et al, 2014; Hill et al, 2024). Long hyphae grow into the underlying skin and break down keratin, which dermatophytes use to fuel growth (Hill et al, 2024). Between 30% and 70% of people harbour dermatophytes without experiencing any symptoms (White et al, 2014). However, some individuals experience an inflammatory response intended to eliminate the dermatophyte (Jartarkar et al, 2022; Rokas, 2022; Hill et al, 2024).
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