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38 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9 Tinea capitis (head ringworm). This involves infections of the scalp that can leave behind scar tissue and permanent patches of baldness. It is seen most often in pre-adolescent children (Image 2). Tinea pedis (athlete's foot). This version often leads to itchy, weeping blisters, with a risk of secondary bacterial infection, between the toes (Image 3). Another form causes more typical ring- shaped lesions on the rest of the foot; this is sometimes called the moccasin distribution. The fungi that cause athlete's foot thrive in warm, humid conditions (like the insides of athletic shoes), so it can be hard to get rid of this infection without changing footwear. Tinea pedis can also lead to new infections on the hands if a person isn't careful about hygiene; this is called tinea manuum. Tinea cruris (jock itch). Jock itch is a fungal infection around the genitalia. It is usually seen in men, since the female version of this is a vaginal yeast infection. It is important to note that the lesions associated with jock itch can be found on the thighs, buttocks, and over the sacrum—this of course has repercussions for bodywork. Onychomycosis Onychomycosis refers to fungal infections of the finger- and toenails (Image 4). These lesions can be long-lasting and disfiguring, sometimes leading to the destruction of the whole nail. They are also resistant to many topical treatments. Candida auris Candida auris was first documented in 2009 when a doctor found it in a woman's ear (auris refers to the ears). This aggressive illness can manifest as a skin infection at the site of a wound, or as an internal infection of the respiratory tract, the blood, bones, or other tissues. The earliest known case in the US was in 2013. Now, the CDC has added C. auris to its list of urgent threats, for several reasons: it can cause extreme illness and death, it is highly contagious, it spreads quickly throughout environments, and it is resistant to standard antifungal medications. As of this writing, C. auris has been reported in New York, New Jersey, and Illinois, where it has caused infections in almost 600 people so far. Smaller outbreaks have been tracked in California, Texas, Florida, and several other states. It is very hard to get rid of, and some hospitals have had to rip out floor tiles, ceiling tiles, ductwork, and plumbing to eradicate the pathogen. The people most at risk for infection with C. auris are those whose immune systems are compromised: the elderly, newborns, those with diabetes, organ transplant recipients, people with autoimmune diseases, and people using steroidal anti-inflammatories. However, some epidemiologists are concerned that C. auris could continue to gain strength and may become able to impact healthier populations as well—including health- care professionals charged with caring for people infected with this fungus. C. auris appears to have arisen from multiple sources around the globe, and all at the same time. Some scientists suggest that the aggressive use of fungicides on crops and in livestock has contributed to the evolution of this drug-resistant microorganism. TREATMENT FOR FUNGAL INFECTIONS Cutaneous fungal infections, like the types of ringworm covered here, are usually sensitive to topical antifungal medications that are applied to the affected areas. More extreme cases, or cases that have infiltrated the lungs or other tissues, need oral medications. A variety of treatment options have been developed that interfere with cellular replication of the fungi. Many of these options require several weeks of use, and they can have some serious side effects. C. auris has become resistant to some first-line antifungal medications, and may require nontypical treatments or treatment with multiple antifungals simultaneously. Tinea capitis (or head ringworm). A fungal infection of the scalp can cause scarring and permanent hair loss. Tinea pedis (or athlete's foot). These itchy blisters and cracks in the skin can be a portal of entry for bacterial infection. Onychomycosis, a fungal infection of the nailbed. 2 3 4

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