Fungal Infection Treatment in Ankara, Turkey

Fungal diseases are common infections encountered in dermatology and develop when dermatophytes, yeasts, or mold fungi settle on the skin, nails, or mucous membranes. These infections generally present with symptoms such as itching, scaling, redness, and bad odor. Early diagnosis and appropriate treatment are important in preventing spread.

Among superficial fungal infections, tinea pedis (athlete’s foot), tinea corporis (body fungus), and tinea capitis (scalp fungus) are the most common. Dermatologists confirm the diagnosis with clinical examination and microscopic evaluation, then direct the patient to the appropriate antifungal treatment.

Topical antifungal agents (clotrimazole, miconazole, terbinafine) are preferred first in mild infections. In more resistant or widespread cases, systemic antifungal drugs (itraconazole, fluconazole, terbinafine) are prescribed. The treatment duration varies according to the type and location of the infection.

Hygiene measures are of great importance in preventing recurrence in fungal infections. Keeping the skin dry, preferring non-synthetic clothing, and avoiding the use of shared personal items are recommended. Dermatologist follow-up ensures the effective management of chronic infections.

What Is a Fungal Infection and What Are Its Types?

Classifying fungal infections according to where the fungus settles in the body and how deep it penetrates into the tissue is the first step in determining the treatment plan.

We can classify fungi according to where they settle in the body as follows.

• Superficial fungi
• Cutaneous fungi
• Subcutaneous fungi
• Systemic (deep) fungi

Superficial ones are found in the outermost, dead layer of the skin or on the outer part of the hair. The best example of this is the condition known as “tinea versicolor” (Pityriasis Versicolor), which generally manifests itself with white or brown spots on the trunk.

Cutaneous fungi are the ones we encounter most frequently. They affect the living layer of the skin, the nails, and the hair roots. The body reacts to this condition, which manifests itself as itching, redness, and inflammation. All fungal types known as “Tinea” (body, groin, foot) are in this group. Subcutaneous and systemic ones are seen much more rarely and are generally more serious conditions that occur in people whose immune system is severely weakened.

What Are the Risk Factors Leading to Fungal Infections?

Fungi are actually everywhere. They can live in the soil, on animals, and even harmlessly on our skin under normal circumstances. However, some conditions cause these fungi to multiply opportunistically and lead to infection. Moisture and warmth are the favorite environments for fungi to reproduce.

Some common risk factors for fungal infections are as follows:

• Weak immune system (due to illness or medication use)
• Diabetes
• Obesity
• Excessive sweating or the skin remaining constantly moist
• Wearing tight, synthetic, and non-breathable clothing
• Insufficient drying after bathing, especially between the toes and skin folds
• Circulatory disorders
• Walking barefoot in shared public areas (gym, Turkish bath, pool)
• Close contact with animals (especially kittens and puppies)

Knowing these risk factors is also a key to understanding the ways to protect against infection.

Can Fungal Disease Be Diagnosed Just by Looking?

An experienced dermatologist can recognize most fungal infections by their typical appearance (for example, ring-shaped lesions with raised edges and a paler center). However, the diagnosis is not always that simple.

Sometimes patients may use cortisone creams without consulting a doctor to relieve itching or redness. These creams temporarily reduce redness and itching by suppressing the immune response. However, this situation feeds the underlying fungal infection, causing it to spread further and change its appearance. This condition is called “Tinea Incognito,” that is, “Hidden Fungus.” Since the appearance of the infection changes, it can be confused with other skin diseases (such as eczema).

For this reason, especially in persistent, recurrent, or atypical-looking rashes, the clinical appearance must be confirmed with laboratory tests. Before starting a long-term treatment, it is necessary to be sure that the problem is truly a fungal infection.

Which Tests Are Performed During the Doctor’s Examination for the Diagnosis of Fungus?

Correct treatment begins with the correct diagnosis. When we suspect fungus, we use simple but effective methods in the dermatology clinic to confirm the diagnosis.

• Potassium Hydroxide (KOH) Test (Scraping Examination)

This is the most commonly used, fastest, and simplest method in fungal diagnosis. A scraping sample is gently taken from the suspicious area (skin, nail, or hair) with the help of a scalpel or slide. This sample is treated with a special solution (KOH) in the laboratory and examined under the microscope. This method shows within seconds whether there are structures called fungal hyphae (intertwined branches) or spores. A positive test proves the presence of fungus. However, a negative result does not mean there is no fungus; it may only mean that enough fungal elements could not be seen in the sample taken at that moment.

• Fungal Culture

Culture is the “gold standard” method used to identify the type of fungus causing the infection. The scraping or nail sample taken is inoculated into a specially prepared culture medium for the fungus to grow. The biggest disadvantage of culture is that it is slow; it usually takes 2 to 4 weeks for the fungus to grow and for its type to be identified.

So, why is it worth waiting so long? Because some fungal species respond better to certain drugs. Especially in the treatment of scalp fungus, knowing whether the causative agent is Microsporum or Trichophyton determines whether the treatment will last 2 weeks or 12 weeks.

• Histopathological Examination (Biopsy and PAS Staining)

If the KOH and culture tests are negative but clinical suspicion continues, or if the infection is suspected to be very deep, the biopsy method is used. A small tissue sample is taken from the area and sent to the pathology laboratory.

This method is especially valuable in the diagnosis of nail fungus. The sample taken is stained with a special dye called Periodic Acid-Schiff (PAS). This dye makes fungal elements in the tissue visible by staining them a bright pink-red color. In the diagnosis of nail fungus, the sensitivity of PAS staining is much higher than KOH and culture. Confirming the diagnosis in this way before starting an oral treatment that will last for months is the most appropriate approach.

• PCR (Molecular Tests)

PCR is a modern, rapid, and sensitive method that detects the genetic material (DNA) of the fungus. It can detect fungi that are difficult to grow in culture or that do not grow in culture because cream has been used previously.

How Is Body and Groin Fungus (Tinea) Treated?

Tinea corporis (Body Fungus) is generally known as “ringworm.” Classically, it appears as an itchy patch in the shape of a ring, with more raised and red edges and a paler center.

Tinea cruris (Groin Fungus), on the other hand, manifests itself especially in the groin folds as sharply bordered, red, and itchy lesions spreading toward the inner thigh.

When these infections are generally limited to a certain area, first-line treatment consists of topical (cream, lotion) antifungal agents. It is important that these creams continue to be used even after the symptoms improve (generally for 1-2 more weeks) in order to clear the infection.

However, in some cases, it may be necessary to switch to oral (systemic) treatment.

• The infection is very widespread (multiple lesions)
• No response is obtained from cream treatment
• “Tinea Incognito” has developed due to previous use of cortisone cream
• Patients with weakened immune systems

What Should Be Done for Athlete’s Foot?

It is the most common fungal infection in society. It usually starts between the toes (especially between the 4th and 5th toes) with peeling, cracking, whitening, and itching. Sometimes it can also take on a dry, scaly, “moccasin”-style appearance covering the entire sole of the foot.

In addition to topical creams, hygiene measures for the feet form the basis of treatment.

Some important points to protect against athlete’s foot and support the treatment.

• Wash your feet every day.
• After washing, dry them very well, especially between the toes, with a towel or paper tissue.
• Be sure to prefer cotton or moisture-absorbing synthetic sports socks.
• Change your socks every day.
• Try not to wear the same shoes two days in a row (allow them to air out for one day).
• If possible, prefer breathable shoes.
• Be sure to use slippers in common areas such as gyms, pools, and showers.

Why Must Scalp Fungus (Tinea Capitis) Be Treated Only with Pills?

Scalp fungus (Tinea capitis) is most commonly seen in children and may appear on the scalp in the form of scaling, redness, hair breakage, or sometimes painful, inflamed swellings called “Kerion.”

The treatment of this infection is different from other skin fungi and cannot be treated with creams or shampoos.

Think of it like conquering a castle: creams and shampoos clean only the outer walls of the castle (the skin surface). However, the fungus has settled deep within the hair root and hair shaft, that is, inside the castle. In order to eliminate the infection, the medicine needs to pass into the bloodstream and reach the hair root from inside, nourishing it and destroying the fungus.

That is why oral (systemic) antifungal treatment is mandatory when scalp fungus is diagnosed. The duration of treatment may vary from 2 weeks to 12 weeks depending on the type of causative agent determined by fungal culture or PCR.

Why Is the Treatment of Nail Fungus (Onychomycosis) So Difficult?

Nail fungus (Tinea Unguium or Onychomycosis) is one of the most difficult and longest-lasting fungal infections to treat. The nail thickens, changes color (yellow-brown), becomes brittle, and may separate from the nail bed.

The reason for the difficulty is the nail plate itself. The nail is like a hard “armor” that is very difficult for medications to penetrate:

What Are the Treatment Options?

• Oral (Systemic) Treatment: This is still the most effective method for nail fungus. The drug reaches the root cells (matrix) that nourish the nail through the blood and, as the healthy nail grows, enables it to “push” the fungal nail out. The treatment duration is generally 6 weeks for fingernails and 12 weeks for toenails. It may take 6-12 months for the toenail to grow back completely healthy.
• Medicated Nail Polishes: These polishes are applied to the surface of the nail. However, their effectiveness is limited. They can generally work only in very mild and early cases where only the very superficial part of the nail is affected and the nail root is intact. The greatest difficulty is patient compliance; these polishes sometimes need to be applied regularly every day or several times a week for 48 weeks (approximately 1 year). Most of the time, they are used in addition to oral treatment or for preventive purposes.
• Laser or Photodynamic Therapy (PDT): Device-based treatments such as laser and PDT are methods being investigated for nail fungus. They may be considered as an alternative or supportive treatment especially for patients who cannot use oral medication (liver disease, multiple drug use). However, their effectiveness is generally lower than oral treatments, and they are not a miraculous solution on their own.

Why Are Blood Tests Requested While Using Antifungal Drugs (Pills)?

This is the issue that patients who need to use oral antifungal drugs ask about and worry about the most: “Will these drugs harm my liver?”

All oral antifungals (Terbinafine, Itraconazole, Fluconazole) carry a potential risk of having an effect on the liver. However, this risk is very rare in the general population.

So, if the risk is rare, why do we request blood tests?

This is a safety measure. Just like wearing a seat belt while driving. The probability of having an accident is low, but if it happens, it protects you. Likewise, before starting treatment, we request “baseline” liver function tests (LFT – ALT, AST) to see the patient’s liver functions. This way, we know the patient’s baseline values.

After treatment begins (generally 4 to 6 weeks later), we repeat these tests. This monitoring enables us to detect at an early stage whether the drug is causing any adverse effect on the liver and, if necessary, to stop the treatment immediately. This routine monitoring is not a dangerous protocol, but rather one that ensures the treatment is continued safely.

Do the Other Medications I Use Affect My Fungal Treatment?

This is one of the most critical issues in this treatment and is known as “drug interactions.” Antifungal drugs, especially Azoles (Itraconazole, Fluconazole), interact strongly with the Cytochrome P450 (CYP) enzyme system, through which other drugs are broken down and processed in the body.

You can think of it like this: our liver is like a factory that cleans the medicines entering the body. Some antifungal drugs can significantly slow down or accelerate the operating speed of this factory. What does that mean? There are two possibilities.

The antifungal drug may cause another medicine you are using (for example, a blood thinner, cholesterol drug, or blood pressure medicine) to accumulate in the blood and its level to rise to a dangerous level.

Or another medication may reduce the level of the antifungal drug, causing the treatment to fail.

For this reason, when you visit a dermatologist, it is vital that you report all the medications, vitamins, and even herbal supplements you use completely.

Why Is My Fungal Treatment Failing or Recurring Continuously?

There are generally two main reasons for this situation: drug resistance or reinfection.

• Antifungal Resistance

Yes, just as bacteria can develop resistance to antibiotics, fungi can also develop resistance to antifungal drugs. This occurs especially as a result of incorrect or incomplete use of medications (for example, stopping a 12-week treatment at 4 weeks because the patient feels better) or unnecessarily using antifungals together with cortisone creams.

If a fungal infection does not respond to standard treatments, resistance should be suspected. In this case, it is necessary to take a fungal culture from the lesion again and this time perform an “Antifungal Susceptibility Test” (AST) on the grown fungus. AST is a roadmap showing in the laboratory which drug kills this specific fungal type and which ones are ineffective, and it enables us to re-plan the treatment accordingly.

• Reinfection (Environmental Factors)

In fact, this is the most common situation. The patient treats their nail or skin by using the medication, but continues using their old shoes or towel where fungal spores are still alive. On the day the treatment ends, they catch the fungus again from their old shoes. This is not a “treatment failure” but “reinfection.”

What Should I Do to Prevent the Fungal Infection from Recurring?

Preventing the infection from returning is just as important as the success of the treatment. For this, “environmental cleaning” is essential.

What needs to be done during and after the treatment.

• All socks, towels, and bed linens should be washed at 60 degrees with detergent.
• In athlete’s foot treatment, old shoes worn during the infection (especially those with fabric interiors) should either be discarded or meticulously disinfected.
• Special ultraviolet (UV) light devices or antifungal sprays/powders can be used to disinfect shoes.
• Wet or damp socks should never be worn.
• Talcum powder or antifungal powders may be used to keep the feet dry.
• If there is a pet at home (cat, dog) and it has regional hair loss (bald patches), it should be checked by a veterinarian (animal-to-human transmission).

If you have fungus in more than one area of your body (for example, both the foot and groin), all active infection areas must be treated at the same time to prevent “self-transmission.”