From the Guidelines
Untreated tinea fascialis can lead to severe complications, including necrotizing fasciitis, which is a life-threatening condition that requires immediate medical attention. The infection can spread beyond the initial area, potentially covering larger portions of the body and even extending to other body parts. Chronic inflammation may develop, causing persistent redness, scaling, and discomfort. The continuous scratching due to itchiness can lead to secondary bacterial infections, particularly with Staphylococcus or Streptococcus bacteria, resulting in impetigo, cellulitis, or folliculitis.
Key Complications
- Long-term inflammation can cause post-inflammatory hyperpigmentation or hypopigmentation, leaving dark or light patches on the skin after the infection resolves.
- In severe cases, particularly in immunocompromised individuals, the fungal infection might penetrate deeper into the skin, causing more serious conditions like Majocchi's granuloma, where the fungus invades hair follicles and deeper dermal tissues.
- Additionally, chronic untreated fungal infections can potentially lead to scarring and permanent skin texture changes.
Diagnosis and Treatment
According to the most recent guidelines 1, the diagnosis of necrotizing fasciitis is primarily based on clinical judgment, and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score can be used to identify patients at high risk of poor outcome. The treatment of necrotizing fasciitis involves surgical intervention, antimicrobial therapy, and supportive care.
Recommendations
- Early recognition and treatment of necrotizing fasciitis are crucial to prevent morbidity and mortality.
- A high index of suspicion is necessary to diagnose necrotizing fasciitis, and clinical judgment is the most important element in diagnosis 1.
- The use of antimicrobial therapy, such as vancomycin and antipseudomonal antibiotics, is recommended for the treatment of necrotizing fasciitis 1.
- Surgical intervention, including debridement and drainage, is necessary to manage necrotizing fasciitis 1.
From the Research
Complications of Untreated Tinea Infections
- Untreated tinea infections can cause significant morbidity and predispose to complications, including cellulitis and ulcers on the feet and alopecia on the scalp 2
- Failure to treat kerion promptly can lead to scarring and permanent hair loss 3
- Tinea infections can be confused with other conditions, such as eczema, alopecia areata, and dystrophic toenails, making diagnosis and treatment challenging 3, 2
Specific Complications of Untreated Tinea Fascialis
- There is limited information available on the specific complications of untreated tinea fascialis
- However, it is likely that untreated tinea fascialis can lead to similar complications as other untreated tinea infections, such as cellulitis and scarring 2
Treatment Options for Tinea Infections
- Topical and systemic antifungal modalities are available for the treatment of tinea infections, and the choice of treatment depends on the subtype and severity of the infection 2
- Oral terbinafine is first-line therapy for tinea capitis and onychomycosis, while griseofulvin is used to treat kerion 3
- Itraconazole has been shown to be effective in the treatment of chronic and chronic relapsing dermatophytosis in India 4