What are the other common sites of fungal infections like the one on the boy's scalp?

Common Sites of Fungal Infections Beyond the Scalp

Fungal infections can occur on virtually any part of the body beyond the scalp, with common sites including the skin of the trunk, extremities, groin, feet, nails, and mucosal surfaces.

Cutaneous Fungal Infection Sites

Skin Infections

• Trunk and Extremities:

  • Candida infections can present as single or multiple nodular skin lesions appearing as discrete pink to red papules on the trunk and extremities 1
  • Tinea corporis (ringworm) affects the glabrous skin of the body, presenting as annular, scaly patches with central clearing
  • Aspergillus skin lesions typically occur on the extremities but can also appear on the face and trunk, beginning as erythematous papules that progress to pustules with central ulceration 1

• Groin Area:

  • Tinea cruris ("jock itch") affects the groin, perineal area, and perianal skin, particularly in adolescents and adults
  • Candidal intertrigo commonly affects skin folds including the groin

• Feet:

  • Tinea pedis ("athlete's foot") affects the soles of the feet and interdigital spaces
  • Dermatophyte infections of the feet are among the most common fungal infections

Nail Infections

• Onychomycosis (fungal nail infection) can affect fingernails and toenails
• Can serve as a reservoir for subsequent disseminated infection in immunocompromised patients 1

Mucosal Surfaces

• Oral candidiasis (thrush) affects the oral mucosa
• Vulvovaginal candidiasis affects the genital mucosa

Invasive Fungal Infections

Invasive Aspergillosis

• Primary sites include lungs with secondary cutaneous involvement
• Cutaneous manifestations appear as erythematous papules progressing to pustules with central ulceration covered by black eschar 1

Mucormycosis/Zygomycosis

• Can involve the sinuses, with potential extension to orbital and cerebral tissues
• Cutaneous manifestations include painful erythematous nodules that become necrotic 1

Fusariosis

• Can present with skin lesions that may be the primary source of life-threatening infections 1
• Skin should be thoroughly evaluated before antineoplastic therapy in at-risk patients

Special Considerations in Children

Age-Related Patterns

• Tinea capitis (scalp) is most common in children
• Tinea pedis, tinea unguium (nails), and tinea cruris are relatively uncommon in young children but increase in adolescence 2

Immunocompromised Children

• Higher risk for invasive fungal infections with cutaneous manifestations
• Candida, Aspergillus, and other opportunistic fungi can cause disseminated disease 1
• Invasive fungal sinusitis is increasingly reported in immunocompromised children 1

Diagnostic Approach

• Direct microscopy with potassium hydroxide preparation
• Fungal culture of skin scrapings or biopsy material
• Wood's lamp examination (particularly useful for certain infections)
• Skin biopsy with histopathological examination for invasive infections

Clinical Pearls

• Fungal infections in skin folds (intertrigo) can be easily confused with other dermatoses
• Onychomycosis can serve as a reservoir for subsequent disseminated infection in immunocompromised patients 1
• Invasive fungal infections with cutaneous manifestations require aggressive systemic therapy and sometimes surgical debridement 3
• Fungal skin infections in immunocompromised children warrant immediate evaluation and aggressive treatment due to risk of dissemination

Understanding these common sites of fungal infections is crucial for proper diagnosis and management, especially in pediatric populations where presentation and treatment approaches may differ from adults.