What is the ICD-10 (International Classification of Diseases, 10th Revision) code and treatment for a fungal infection of the face?

ICD-10 Code and Treatment for Fungal Infection of the Face

ICD-10 Code

The ICD-10 code for a fungal infection of the face is B36.9 (superficial mycosis, unspecified) or more specifically B35.8 (other dermatophytoses) for dermatophyte infections, or B37.2 (candidiasis of skin and nail) for candidal facial infections.

Treatment Approach

First-Line Topical Therapy

For uncomplicated superficial fungal infections of the face, topical azole antifungals applied twice daily for 2-4 weeks are the primary treatment. 1

• Topical azole options include:

  • Clotrimazole cream applied twice daily 1
  • Miconazole cream applied twice daily 1
  • Nystatin cream as an alternative polyene option 1

• No single topical agent has demonstrated superiority over others for superficial candidal infections 1

Critical Adjunctive Measures

• Keep the infected area dry, as moisture promotes fungal growth 1
• Apply absorbent powder or barrier creams after antifungal application to maintain dryness 1
• Address predisposing factors such as diabetes, obesity, or immunosuppression to prevent recurrence 1

Systemic Therapy Indications

For moderate to severe cutaneous fungal infections of the face, or when topical therapy fails, oral fluconazole 100-200 mg daily for 7-14 days is recommended. 1, 2

• Oral fluconazole dosing: 200 mg on day 1, then 100 mg once daily for at least 2 weeks 2
• Treatment should continue until clinical resolution to decrease likelihood of relapse 2

Special Considerations for Immunocompromised Patients

• Immunosuppressed individuals may present with severe manifestations requiring more potent systemic antifungal agents 3
• For fluconazole-refractory disease, consider voriconazole 200 mg (3 mg/kg) twice daily for 14-21 days 4
• Alternative agents for refractory infections include itraconazole solution 200 mg daily or echinocandins 4

Important Clinical Pitfalls

• Avoid using corticosteroids (prednisone) as they can alter the appearance of superficial fungal infections, making diagnosis difficult 3
• Cutaneous fungal infections in immunocompromised patients may represent hematogenous dissemination from systemic infection, particularly with Aspergillus or Candida species 4
• Skin biopsy with fungal culture is indicated when the diagnosis is uncertain or when lesions appear atypical (erythematous papules progressing to pustules with central ulceration and black eschar suggest invasive aspergillosis) 4

When to Suspect Invasive Disease

• Painful skin nodules that rapidly become necrotic suggest angioinvasive fungi like Aspergillus or Mucor species 4
• Multiple erythematous macules with central pallor evolving to necrotic nodules, especially in neutropenic patients, suggest disseminated Fusarium infection 4
• These presentations require aggressive systemic antifungal therapy with amphotericin B formulations or newer azoles like voriconazole 4, 5