The fungus on our skin

The skin is red and itchy, there are scales and sometimes small blisters - a sign that a fungus may have taken up residence. This is not rare: fungal infections are among the most common infectious diseases worldwide. Children are affected just as much as adults. Fungi can settle on the skin or mucous membranes and multiply until they make us ill.

In the worst case, such a fungus can also infect internal organs and lead to death. This almost never happens in normally healthy people, but people with a weakened immune system, for example after an operation or chemotherapy, are particularly at risk.

The immune defence keeps the germ in check

«Fungi are everywhere in our environment, and some benefit from the top layer of our skin, feeding on the keratin it contains,» says Emmanuella Guenova, dermatologist at Lausanne University Hospital. Although we are almost constantly in contact with fungi, this does not permanently lead to inflammation, so-called mycoses.

This is because our body can actually manage this quite well. The immune defence keeps the germ in check and prevents it from multiplying too much. «If this balance is upset and the immune defence has to ramp up its defences, we see this immune response as a clinical reaction in the form of inflammation,» explains Guenova.

There are more than 100,000 different types of fungi, only a few of which make people ill. Others, however, have absolutely no place on our skin or nails. One such candidate is Trichophyton rubrum, a fungus with very long-lasting and stable spores that remain infectious for months.

Trainers are a mushroom paradise

But where do you pick up such a potentially pathogenic fungus? Where it is damp, dark and warm. Because that's exactly what these creatures love. The trainers of teenagers and adults are therefore a fungal paradise, where foot and nail mycoses thrive. «More than 60 per cent of the population contract them once in their lives,» says Guenova. Shared washbasins or hotel carpets are also places where you can quickly pick up an itchy souvenir to take home with you. Here, too, our immune defences generally do a good job.

For children, a particularly relevant source of infection is a completely different one: Street animals and pets. Cats and guinea pigs in particular, but also dogs, contract fungi, which they then pass on to humans when cuddled and stroked. We often don't realise that the animal itself is suffering, reddened areas under the fur are not noticeable and the fact that a four-legged friend scratches itself seems more normal than suspicious. «Unfortunately, it often happens that the first signs of a fungal disease are then misjudged and treated incorrectly in children,» says Guenova. Other family members or friends are then often infected until the cause is finally discovered. In order to break such chains and prevent re-infection, pets must also be treated.

«We also see extremely often that children bring back fungal infections from their summer holidays,» says Guenova. In southern countries such as Spain, Italy, Greece and Bulgaria, there are traditionally more street cats and dogs that children like to play with. «Fungal infections have a certain latency, so the red, itchy spots only become noticeable a few weeks later - by then the cat from the holiday has long been forgotten, so we have to make specific enquiries,» says Guenova.

Fungal infections are easily treatable

Mycoses can be treated well, fungicides - so-called antimycotics - can be used in a targeted manner. However, the prerequisite for this is that the type of fungus responsible for the inflammation has been precisely identified. «Certain types of fungi favour certain areas of the body, so an experienced dermatologist can draw conclusions about the possible pathogen. However, the gold standard that we recommend is to create a culture in the laboratory,» explains Guenova. «This also allows other inflammatory skin diseases to be ruled out.» In addition, with a precise determination of the pathogen, the treatment can be even more targeted and can then be cured more quickly.

The constant scratching can leave children with scars. There is also a risk of additional infection from bacteria.

It makes sense to start fungal treatment as soon as possible. If you wait, the pathogens multiply and the affected area becomes larger and larger. «It's visually unattractive and difficult to bear, as it's usually very uncomfortable,» says Guenova. The constant scratching can leave children with scars, and there is also the risk of a so-called superinfection: bacteria colonise the inflamed area and make the situation worse. «In the event of an infection, the family doctor or dermatologist should always be consulted quickly. This is the only way to make a proper diagnosis and provide targeted treatment,» says Guenova.

If the scalp is affected

Mycoses that are most often overlooked include those on the head. Tinea capitis - the technical term - is often misinterpreted as dandruff, neurodermatitis or a bacterial inflammation, even by paediatricians. «For many colleagues, the scalp is a question mark, they find it difficult to correctly diagnose diseases there and like to send the children back to us for precise clarification,» says Antonia Reimer-Taschenbrecker, specialist in paediatrics and adolescent medicine at the Department of Dermatology and Venereology at the Freiburg University Medical Centre. The specialist says that children with fungal skin diseases come to the clinic's consultation hours several times a week.

In the case of tinea capitis, treatment must be two-pronged: from the inside and from the outside. «The fungi migrate along the hair shaft into the follicle, so a cream won't do much good,» explains Reimer-Taschenbrecker. Infected children should only go back to school or nursery once the pathogen has been clearly identified by laboratory analysis and treatment with medication from the inside has been started. It must be continued for several weeks.

According to the expert, it is also crucial to check whether all affected areas have really been covered. «This is so important because this mycosis is highly contagious. For example, we repeatedly have outbreaks in entire families, in sports groups or wrestling clubs, where the spores remain on the mats and in the communal areas,» says Reimer-Taschenbrecker.

In these cases, parents should react quickly

Medical treatment is also very important because certain fungi in the head area can lead to permanent hair loss and scarring. Parents should therefore react immediately if they discover areas on their child's head that are flaking or crusty or where hair is falling out.

«This is suspicious, even if the child complains of pain in this area. This is usually much more severe than a simple itch,» says Reimer-Taschenbrecker. It is also helpful to explain to children that they should not swap their caps with friends and siblings. This reduces the risk of infection.

Change socks daily: The spaces between the toes should be kept as dry as possible.

Athlete's foot: first itchy, then flaky

First an itch between the toes, then the skin reddens slightly and begins to flake. Athlete's foot - tinea pedis - is a widespread chronic fungal disease. It can appear between the toes - typically between the fourth and fifth toes, on the sole of the foot or in the arch of the foot. Experts estimate that one in three adults will suffer from it at some point in their lives.

«This is also on the increase among teenagers, around ten per cent of whom have already had athlete's foot,» says Freiburg paediatric dermatologist Antonia Reimer-Taschenbrecker. Current shoe fashion is one reason why fungi feel so comfortable on teenagers' feet, with warmth and moisture building up in trainers and trainers.

«Leather shoes or sandals are clearly the better alternatives,» says Reimer-Taschenbrecker. As a preventative measure, she also recommends changing socks every day and disinfecting shoes with special sprays if feet are particularly sweaty. «The spaces between the toes should be kept as dry as possible to prevent infection or re-infection.»

If siblings or parents also suffer from athlete's foot, they should also be treated. The fungal spores are mainly found in horn particles, which spread almost invisibly in bathrooms, changing rooms or communal showers. The good news is that with consistent hygiene and an antifungal ointment, athlete's foot can be treated within two to three weeks. If the fungal spores migrate to the nail, a nail fungus can develop, which is much more complex to treat than a pure athlete's foot.