Inguinal yeast infections, athlete's foot, and tinea versicolor are the most common skin infections caused by yeast.  About 75% of patients are males.  Yeast infections can also occur on the scalp, face, skin folds, arm pits, hands, nails, or around facial hair.  Ringworm is an example on the body. The yeast can be spread in locker rooms or dormitories, especially where showers are shared.  Swimmers and athlete's are particularly susceptible due to their frequent contact with water and loss of natural skin protective oils.  Moist climates also increase the frequency, as can obesity.  Yeast skin infections of the feet as so common that in a 16-country study of 90,000 older adults in Europe, 50% had some evidence of fungal foot infection (Dermatology. 2001;202(3):220-4). 

Fingernail onychomycosis is caused by some Candida species in 70% of cases. Trichophyton rubrum remains the most prevalent fungal pathogen in general, and increased incidence of this species was observed in finger and toe onychomycosis, tinea corporis and tinea cruris, tinea manuum, and tinea pedis. As the causal agent of tinea capitis, T tonsurans continues to increase in incidence in the United States (J Am Acad Dermatol. 2004 May;50(5):748-52).

Washing less than once a day helps.  Instead of showering every day after my vigorous workout, every other day, I simply dry off with a towel while cooling off in front of a fan.  Dry off as quickly as possible after high perspiration exercise or swimming including changing wet or very moist clothing.  Olive oil or a similar oil may help protect skin after swimming for those who swim frequently or who simply must shower every day.  Frequent bathing can also increase the risk of asthma, especially more than once a day bathing.

Treating fungal infections of the skin with honey and olive oil appears quite successful.  Honey by itself may work just as well.  It is definitely my first line treatment.  Not only does it work well on fungal infections, it also is very good for skin wounds of all types except full thickness burns.  It is great for oral or genital herpes, and may even be good for acne.  

Many low cost topical anti-fungal products are available without prescription.  While physicians often prescribe expensive patented creams, much less expensive over the counter products work just about as well.  Frequently used topical medications for tinea and candidal infections include clotrimazole (Lotrimin, Mycelex), econazole nitrate (Spectazole), ketoconazole (Nizoral), miconazole nitrate (Monistat-Derm, Micatin), oxiconazole nitrate (Oxistat), and ciclopirox olamine (Loprox). Topical selenium sulfide lotion can also be used for tinea versicolor, which is often a recalcitrant problem.

Oral treatment with terbinafine or itraconazole have been used successfully, although side-effects occur in about 11% of patients (Acta Dermatovenerol Croat. 2003;11(1):17-21). Other oral choices include fluconazole 150 mg once weekly or griseofulvin 500 mg once daily for 4-6 weeks with griseofulvin working a little faster but having more side-effects (12% vs. 7%) (Br J Dermatol. 1997 Apr;136(4):575-7).

Tinea versicolor consists of benign scaly and hypopigmented or hyperpigmented macules and patches on the chest and the back which may vary in color from reds to browns.  It is very common in moist climates and many people do not seek treatment for it.  The lesions sometimes mildly itch and frequently fail to tan in summer, making them stand out more.  It is not contagious, since it is caused by a normal skin fungus.  Selenium sulfide lotion is liberally applied to affected areas of the skin daily for 2 weeks; each application is allowed to remain on the skin for at least 10 minutes prior to being washed off. In resistant cases, overnight application can be helpful. Topical azole antifungals can be applied every night for 2 weeks. Weekly application of any of the topical agents for the following few months may help prevent recurrence. In patients with widespread disease, topical antifungal therapy can be expensive.  Oral treatments can be used for extensive infections, although side-effects are more common with oral treatments.  Infections tend to recur.  While I have not seen any research, honey will probably work very well if the infection is not too widespread so as to be inconvient.  Honey is less inconvient than you might think.  Taping a piece of plastic wrap over the honey can usually keep it in place over night and any stickiness disappears by morning.  Honey doesn't feel sticky in groin or skin fold areas.  Honey both nourishes the skin and acts as a powerful antibiotic against yeast, bacteria, and viruses.

Oil of bitter orange (Int J Dermatol. 1996 Jun;35(6):448-9), ojoene (Arzneimittelforschung. 1999 Jun;49(6):544-7), and a eucalyptus oil have all been shown to work in controlled studies with the results as good as standard anti-fungals.  Tea tree oil or cream has also been used.

Tinea Cruris: Personal Hygiene with "Restricted Bathing" Better than Griseofulvin: 226 adults with t. cruris were in a DB PC study comparing 10 days of griseofulvin vs. restricted bathing hygiene instruction. Tinea markedly decreased with meds but returned in 87%. The hygiene group gradually eliminated tinea by 10^th week. Personal hygiene as an alternative to griseofulvin in the treatment of tinea cruris. Akinwale SO. Afr J Med Med Sci 2000 Mar;29(1):41-3, Nigeria. Unfortunately, neither this article’s abstract nor other articles explain "hygiene." Keeping feet dry and wearing sandals in locker rooms was recommended by one article on tinea pedis. Try to avoid showering daily.

Tinea Pedis Higher with Frequent Foot Washing: Children washing feet twice a day had 3.2 times higher rate in Israel than children washing less than daily. Population-based epidemiologic study of tinea pedis in Israeli children. Leibovici V, Evron R, Dunchin M, Strauss-Leviatan N, Westerman M, Ingber A. Pediatr Infect Dis J 2002 Sep;21(9):851-4; One article found it more common in Muslims in South Africa and that it was spread by the common use of prayer mats. Int J Dermatol 1998 Oct;37(10):759-65

Tinea Pedis: Nail Fungus 3 Times More Common in Swimmers, Runners, Diabetics: General population rate estimated at 3%-8%. Study of 260 swimmers found 20% with confirmed cases. Onychomycosis in Icelandic swimmers. Gudnadottir G, Hilmarsdottir I, Sigurgeirsson B. Acta Derm Venereol 1999 Sep;79(5):376-7; Runners 31% infected, 22% with lesions. Tinea pedis in European marathon runners. Lacroix C, Baspeyras M, de La Salmoniere P, Benderdouche M, Couprie B, Accoceberry I, Weill FX, Derouin F, Feuilhade de Chauvin M. J Eur Acad Dermatol Venereol 2002 Mar;16(2):139-42; In diabetes, 17% vs. 7% of non-diabetics had nail fungal infections. Epidemiology of onychomycosis in patients with diabetes mellitus in India. Dogra S, Kumar B, Bhansali A, Chakrabarty A. Int J Dermatol 2002 Oct;41(10):647-51

Tinea Pedis: Tea Tree Oil Helped: In a 4-week DB PC study of 158 patients with tinea pedis (athlete's foot) using twice daily treatment, marked improvement occurred in 68% of the 50% tea tree oil group and 72% of the 25% tea tree oil group, compared to 39% in the placebo group. Mycological cure was assessed by culture of skin scrapings taken at baseline and after 4 weeks of treatment. The mycological cure rate was 64% in the 50% tea tree oil group, compared to 31% in the placebo group. Four (3.8%) patients applying tea tree oil developed moderate to severe dermatitis that improved quickly on stopping the study medication. Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: a randomized, placebo-controlled, blinded study. Satchell AC, Saurajen A, et al Camperdown, New South Wales, Australia. Australas J Dermatol. 2002 Aug;43(3):175-8.

Tinea Pedis: Terbinafine (Generic Lamisil) Ointment Best: In a review of 40 DB PC study of patients with tinea pedis, azoles vs. placebo had cure rates between 60 - 91 % (placebo 10 - 67 %) and clinical cure rates between 64 - 95 % (placebo 10 - 63 %). Allylamines (naftifine and terbinafine) cure rates were between 62 - 100 % (placebo 10 - 45 %) and clinical cure rates between 66 - 86 % (placebo 4 - 44 %). Comparative studies between azoles and allylamines occasionally indicated the significantly superior cure rates of allylamines (especially terbinafine). The high cure rates of terbinafine could be detected after therapy duration of merely one week, whereas the azoles have to be applied for four weeks before good efficacy was reached. Treatment of interdigital tinea pedis. Korting HC, et al. Universitat Munchen, Munich. Deutsch Med Wochenschr 2003 Sep 5;128(36):1819-24.

Tinea Pedis: Tea Tree Oil Helped Although Tolnaftate Somewhat Better: In a DB PC study of 104 patients with tinea pedis, 10% w/w tea tree oil cream was compared with 1% tolnaftate and placebo creams. More tolnaftate-treated patients (85%) than tea tree oil (30%) and placebo-treated patients (21%) showed negative cultures at the end of therapy (p < 0.001). Scaling, inflammation, itching and burning was reduced in 64% with tea tree oil, 57% with tolnaftate, and 41% with placebo (p = 0.022 and p = 0.018). Tea tree oil in the treatment of tinea pedis. Tong MM, Altman PM, Barnetson RS. Camperdown, NSW. Australas J Dermatol. 1992;33(3):145-9.

Tinea Pedis Testimonial: Urine Treatment: One of my adult patients says she uses her own urine to treat her athlete's foot.  She came from a family of eleven children and learned of it through her mother.  I'd rather try honey first.  Her mother also used urine to treat pink eye by having the child urinate on a diaper and then wiping the diaper of the eye. Testimonials aren't worth very much, but I thought I would post it.  10/15/06.

Toenail Fungus: Butenafine with Tea Tree Creams Very Effective: Onychomycosis, a superficial fungal infection that destroys the entire nail unit, is very difficult to cure. In a 16-week DB PC study of 60 adults with the disease for 6-36 months, those using 2% butenafine hydrochloride with 5% Melaleuca alternifolia oil incorporated in a cream had an incredible 80% cure rate vs. 0% for placebo. Four patients in the active treatment group experienced subjective mild inflammation without discontinuing treatment. During follow-up, no relapse occurred in cured patients and no improvement was seen in medication-resistant and placebo participants. Treatment of toenail onychomycosis with 2% butenafine and 5% Melaleuca alternifolia (tea tree) oil in cream. Syed TA, Qureshi ZA, et al. University of California, San Francisco. Trop Med Int Health. 1999 Apr;4(4):284-7.

Toenail Funger: Oral Lamisil 250 mg Daily Standard Treatment but Expensive: Even generic terbinafine from Canada costs $2 a tablet when purchasing 100 tablets. In the U.S., it costs over $200 per month. Using both tea tree cream with an antifungal solution topically is much, much less expensive.

Toenail Fungus: Clotrimazole and Tea Tree Oil Equally Effective: In a 6-month DB PC study of 117 patients with onychomycosis, topical application of 1% clotrimazole solution compared with that of 100% Melaleuca alternifolia (tea tree) oil twice-daily did equally well based on culture cure (CL = 11%, TT = 18%) and clinical assessment documenting partial or full resolution (CL = 61%, TT = 60%). Three months later, continued improvement or resolution was equal as well (CL = 55%; TT = 56%). Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia (tea tree) oil and clotrimazole. Buck DS, Nidorf DM, Addino JG. University of Rochester. J Fam Pract. 1994 Jun;38(6):601-5. Ed: Using both together as above is probably the desired strategy.

Tinea Capitis Related to Exposure, Not Hair Care: Kansas study of 66 children. Previous infection OD 3.11, exposure to infection OD 16.32. Not related with washing frequency, use of hair oil, hair style. Do hair care practices affect the acquisition of tinea capitis? A case-control study. Sharma V, Silverberg NB, Howard R, Tran CT, Laude TA, Frieden IJ. Arch Pediatr Adolesc Med 2001 Jul;155(7):818-21; Shared grooming instruments called a problem.

Tinea Fungal Infections: Honey Appears to Help Tinea and Pityriasis Versicolor Infections: In an open, non-scientific report using a mixture of honey, olive oil and beeswax three times a day for up to 4 weeks to treat 37 patients with fungal infections (pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei), clinical response occurred in 86% of patients with pityriasis versicolor, 78% of patients with tinea cruris and in 75% of patients with tinea corporis. Negative fungal cultures were obtained in 75, 71 and 62% of patients with PV, tinea cruris and tinea corporis, respectively. Tinea faciei disappeared clinically and mycologically in 3 weeks. An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study. Al-Waili NS. Islamic Establishment for Education, Dubai, United Arab Emirates. Complement Ther Med. 2004 Mar;12(1):45-7.

Thomas E. Radecki, M.D., J.D.

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