Nasty infections & rashes
COLD sores, athlete’s foot, fungal nails, thrush — they may not be life-threatening but they can really get you down. In the fourth part of our unique series, we ask the experts what you can do to shift those niggling infections . . .
HOW TO GET RID OF ATHLETE’S FOOT
DRY, flaky, red, and unbearably itchy — athlete’s foot is a highly contagious fungal infection affecting the soles of the feet and in between the toes. Skin can look white and ‘soggy’ or small blisters can form.
The fungus tinea pedis, to give it its proper name, can be hard to shift and is right at home on human skin. It dines on keratin, a protein that is one of the main parts of the outer layer of skin and thrives in sweaty trainers and between toes.
‘In and of itself it’s not dangerous,’ says Walayat Hussain, a consultant dermatologist at Leeds Teaching Hospitals NHS Trust and a spokesman for the British Association of Dermatologists. ‘But it becomes very itchy and you can get a secondary infection if you’re scratching.’
In many cases ignored or poorly treated fungal infections will continue to spread and over time become harder to shift.
Meticulous hygiene is key when it comes to tackling athlete’s foot, says Mr Hussain — especially after sweaty exercise. And it rarely gets better on its own. So don’t just blame your worn-out running shoes and hope for the best.
‘It’s any warm and moist environment that the fungus or yeast like, so if you’ve got athlete’s foot, no matter what trainers you’re wearing, you are always going to have that problem. If you’ve got a really old pair of trainers, it’s good to get a new pair. But I wouldn’t be ditching those really expensive new Nikes just because you’ve been diagnosed with athlete’s foot.’
More important is to treat it with an over-the-counter antifungal product, which come as creams, sprays and powders.
Make sure you wash and dry feet thoroughly, and allow them to breathe by choosing cotton socks and shoes made of natural, breathable materials, such as leather. A GP can also prescribe steroid cream if an infection is particularly sore and itchy.
As athlete’s foot is so contagious, don’t share towels and wash them frequently.
It’s possible to pick up fungal infections from weights at the gym, or from skin-to-skin contact with someone already infected. That’s why it’s advisable to wear flip-flops in public spaces, such as showers, pools, and changing rooms. Other steps to prevent its return are to avoid wearing the same shoes for more than a couple of days and don’t use moisturiser on your feet — more moisture is not what you need.
COLD SORES: A CURSE FOR LIFE
HERPES — most widely experienced as a dreaded cold sore on the lips that starts with an ominous tingle and bursts into an scabby blister — is the contagious infection that keeps on giving. Once you’ve caught it, says Mr Hussain, ‘you’ve got it for life’.
According to the World Health Organisation more than 67 per cent of humans carry the herpes simplex virus, which can be passed on in secretions from the mouth, eyes or genitals.
There are two varieties — type 1, an oral infection, and type 2, which is genital herpes.
The warning you shouldn’t kiss babies when you have a cold sore is sound advice, but clearly widely ignored: most people with herpes type 1 are believed to have contracted it by the age of two.
You may know nothing about it when you’re first infected — often it produces only a short-lived redness of the skin, rather than a tingle and blister, according to the British Association of Dermatologists. Or it may come with a temperature, swollen lymph glands and soreness and blisters, in the mouth and on lips.
Once you’ve been infected, the virus enters sensory nerves near the surface of the skin and takes up residence in the central nervous system, where it is protected from the body’s immune response. Here, it will lie dormant until it is reactivated by anything from sunlight to a bout of flu, at which point it travels back along the nerve to the skin.
It’s not known why UV rays ‘wake up’ the virus, but use of sunscreen every day can prevent this happening. Running a fever can also bring the virus back into action — indeed, cold sores used to be known as ‘fever blisters’.
Cold sores usually last a week or more from the first tingle to the blister clearing up — until the next time. That might be months or even years away, but the virus will always be there, lurking.
There are no preventive treatments, but hope may be on the horizon.
‘Some people report that a cream containing penciclovir [an anti-viral drug] will prevent cold sores; others prefer to prevent outbreaks with a herbal cream containing lemon balm mint, such as Loma-Herpan,’ says Marian Nicholson, director of the Herpes Viruses Association. ‘New
tablets and possible vaccines are in the pipeline, but it is still anyone’s guess if they will work well enough to bring to market.’
over-the-counter treatments for cold sores, which contain the anti-viral drug aciclovir, rarely have much impact unless applied the moment that first telltale tingle is felt, says mr Hussain. Though if treatments are applied in time, the length of an outbreak can be shortened by 12 per cent.
It’s not a lot — down from an average of seven days to six and a bit.
other over-the-counter creams, such as Lidocaine BP, containing 5 per cent of the anaesthetic lidocaine, are designed to numb the cold sore’s tingling sensation.
one study, published in The Lancet, found such lidocaine preparations stopped 50 per cent of outbreaks in their tracks, shortening the course of the rest from an average of 4.9 days to 1.9.
‘There’s no detailed research as to why,’ says marian Nicholson. ‘one could speculate that numbing the nerve stops the flow of nutrient fluids on which the virus rides down to the skin surface.’
Anti-viral drugs such as aciclovir, famciclovir and valaciclovir work better in tablet form, says mr Hussain, as they attack the virus from within. But he adds: ‘I wouldn’t prescribe anti-virals for a run-of-the-mill case, as by the time the patient goes to the doctor it’s probably too late to do any good.’
However, for patients who get many cold sores throughout the year, prescription antivirals taken regularly at a low dose may be an option.
‘As a doctor, one needs to find the lowest dose of aciclovir someone needs to take, maybe one or two tablets a week, to keep the virus switched off,’ says mr Hussain.
‘It is possible to establish an effective regime in some who are getting ten to 12 outbreaks a year, which is quite debilitating. The number of episodes can drop down.’
Ask your GP if this sounds like you.
THE TRUTH ABOUT THRUSH AND SEX
THrUSH — which can affect both men and women — is a yeast infection caused by Candida albicans, a fungus found naturally in and on the body. It leads to redness and itching at the head of the penis or soreness at the entrance to the vagina, some discharge and a stinging sensation when passing urine in men and women.
Candida albicans is normally kept under control by the immune system and the balancing effect of other bacteria. But that balance can be disrupted when your immune system is weakened or if you take antibiotics, causing candida to multiply.
Contrary to popular belief, says mike Kirby, professor of men’s health at the University of Hertfordshire and The Prostate Centre in London, thrush is not a sexually transmitted disease, nor should it be associated with sexual promiscuity.
‘It is a candida yeast infection which is in the environment,’ he says. However, it can be passed from person to person so men should wear a condom if they or their partner has it.
Women who get thrush frequently are advised to avoid perfumed products, including shower gels, soaps, wipes and vaginal deodorants.
Good hygiene is the best way to prevent thrush, says Professor Kirby. When they do catch it, men need to keep the area clean and use an anti-fungal drug, such as Fluconazole, available over the counter as tablets.
Women can treat thrush with over-thecounter anti-fungal medicines, available as pessaries and creams inserted into the vagina with an applicator, or as capsules.
These may cause upset stomachs, and shouldn’t be taken by women who are expecting or breastfeeding, as the active ingredient fluconazole has been shown to cause harm when taken extensively during the first three months of pregnancy.
WHAT’S CAUSING THAT BUMPY RASH?
AN ITCHY rash, often with small, flattopped, raised bumps, lichen planus is non-contagious and can appear almost anywhere on the arms, legs or body, but may also crop up in the mouth or on the sex organs. It is seen most often over the age of 40, and affects about one person in 100.
Superficially similar to other conditions, ‘it’s easy to diagnose for a dermatologist, but can be tricky for non-experts’, says consultant dermatologist Anton Alexandroff. It can be mistaken for warts, or eczema.
The signs are ‘itchy red or pink flat bumps, or papules, often grouped together’, he says. They measure about 3mm to 5mm across.
The clue is in the name: ‘lichen’ means small bumps and ‘planus’ means flat. Though most frequently found on the wrists, ankles and lower back, ‘It can also pit and even destroy nails,’ adds mr Alexandroff.
In bad cases, nails may split along their length or be eaten away, as if by a fungus.
The scalp is also vulnerable, but this is rare. Here, the condition can permanently damage follicles and cause hair loss.
The diagnosis of lichen planus may be made by a dentist. ‘It often creates lacy changes on the mucous membrane on the inside of cheeks and lips, and can also give oral ulcers,’ says mr Alexandroff. These ulcers — normally more widespread than the mouth ulcers we all get — may be extremely painful but can be tackled with antimicrobial and painkilling mouthwashes, available over the counter.
more rarely, it is found on the penis, where it causes purple or white ring-shaped patches. Unlike other patches of lichen
planus, these often do not itch, says consultant dermatologist Walayat Hussain.
Lichen planus can affect the genital area
in women too, ‘but this is less common’. The cause is not fully understood, says Mr Hussain, ‘but it is thought to usually be a reaction to drug treatments or an anti inflammatory response’. It has been linked to antimalarial tablets and disease-modifying anti-rheumatic drugs (DMARDs) injected into some arthritis patients. There is no cure. But you can alleviate symptoms with steroid creams and ointments, which can be bought over the counter; stronger versions must be prescribed. In severe cases a GP or dermatologist may prescribe antihistamines, light treatment with an ultraviolet B lamp, or drugs such as acitretin, a retinoid (derived from vitamin A) which works by slowing cell growth in the skin, and cyclosporine, which suppresses the immune system.
Left alone, it will heal in about 18 months, though it can recur. It will persist longest in the scalp, nails or mouth, where it can last for several years.