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Now, let’s review some physiology. Normally, the skin surface is colonized by a huge number of microorganisms that make up the normal skin flora. This flora has a healthy balance that consists mostly of bacteria, such as Staphylococcus epidermidis, as well as low amounts of certain fungi, such as Candida albicans, Malassezia, and dermatophytes like Trichophyton. These microorganisms are typically non-pathogenic, meaning that they don’t cause any disease. In fact, they are beneficial, since they serve as a physical and competitive barrier that helps prevent pathogenic microorganisms from invading and infecting the skin.
Okay, so cutaneous fungal infections are typically caused by a disruption of the healthy balance of the skin flora. Now, clients can develop different infections based on the causative fungus. The most common ones include candidiasis, which is caused by an overgrowth of Candida albicans; as well as tinea or pityriasis versicolor, which is caused by Malassezia furfur; and tinea infections, which are caused by a variety of dermatophyte fungi.
Risk factors of fungal infections include medications like antibiotics or glucocorticoids, poor personal hygiene, as well as warm and humid environments, in addition to close contact with animals, such as dogs, cats, cows, and goats. Additional risk factors include obesity, diabetes mellitus, and being immunocompromised; as well as high estrogen levels due to oral contraceptive use, estrogen therapy, or pregnancy.
So, cutaneous fungal infections occur when the healthy balance of the skin flora gets disrupted, which may allow the fungi in the skin to overgrow. In most cases, a healthy immune system is able to notice and stop this, keeping the fungi under control. However, in some cases, fungi manage to persist, and ultimately cause an infection. Typically, cutaneous fungal infections are superficial and localized; but in certain cases, such as in clients who are severely immunocompromised, fungi may also cause more serious invasive infections, spreading to the bloodstream or to other tissues and organs.
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