30 minute read
Editor’s choice health
R295
Coco Balls All-in-One Multivitamin
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R213
Bach Rescue Remedy Night (10ml)
Available at health shops, Wellness Warehouse, Dis-Chem and selected health pharmacies
R315
Coco Balls Focus
Available online at www.pandabear.health
R310
Coco Balls Chill
Available online at www.pandabear.health
R80.50
Lacti-Nose 20ml Probiotic Nasal Spray
Available online at www.albiofa.com
R65
Soil Easy Breathe Available online at www.soil.co.za
R306.97
BETADINE™ BV Gel (40g)
Available at Clicks stores
health
R39.99
Wintergreen Hygiene Spray
Available online at www.wintergreensport.co.za
R230
Chaya Leaf Capsules (120 caps)
Available online at www.nutridry.co.za or www.faithful-to-nature.co.za
R279
Sh’Zen Daily Omegas (30 soft gels)
Available online at www.shzen.co.za
R109.95
Nutri Pure for Kids MULTI VITAMIN Complete, 60
Available at Dis-Chem & Yooper, limited items available on Takealot, PnP, Spar and soon Clicks
R236.99
Reuterina Femme Available at Clicks
R134.95
Nutri Pure for Adults Multi Vitamin Complete, 60
Available at Dis-Chem & Yooper - limited items available on Takealot, PnP, Spar and soon Clicks
R98.95
Pholtex Broncho Stop (120ml)
Available at Clicks, Dischem, Takealot and selected Shoprite & PnP pharmacies
R46.95
Stress Away Tablets
Available at all leading pharmacies
What to expect during the first trimester?
By Dr Latiefa Vinoos
Congratulations Mom! You have an exciting journey ahead.
During the first trimester (first 12 weeks of pregnancy), your baby grows from a tiny egg to a little foetus measuring 6cm. Despite this rapid development, your baby bump is unlikely to be visible. In most cases, it is still too early to tell the sex of your baby when performing an ultrasound. While your body is adjusting to its newfound tenant, you may experience the dreaded morning sickness, mood swings, fatigue, breast tenderness, bloating and back pain.
Antenatal care
Antenatal care is best to begin at 10 weeks. Ultrasound scans are performed to confirm the pregnancy and identify any risk factors for conditions such as Downs Syndrome or other structural abnormalities.
Some of the blood tests carried out include your blood type, iron stores, immunity against Rubella and Hepatitis B, HIV status and your blood sugar levels, amongst others. Your urine is tested for any signs of infection to limit the occurrence of pre-term labour.
Your pre-existing medical conditions and chronic medication may also need to be monitored and adjusted for the duration of the pregnancy.
Make a list of all your questions and discuss them with your doctor. Pregnancy can be a wondrously overwhelming journey and it is important that you feel comfortable and supported.
What you can do
A good multivitamin that includes folic acid and iron is important in keeping both you and your baby healthy. Folic acid reduces the chance of neural tube abnormalities such as Spina Bifida.
A healthy and nutritious diet with added fibre will prevent acid reflux and alleviate constipation. Moderate exercise and an active lifestyle are encouraged.
What to avoid
Things to avoid during the first trimester include alcohol and smoking as this can affect the development and growth of your baby. Raw or undercooked foods including sushi are also discouraged. Changing cat litter is best avoided to limit exposure to Toxoplasmosis.
It is important to consult your doctor about all medications that you plan to continue or commence during the pregnancy, as some may be considered harmful to the foetus.
When to contact your doctor
If you experience heavy bleeding or you pass clots of blood, you should seek urgent medical attention. Severe abdominal pain should be investigated in hospital and if you are vomiting and unable to keep food or fluids down, you may need an IV fluid administered to prevent dehydration.
Severe calf pain or swelling can indicate a blood clot in the leg and severe or one sided headaches can indicate blood clots in the brain. A high fever, rash and sore throat should be investigated. If you are uncertain, it is always advisable to contact your healthcare provider to allay your concerns.
When to make the announcement
Many women are unsure when they should announce their pregnancy to their friends and families. Some may want to reveal the pregnancy as soon as they find out, while others may prefer to wait.
The risk of early pregnancy loss is highest during the first trimester and sharply decreases during the second trimester. There is no right or wrong time to make the announcement and it only depends on when you would feel most comfortable.
Good luck Mom! You are going to be amazing.
Dr Latiefa Vinoos completed her undergraduate training at Stellenbosch University in 2008. She developed an interest in obstetrics and gynaecology during her internship at Chris Hani Baragwanath Hospital in Soweto and subsequently completed her community service at Mowbray Maternity Hospital. Through the University of Cape Town, she went on to earn her Fellowship in obstetrics and gynaecology with a distinction in the Masters of Medicine Degree. Thereafter she worked at Groote Schuur Hospital as a consultant in the andrology lab, family planning, gynaecology outpatient, mature women and endocrine clinics.
Tel: 021 506 5500 Email: info@drlatiefavinoos.co.za / drlatiefavinoos.co.za Life Vincent Pallotti Hospital, Suite 322, 3rd Floor, The Park Building
STERILISES, WHITENS, DEODERISES AND REMOVES ALL STAINS
Babies Bibs, Burp Cloths & Clothes
NOTNOT JUSTJUST FORFOR NAPPIESNAPPIES
Clothing, serviettes, tablecloths (popular with restaurants)
Bump up your fitness!
By Thania Enous, Physiotherapist
Exercising and keeping mobile during your pregnancy is highly recommended as it has many benefits for you and your baby. Improving your general well-being is vital in preparation for meeting your new little bundle and enhancing your recovery after delivery.
The recommended exercise allowance is 150 minutes a week. Yip, that’s a reasonable amount of moving around to do. Women who have been physically active should continue and adjust their programmes as needed. For those who are waiting to take that initial step, now is a positive and exciting time to start.
Bear in mind, it is best to spread your sessions across seven days and allow for rest days in-between if needed. As the weight of your baby and belly size increases through your trimesters, your endurance will change, and your exercise regimes will need to be adapted accordingly. Remember, exercise should not cause any pain or strain.
Always consult your obstetrician and gynaecologist or midwife before beginning any exercise, especially if you have experienced any health issues during your pregnancy or have any pre-existing medical conditions. This may not necessarily mean that you are not allowed to exercise but, with the help of a trained, qualified instructor, a tailored programme will be designed for you.
Appropriate exercises during your pregnancy and after delivery
• Light to moderate aerobic activities such as brisk walking, stationary cycling, swimming or aqua aerobics. • Light resistance exercises using elastic bands, light weights, body weight training (e.g., mini squats, wall push-ups). • Yoga, pilates and stretching. • Kegel exercises to help tone your pelvic floor muscles which help to support your baby in your pelvis. • Postural exercises.
Where to start with so many options. Firstly, don’t rush into attempting all at once. Start off slowly with walking or stationary cycling or swimming, and gradually increase your time or pace. Add stretching and light weight-training as you can manage.
Joining an ante-natal yoga or pilates class is always enjoyed and a great way to relate and share with other moms-to-be.
Avoid high impact activities which involve jumping, sudden twisting or place increased pressure on your abdomen or pelvis. Contact sports and activities which may raise your risk of falling are also strongly discouraged.
Avoid lying on your back for prolonged periods especially in your last trimester as the weight of the baby rests on your intestines and your main abdominal vein which brings blood back to your heart. Avoid training in hot humid weather and make sure you are adequately hydrated and carry healthy snacks with you.
Health benefits of exercise
• Burning calories • Decreased risk of obesity, excessive weight gain, gestational diabetes and hypertension • Assists in reducing constipation • Reduces water retention • Improved heart and lung health • Decreases post-partum recovery time • Lessens the incidence and severity of lower back pain • Improves your posture and balance • Encourages the release of “happy hormones” resulting in improved mood, therefore assisting with managing postpartum depression
Always exercise with care, even if you’ve been an active individual. As with any exercise, always start with a warm-up, end off with a cool-down and include gentle comfortable stretches. Pay special attention to your breathing technique, making sure you’re taking in slow, relaxed deep
breaths through your nose allowing your stomach and chest to rise as you inhale. You should always be able to hold a conversation and exercise. If not, slow down, have a rest and continue only if it’s comfortable.
You should discontinue your training session immediately and contact your obstetrician and gynaecologist or midwife if you experience any of the following: • vaginal bleeding • amniotic fluid leakage • difficulty breathing • dizziness or headache • regular or painful contractions • sudden onset of pain across your abdomen or pelvis • calf pain or swelling • chest pain
Experiencing backache and pelvic pain?
A common challenge faced toward the middle and end of pregnancy is backache, pelvic pain or pressure. As your baby grows and requires more space in your pelvis, your ligaments become stretched. The weight of the baby also shifts your centre of gravity forward and places added strain on your lumbar spine. In some cases, pain may be worse on one side and radiate into the buttock or down the leg, often as a result of how baby is resting.
The use of a good pelvic brace is helpful for moms who are on their feet all day as it supports the belly and stabilises your pelvis. Seeing an experienced physiotherapist may assist in pain relief. You will also be educated and advised on how to manage your symptoms and given an individualised home exercise programme. Practice good posture positions throughout the day at home and your workplace. Good pointers are to sit or stand tall, tucking in your chin, keep your shoulder blades back and relaxed and avoid swaying at your hips. Refrain from sitting for prolonged periods. By ensuring adequate hydration, your bladder will keep you marching to the loo regularly.
How soon to start exercising after delivery?
Women who have had vaginal birth may commence exercising as early as their bodies allow. It is best to wait around three weeks if you’ve had any tearing. With a C-section, one needs to allow the area and incision to heal and wait six to eight weeks before exercising.
One can start almost immediately with relaxation exercises, seated or lying down pelvic floor exercises and practicing good posture and positioning with baby. As soon as you get the green light from your obstetrician and gynaecologist or midwife, you may start light intensity aerobic exercise and weight training.
Exercising during pregnancy and after giving birth offers many physical and emotional benefits. It can be done from the comfort and convenience of your own home. Exercising needn’t be an overpriced expense. A good supportive pair of sneakers and comfortable clothing is all your need to get going.
Walking is free, so grab your neighbour, dog or partner or all three!
Thania Enous is a senior physiotherapist working at West Physiotherapy based in Claremont, Cape Town. She is passionate about restoring health and well-being to patients and has a special interest in assisting new moms during their initial challenges.
West Physiotherapy T +27 (0)21 671 5300 E admin@westphysiotherapy.co.za
Help for
cracked nipples
By Emma Numanoglu, Certified Lactation Consultant
One of the most common reasons that women give up breastfeeding is due to painful and cracked nipples. As a Certified Lactation Consultant, I receive calls every week from desperate mothers asking what they can do to be able to feed without pain. Breastfeeding should never hurt, and cracked nipples are a sign that you need urgent help from a certified lactation specialist – either a South African Certified Lactation Consultant (SACLC) or International Board Certified Lactation Consultant (IBCLC).
How to prevent cracked nipples
All pregnant women should attend antenatal classes in pregnancy that cover breastfeeding and see a lactation consultant before birth to help prepare for breastfeeding. A lactation consultant can show the mother what a good or poor latch looks like to prevent damaged nipples.
Damage occurs when the baby does not get enough breast tissue in its mouth or when the tongue is not positioned correctly. There is a lot that can be done to prevent this such as: • Making sure that your baby is positioned correctly to be able to compress your breast tissue with your nipple positioned deep in baby’s mouth. • Wait for the baby to open its mouth very wide, like a yawn, before offering the breast. The baby’s lower lip should be fanned outward on the breast.
When you gently pull down the corner of the baby's mouth while it is nursing, you should see the underside of its tongue, which should extend over its lower gum line, cupping the breast. • The baby’s nose should be away from the breast and the chin close to the breast. • Try and feed baby skin-to-skin as much as possible in the early weeks.
Holding your baby skin-to-skin helps to increase your milk volume by increasing your levels of oxytocin
“the love hormone” and these levels increase when you snuggle your baby close.
Tongue-tie can cause difficulties
Tongue-tie can also cause sore and cracked nipples. If the baby's tongue appears heart-shaped, it could be a short or restricted frenulum (tongue-tie) that prevents a good latch on to the breast.
A tongue-tied baby may: • have difficulty attaching to the breast • feed for a long time • have a short feed and need to feed again • be unsettled and seem to be hungry a lot of the time • not pick up weight well, or • make a clicking sound as they feed, although this can also be a sign that you need help to get a deeper latch or better positioning.
Thrush and nipple eczema can cause cracked nipples
Nipple eczema can also lead to cracked nipples. Thrush and eczema of the nipples are both treatable conditions and require a trip to a breastfeedingfriendly doctor, who will give you a script for creams to help heal your nipples quickly. You do not need to stop breastfeeding. Typical signs of thrush on the nipples are: • burning nipple pain • flaking skin on the nipple or areola • shiny skin on the nipple or areola • painful breasts without tender spots or sore lumps • stabbing pains in the breasts behind the areola • itching on or around the nipple and areola
Flat or inverted nipples
Flat or inverted nipples can make it difficult for a baby to grasp the breast in its mouth and properly latch on. With a proper latch-on, the baby’s sucking can effectively draw out flat or inverted nipples.
Gentle pumping or special exercises are sometimes recommended to draw the nipple out. If you received IV fluids for several hours during the birth process, this can be a cause of edema (swelling) in the breast and nipple.
Reverse Pressure Softening can help create a softer nipple and areola that a baby can more easily grasp. It involves using gentle finger pressure around the base of the nipple. This temporarily moves some of the swelling slightly backward and upward into the breast.
This technique is also helpful in preventing sore nipples if your breasts become engorged (swollen and uncomfortable) when your milk supply comes in several days after birth, making it difficult for baby to latch on comfortably.
Correct breastfeeding position
Removing baby from the breast without breaking the suction first can be painful and cause damage to the sensitive breast tissue.
If baby is latched on and sucking well, it will end the feeding itself by letting go of the breast or releasing the nipple as it falls asleep. If you decide to take the baby off the breast before it is finished, you can break the suction by inserting your finger into the corner of baby’s mouth.
Feeding bras, soaps, detergents and perfumes
Avoid bras that are too tight and made of itchy fabrics. Be vigilant about thorough rinsing of nursing bras to be sure any laundry detergent residue is removed, as this may cause nipple irritation.
Avoid perfumes, scented roll-on, hair spray, scented body lotions or talcum powder near your nipples. When bathing, rinsing breasts with clear water is all that is needed to keep your breasts and nipples clean. Do not scrub your breasts with soaps or apply thick layers of cream, as this can irritate nipples and is not needed. If using breast pads, change them regularly.
Your breasts are amazing. You may notice Montgomery glands (also called tubercles) that are small sebaceous glands found around the nipple and areola (the area of pigmented skin around the nipple). The secretion of an oily or waxy substance in the nipple area helps to keep the nipples soft and supple. The substance also contains anti-infective properties that help keep germs away.
How to soothe sore nipples
When your nipples are sore you can gently apply your own milk or an emollient that is safe for the baby to ingest, such as Lanolin. Either of these can be very soothing.
See a professional!
Lastly, if you are struggling with cracked nipples it is better to ask for help sooner rather than later. For lactation consultants in your area, visit the below websites: • www.salactationconsultants.co.za • www.lacsa.co.za • www.breastfeedingmatters.co.za Emma Numanoglu, founder of www.breastfeedingmatters.co.za, is a registered nurse and midwife. She has a BA, BSc Hons (Psych) and is a South African Certified Lactation Consultant (SACLC) and International Board Certified Lactation Consultant (IBCLC).
Emma is also an antenatal teacher and currently sees mothers at Life Vincent Pallotti hospital, provides home visits and runs a private clinic from her home in Newlands.
PCOS dispelling the myths & looking at facts
Polycystic ovarian syndrome (PCOS) is a common medical condition in women. Some of the latest data estimates 8-13% of women are affected, with 70% of affected women remaining undiagnosed. With a broad range of symptoms, this condition is both misunderstood by patients and doctors alike, so let us get into some questions a lot of patients have about the condition.
By Dr Lizle Oosthuizen, MBChB (UCT) Certified Reproductive Medicine, FCOG (SA), Mmed (UCT)
What is PCOS?
Polycystic ovarian syndrome is more complex than many people think, and it can cause more symptoms than just irregular periods. PCOS may present in a few ways, including irregular or absent periods, signs of increased testosterone (acne, excess body hair), and/ or characteristic appearing ovaries on ultrasound. It is NOT a condition of multiple cysts on the ovaries – many patients panic they have cysts; this is a misnomer and simply a part of the name.
It is important to note that there are many ways in which PCOS presents, and not all women will have these symptoms. More importantly, not all women will go on to develop these symptoms. A diagnosis of PCOS does not mean a woman will definitely struggle with fertility, hair growth or weight loss.
Symptoms include irregular periods or the absence of a period, acne, and excess hair growth. PCOS can also be associated with a
What are the symptoms of PCOS?
metabolic syndrome that may include difficulty losing weight, insulin resistance or Type II Diabetes, and raised cholesterol.
Women may have difficulty conceiving as many women with PCOS have what we call an ‘anovulatory’ cycle (i.e. they do not ovulate each month). This, besides causing irregular bleeding, also makes it harder to fall pregnant – if you don’t ovulate, there is no eggs for the sperm to fertilise.
What causes PCOS?
We don’t fully understand this yet. There is often a trend in a family to have PCOS, so we think there is a genetic aspect, but there is ongoing research into the exact cause. We do know weight loss can improve the symptoms. Similarly, some patients may only develop symptoms after a period of weight gain.
Can the onset PCOS be prevented?
Currently, we can’t prevent the development of PCOS. Maintaining a healthy lifestyle and a healthy weight does help in the management of PCOS, so avoiding gaining weight may prevent some of the symptoms and complications. Minimising your refined sugar intake can also be helpful in managing any insulin resistance you may develop.
How is PCOS diagnosed?
PCOS is diagnosed by having two out of three of the following criteria: 1. irregular or absent periods; 2. clinical (acne/increased hair) or biochemical (blood test proven) signs of increased androgens (androgens include hormones like testosterone); and 3. the appearance of the typical polycystic ovary on ultrasound.
We have to be sure that the problem is in fact polycystic ovaries as many things can masquerade as it. We do a panel of blood tests, but these are not to “diagnose” PCOS, rather to identify associated problems (such as insulin resistance or high cholesterol) and to exclude other conditions that can present just like PCOS.
Can PCOS be cured or only managed?
It can be managed. As the symptoms are what bother women, we can manage these and therefore it can appear to fix the problem. The symptoms can also improve with diet and weight loss, but if a patients gains a significant amount of weight, the symptoms will probably reappear.
How can you treat PCOS?
Treatment is multifactorial and addresses the metabolic side, the future health concerns and the current symptoms.
Irregular cycles can be managed with multiple strategies. Commonly we prescribe an oral contraceptive pill to regulate the cycle in patients who do not currently want to be pregnant.
We can also use progesterone in a cyclical pattern (a few days of the month) to cause a withdrawal bleed once a month. This “return of a regular cycle” is often misunderstood as a way to ovulate – this is not true; it is simply causing a regular bleed.
We also sometimes use a Mirena intrauterine device. This is best in women not planning on falling pregnant soon or currently desiring contraception. Although it usually takes away the period, it does this by thinning the lining of the uterus and preventing a bleed. It is very different to not having a period on your own.
The reason we want to have a regular period OR a medically induced “absence of a period” is the future risks of PCOS. If a woman does not have frequent periods, she is at risk of developing cancer of the uterus lining when she is in her 40s and 50s.
The theory is that because the lining is not bled away every month, it has a higher chance of eventually undergoing a cancerous, or precancerous change. Most women who take a contraceptive that takes away a period will then panic – this a very different situation. When we medically take away a period using a contraceptive, the lining is not building up every month, and so there is actually a lower risk of uterine cancer.
We can treat the high testosteronelike hormones too. If a patient is on a contraceptive pill, usually these androgen levels will drop. If the patient has complaints such as acne or excessive or unwanted hair growth, we can use specific contraceptive pills (such as Diane or Ginette) which contains a special type of progesterone to act against the androgen levels.
We have multiple other medications we can also use to reduce androgen levels, but these need to be monitored closely by your doctor and should be used with contraception. If you are pregnant and taking strong anti-testosterone drugs, you may prevent a male fetus from developing normally. The best approach to excessive or unwanted body hair will always be laser treatment, as although we can prevent further hair growth and slightly reduce what is already there, we can’t completely undo the hair growth.
High insulin levels and Type II Diabetes can be managed with medication and lifestyle changes. Fertility treatment is also offered to couples trying and struggling to conceive.
Can you make lifestyle changes to manage PCOS?
Yes, you can. Weight loss and exercise are very important. A loss of 5-10% of body weight can make a dramatic difference to symptoms and even result in a regular cycle. A diet low in refined carbohydrates should be followed. Many dieticians are well trained in the best approach to diet in PCOS. Heart health is very important and a healthy lifestyle with exercise will also help to keep the heart healthy.
What can happen if you do not treat PCOS?
Worst case scenarios are uterine cancer later in life, heart disease, diabetes, and raised cholesterol. Quality of life is a major concern and the risk of anxiety and depression as a result of the physical manifestations of PCOS and difficulty conceiving also need to be considered. It is important to consider the effect on body image, selfconfidence, sexual relationships as well as your emotional relationship.
How does PCOS affect fertility?
In PCOS, irregular periods are often caused by the lack of reliable ovulation. Ovulation is the process of releasing the egg and should occur once per cycle. If you are not ovulating, there is no egg for the sperm to fertilise.
We have multiple medications we can prescribe to assist with inducing ovulation. This is not something that should be asked for from your doctor without correct monitoring. The medication needs to be monitored with ultrasounds in every cycle it is used. Some women may not respond at all to a certain dose, some may over respond and be at risk of a multiple pregnancy (such as triplets or quads).
Many patients expect their doctor to write a prescription for them for six months. However, fertility is more complex than this and just because you don’t ovulate, doesn’t mean there isn’t another issue with falling pregnant that should be dealt with. Drugs like Clomid, Femara and injectable medications should be prescribed by a fertility specialist. Your fertility doctor will also be able to advise you when other strategies need to be tried.
Is PCOS becoming more common?
Recent work on improving guidelines and diagnostic criteria have meant that we are better at diagnosing it. Women are also more empowered and informed, and they are asking their doctors to look for the condition. Ultrasound machines are more available and better in quality, making diagnosis more reliable.
One aspect to consider is the fact that our society has never been more overweight. As our health is declining, more women who would have been controlled PCOS patients are probably tipping into the syndrome.
The most important message I always want readers to take home about PCOS is that if you are experiencing these symptoms, then alert your doctor to them so that you can be properly investigated. Help is available and we are able manage to improve the symptoms and quality of life of patients with PCOS, so don’t be afraid to ask for help. Dr Lizle Oosthuizen is a specialist Gynaecologist in reproductive medicine. She is one of four specialists at the Cape Fertility Clinic in Claremont and works at Life Kingsbury Hospital. Her special interests include fertility, endocrinology, and recurrent pregnancy loss.
Cape Fertility, 1 Wilderness Road, Claremont, 7708, T +27 (0)21 685 0336 E loosthuizen@capefertility.co.za W www.capefertility.co.za
PCOS SYMPTOMS
Hair loss Hirsutism Pelivic pain
Infertility Overweight Irregular periods
Fatigue High testosterone levels Acne
Ringworm –
a fungus, not a worm!
By Dr Kesiree Naidoo
Ringworm is the common name for a type of fungal infection caused by a group of fungal organisms called dermatophytes. The proper name for ringworm is dermatophytosis or tinea. Ringworm (or tinea) is not caused by worms as the name suggests, but is named for the typical appearance of a rash that is ring-shaped.
Dermatophytes can cause infection of the skin, hair and nails. They are easily spread from person-to-person contact, contact with pets and from the environment. Dermatophytes are very resistant and contagious.
There are many different types of dermatophytes, but the most common cause of infection in humans is trichophyton rubrum and trichophyton tonsurans.
Tinea infection is named for the area of the body it affects. It is typically very itchy and can be passed on by sharing towels, clothing, or socks and shoes from a person that has the infection. Walking barefoot on wet floors and outside in soil is another way of getting the infection on your feet. Tinea thrives in hot humid environments which is why common areas that are affected are the groin and between the toes.
Tinea corporis (of the skin on the trunk)
Dermatophyte infection of the skin on the trunk is called tinea corporis. It typically appears as a circular or annular ring on the skin with an outwardly spreading scaly, red edge and an area of central clearing. The ‘active’ edge often has tiny visible pustules. Tinea corporis can be an isolated patch or multiple coalescing patches and can occur at any age.
Tinea corporis can be treated with a topical antifungal for minimal infection, but more widespread disease needs oral medication. While it is easily diagnosed by a doctor or dermatologist, it can sometimes appear atypical and be confused with eczema. Patients with eczema often get secondary infection with fungus which makes it more difficult to differentiate the eczema from the fungal infection.
Another very common fungal infection on the trunk is pityriasis versicolor caused by Malassezia yeasts. It is not usually itchy or inflamed, but presents as flat hyper pigmented or hypo pigmented, lightly scaling patches on the trunk which are frequently recurrent in hot, humid weather.
Tinea facei (of the face)
Dermatophyte infection of the face is called tinea facei and typically occurs in children from close contact with pets. This type of fungal infection is often mistaken for eczema and treated with topical steroids, which then distorts the clinical picture so the doctor is no longer able to see the typical pattern and the active edge with pustules to identify a fungal infection.
When eczema on the face seems resistant to treatment it may be that there is a secondary fungal infection and a skin scrape with examination of the cells under a microscope can help to make the diagnosis.
Tinea cruris (of the groin)
Dermatophyte infection of the groin is called tinea cruris or ‘jock itch’. It occurs mostly in men and boys and is associated with sweating in the groin area and tight clothing, creating a humid environment. The typical well-defined edge may spread out onto the upper thighs. Yeast infections caused by candida can also cause an itchy rash in the groin. Candida infection typically presents with a white skin discoloration.
Tinea capitis (of the scalp)
Dermatophyte infection of the scalp is called tinea capitis. Tinea capitis generally affects children before puberty. It can appear on the scalp as a patch of hair loss, scaling white or grey patches, yellow pustules or black dots. It may also be a red and inflamed patch and sometimes even a large pus-filled boil called a kerion.
It can be spread by close contact with pets and by sharing hairbrushes, bedding and towels. Tinea capitis may be mistaken for eczema, but eczema does not cause hair loss. Tinea capitis is uncommon in adults, usually only affecting those that are immunocompromised.
Scalp fungal infections always need oral medication for at least 6 to 8 weeks. The hair usually grows back once the fungus is treated.
Tinea pedis (of the feet)
Dermatophyte infection of the feet in called tinea pedis, commonly known as ‘athletes’ foot’. This type of fungal infection is common in sportsmen or any occupation that needs to spend a prolonged time in closed footwear, like safety boots.
Tinea pedis occurs more in older children and most often occurs in the toe web spaces. It may also present as tiny itchy blisters on the feet or a thickening and scaling of the entire foot, also called ‘moccasin type’ tinea pedis, which can only be treated with oral medication. It typically affects just one foot, or two feet and one hand. This asymmetry in presentation points to ‘moccasin type’ tinea pedis and not just dry skin. The subtype of athlete’s foot that occurs between the toes may be treated by easily available over-the-counter creams, though recurrence is the norm.
Tinea unguium (of the nails)
Dermatophyte infection of the nails is called tinea unguium or onychomycosis. This most often affects the big toe nails with subsequent spread to the adjacent toenails. An injury to a toenail can predispose you to nail fungal infection. This is the most difficult type of fungal infection to treat. Oral treatment is most often needed and the maximum success rate with all treatments available is 60-70 %. Some patients with very minimal nail involvement, which we call distal lateral onychomycosis, can be treated with topical prescription nail treatment. Treatment is always for prolonged periods and success is not guaranteed.
Fungal infections are sometimes difficult to differentiate from other skin rashes like eczema, but once a diagnosis is made most fungal infections can be treated successfully. Parents and caregivers should make careful observations as rashes develop and seek advice early from your paediatrician or dermatologist.
Dr Kesiree Naidoo is a Specialist Dermatologist based at Life Vincent Pallotti hospital in Cape Town. She completed her medical degree at Nelson R Mandela School of Medicine at the University of Natal and worked in hospitals in England and Canada before specialising in Dermatology at the University of Stellenbosch. Dr Naidoo has a special interest in treatment of acne, eczema, skin cancers, mole mapping and anti-ageing. She has completed cosmetic dermatology training accredited by the University of Stellenbosch and the practice also offers a range of aesthetic treatments and services. In 2017 Dr Naidoo founded Skinsmart, her online specialist skincare site, where clients and patients can purchase dermatologist strength skincare across premium brands delivered anywhere in South Africa. Dr Naidoo believes in a comprehensive approach to Dermatological care encompassing skin health and aesthetics.
