PART 2 OF 5: Fungal skin infections are caused by dermatophytes called tinea, which thrive on keratin found in skin. This article features massage modification for fungal skin infections including ringworm, athlete’s foot, nail fungus, and jock itch. Bonus material included is how to disinfect contaminated linens.
Fungi are a primitive life form, living in the air, water, soil, and some even live in the human body. They thrive in warm, humid areas such shoes, socks, communal locker rooms, and swimming pools to name a few. They can become uncomfortable, with symptoms ranging from itching to cracking, peeling skin.
Ringworm: Ringworm is a fungal infection of the skin. It is transmitted by contact with infected skin or infected domestic animals, such as cats and dogs. This condition occurs more frequently in warm and humid climates. Ringworm is also called tinea corporis. Ringworm is characterized by a red, raised, round, or oval scaling skin that spreads peripherally with central clearing, creating the ring appearance. Affected skin may itch, burn, or ooze clear fluid and usually appears darker or lighter in color. Multiple lesions may overlap.
Massage Therapy and Ringworm: Avoid the affected area during the massage because the pathogen that causes ringworm is contagious. Although fungal infections are not spread easily by contact with contaminated linens, it is best to treat all linens that come into contact with lesions as contaminated.
Athlete’s Foot: Athlete’s foot is a fungal infection of the foot, most often the sole and between the toes. It is most prevalent among teenagers and adult men, as well as people with weakened or impaired immune responses, such as individuals with diabetes. Athlete’s foot is caused by several species of fungi called dermatophytes. Athlete’s foot is characterized by itching, stinging, or burning sensations and skin discoloration with a raised red border. The infected foot often appears dry and has an unpleasant, musty odor.
Massage Therapy and Athlete’s Foot: Avoid direct contact with the infected areas because athlete’s foot is contagious. As an alternative, you can massage the client’s feet through a barrier such as disposable gloves or the sheet drape. Although fungal infections are not spread easily by contact with contaminated linens, it is best to treat all linens that come into contact with lesions as contaminated.
Nail Fungus: Nail fungus is an infection involving one or more nails. It is most often seen in toenails and less frequently in fingernails. Nail fungus is typically spread by the nails of the infected person and is more common in the elderly, people who have impaired circulation or weakened or impaired immune response such as individuals who have diabetes. In most cases, the nail turns yellow or white and then becomes elevated as infection becomes established beneath the nail plate. The infected nail then becomes thickened and brittle; it may crack or even crumble. A slight odor is often present.
Massage Therapy and Nail Fungus: Avoid direct contact with the infected areas because nail fungus is contagious. As an alternative, you can massage the client’s hands and feet through a barrier such as disposable gloves or the sheet drape. Although fungal infections are not spread easily by contact with contaminated linens, it is best to treat all linens that come into contact with lesions as contaminated.
Jock Itch: Jock itch is a fungal infection in the groin, sometimes spreading to nearby areas such as the inner thighs and buttocks. This condition can be exacerbated by physical activity, perspiration, and tight-fitting garments; it is more common in warm and humid climates. Jock itch is mildly contagious and can be spread by contact with infected skin or contact with contaminated items such as towels or clothing. Jock itch is characterized by an itchy, dry, scaly skin with a raised, red border . The skin in the affected area may appear abnormally dark or light and have an unpleasant, musty odor.
Massage Therapy and Jock Itch: Avoid the infected area because fungal infections are contagious. Be sure to ask the client how widespread the infection is because lesions may be found across the buttocks and medial thighs. Although this condition is not spread easily by contact with contaminated linens, it is best to sanitize them after the massage.
How to Disinfect Contaminated Massage Linens. The following procedure is recommended by the CDC to disinfect laundry, surfaces, and reusable objects when they become contaminated (1). These items become contaminated if they come into contact with body fluids such as blood, blood-tinged saliva, vomit, fluid from skin lesions, or respiratory fluids.
- While wearing disposable gloves, transport the linens to a washing machine while avoiding contact between the linens and other surfaces such as your uniform.
- Once the linens are in the drum, remove and discard the gloves and sanitize your hands.
- Add laundry detergent according to the manufactures directions and add unscented chlorine bleach. The new recommended amount of bleach in wash water is 50-150 ppm or parts per million. According to the Consumer Energy Center (2), older top-load washing machines use approximately 40 gallons of water, which means adding about one cup of bleach per wash. Front-load washing machines and newer top-load washing machines use approximately 24 gallons of water, which means adding a little over ½ cup or 4.8 oz of bleach per wash. Check your owner’s manual to find out its water capacity and calculate the correct amount of bleach per machine.
- Wash linens in hot water (water temperature recommendation by CDC is ≥165º F).
- Dry linens in a hot dryer (air temperature recommendation by CDC is ≥171º F).
- There is no need to disinfect the tubs of washers or tumblers of dryers if cycles are run until they are completed.
If you are unable to wash contaminated linens immediately, place them in a container away from other linens. Wash these linens as soon as possible and be sure to wear disposable gloves while handling them before they are washed. If you have to carry your linens back to your home or office to launder them, be sure you bag contaminated linens separately.
Salvo Susan “Mosby’s Pathology for Massage Therapists, 4e.
Articles and Journals Referenced:
- Centers for Disease Control and Prevention. Laundry: washing infected material. http://www.cdc.gov/HAI/prevent/laundry.html
- Consumer Energy Center: Clothes washers. http://www.consumerenergycenter.org/residential/appliances/washers.html
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.