PART 2 OF 5: Fungal skin infections, also called superficial fungal infections, manifest as a rash caused by dermatophytes called tinea. These are mold-like parasites which thrive on the protein keratin found in skin. This article features massage modification for fungal skin infections including ringworm, athlete’s foot, nail fungus, and jock itch. An infected person may have several fungal skin infections at the same time.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 (Tinea Corporis): Ringworm is a fungal infection of the skin. Ringworm can be transmitted by direct skin-to-skin contact with an infected person or contract with domestic animals or with fomites. Ringworm is more common in men than in women and usually affects nonhairy areas of the face, trunk, and limbs. This condition occurs more frequently in warm and humid climates. Ringworm gets its name because of its ringlike appearance; a worm is not involved. 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.
Athlete’s Foot (Tinea Pedis): 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 can be transmitted by contact with infected skin or contaminated objects such as flooring, towels, and shoes or socks. This condition is more common in warm and humid climates. A fungal nail infection often coexists. The infection can spread to the hands, especially if the person scratches the infected area. Athlete’s foot is characterized by itching, stinging, or burning sensations and skin discoloration with a raised red border. Itching often worsens once shoes and socks are removed. The skin may flake, crack, and bleed or ooze clear fluid. The infected foot often appears dry and has an unpleasant, musty odor. Athlete’s foot may be mistaken for eczema or dry skin.
Nail Fungus (Tinea Unguium): Nail fungus is an infection involving one or more nails. It is most often seen in toenails and less frequently in fingernails. Nail fungus can be transmitted by contact with infected skin or contaminated objects such as towels and clothing. These infections are more common in older adults, people who have impaired circulation or weakened or impaired immune response such as individuals who have diabetes. Nail fungal infections are not the same as athlete’s foot, even though they can occur simultaneously. 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.
Jock Itch (Tinea Cruris): 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 and Skin Fungal Infections: Skin fungal infections are local contraindications or contact precautions. Contact precautions are methods to reduce or prevent disease transmission which spread by direct or indirect contact. Contact precautions require the use of barriers such as gloves and disinfecting of contaminated surfaces. For ringworm and jock itch, use gloves or other barrier such as the sheet when massaging the hands as they may be contaminated by the client touching his or her own lesions (CDC, 2018). For jock itch, ask the client how widespread the infection is because lesions may be found across the buttocks and medial thighs; these areas are avoided.
For Athlete’s foot and nail infections, use gloves or other barrier such as the sheet when massaging the hands or feet IF they do not contain broken skin. Massage linens are treated as contaminated.
If the massage practitioner has a nail fungal infection, gloves are worn during the massage.
Disinfecting Contaminated Laundry.Use this procedure when contaminated laundry such as sheets, face rest covers, bolster covers, towels, blankets, clothing, and other items (CDC, 2020).
- While wearing gloves, transport linens to the washing room and place them in the washing machine tub. Avoiding contact between the linens and other surfaces, such as your uniform. Do not shake soiled laundry.
- If unable to wash contaminated linens immediately or if the washing machine tub is unavailable, place contaminated linens in a clothes basket or hamper labeled “Contaminated Linens Only.” Wash and dry these items as soon as possible. Contaminated items can be washed with non-contaminated items (CDC, 2020).
- Remove and discard gloves and wash your hands with soap and water.
- Add the amount of bleach listed in the washing machine owner’s manual. This amount ranges from ½ cup to 1¼ cup of bleach. Use the bleach dispenser if the machine has one and do not exceed the maximum capacity of the bleach dispenser.
- If available, select the “sanitize” cycle on the washing machine. Otherwise, select the warmest water setting and the longest wash setting. The CDC (2015) recommends wash water should be at least 160° F (71° C) and washed for a minimum of 25 minutes.
- If available, select the “sanitize” cycle on the dryer. Otherwise, select the highest temperature setting and dry items completely. The CDC (2015) recommends air should be approximately 170° F (76° C).
- Clean and disinfect clothes hampers according to guidance above for surfaces.
Consider having several labeled baskets or hampers for different types of linens such as clean, soiled, and contaminated. An alternative is to use different colors to denote which basket contains clean, soiled, or contaminated linens.
Salvo Susan “Mosby’s Pathology for Massage Therapists, 4e.
Centers for Disease Control and Prevention. (2020a). Cleaning and disinfecting your facility. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html
Centers for Disease Control and Prevention. (2015). Parameters of the laundry process. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/laundry.htm
Centers for Disease Control and Prevention. (2018). Type and duration of precautions recommended for selected infections and conditions: appendix A updates. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/isolation/appendix/type-duration-precautions.html?fbclid=IwAR0wKVWUgn6H5Gf34X2wCMI38mknFejJzjCPXicGZaKLIwrk8w6hHvfdaHI#I
Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at firstname.lastname@example.org.