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Living with a skin condition can be frustrating, especially when itchy and scaly patches start to appear. Although fungal infections and psoriasis can cause similar symptoms, identifying the cause can pave the way for treatment and much-needed relief. Seeking professional help early on may prevent the condition from getting worse or causing complications.
An autoimmune disease is a condition in which the immune system mistakenly attacks and damages the body’s healthy cells and tissues. Psoriasis is an autoimmune disease that causes raised, scaly plaques on different areas of the body. It often affects the knees, elbows, and scalp. The plaques may flake, itch, burn, or sting. If you’re nodding your head while reading this because the symptoms of psoriasis sound familiar, is it safe to assume you have this chronic skin condition? Not necessarily. Some fungal infections can cause symptoms and rashes that look like psoriasis.
“After being misdiagnosed with athlete’s foot several times, I finally decided to go to a dermatologist,” said one MyPsoriasisTeam member. “She diagnosed me with the same thing at first. So, when I had another flare-up, I took pictures of the stages of the plaques, and she said it was classic psoriasis. She gave me a regimen to do and referred me to a rheumatologist for my arthritis.”
In this article, we provide an overview of four fungal infections commonly confused with psoriasis: ringworm, fungal jock itch, athlete’s foot, and Candida.
According to the American Academy of Dermatology, psoriasis affects approximately 7.5 million people in the United States. It is a chronic condition — it requires long-term medical care and there’s no cure — but psoriasis treatments can help manage your symptoms and clear your skin. About 30 percent of people with psoriasis also develop psoriatic arthritis, which can potentially cause severe joint damage.
There are several types of psoriasis, including:
Plaque psoriasis is the most common type, and erythrodermic is the least common. Psoriasis is not contagious. Bacteria, viruses, or other infectious agents do not cause psoriasis, so it cannot be spread from person to person through contact.
Although psoriasis is an autoimmune condition likely caused by genetic and environmental factors that disrupt the immune system, fungal infections are the result of a fungus, like yeast or mold. Fungal infections can develop on your skin and nails or in your mouth, throat, lungs, and other parts of your body. Some fungal infections are contagious by skin contact.
Despite its name, ringworm has nothing to do with worms. This fungal infection gets its name from its appearance — it often causes a round (circular), ring-like scaly rash surrounded by clearer skin. Other symptoms of ringworm include:
Unlike psoriasis, ringworm is contagious. The fungi that cause ringworm, or dermatophytosis, are called dermatophytes. They can live on skin, clothes, bedding, bath linens, and other household items and surfaces, and they can spread from direct contact with other humans, animals, objects, and soil. Ringworm on the body is called tinea corporis, and ringworm on the scalp is tinea capitis. Ringworm can also affect the face, hands, feet, groin, and inner thighs.
A circular rash may strongly indicate that you have ringworm rather than psoriasis, but you’ll need to get an accurate diagnosis. Although topical steroid creams are a common psoriasis treatment, they can make ringworm worse because they suppress the immune system that fights infections. If you have ringworm, your health care provider may recommend an over-the-counter antifungal medication or prescribe a strong topical treatment. Oral antifungal medication may also be prescribed. Unlike psoriasis, ringworm is curable but you can get infected again.
“When I was first diagnosed, they thought it was ringworm, but it was plaque psoriasis,” said one MyPsoriasisTeam member. Another member said, “I went to the doctor, and the skin problem I have now is not psoriasis. It is ringworm again. I seem to get this a lot.”
Fungal jock itch, or tinea cruris, is a type of ringworm. It is also contagious, is caused by dermatophytes, and spreads from person to person and from infected towels, clothing, and surfaces.
Jock itch may cause a ring-shaped skin rash usually with clearly defined borders, but other symptoms include:
According to Cleveland Clinic, men are three times more likely than women to develop jock itch. Risk factors include wearing tight underwear or pants that trap heat and moisture in the groin area. Jock itch rarely affects the genitals but is commonly found on the inner thighs, groin, and buttocks.
Jock itch and inverse psoriasis are commonly mistaken for each other because both affect the groin area and cause similar symptoms. Inverse psoriasis can also affect the armpits, skin under the breasts, belly button, and anywhere there are skin folds. Like jock itch, it can cause itching and cracked skin.
One difference between the two skin conditions is that jock itch sometimes causes the telltale round ring of ringworm. Jock itch is also more likely to cause scaly or flaky skin, while inverse psoriasis tends to cause shiny or smooth skin or colored lesions that vary by skin tone. If you have symptoms of skin disease, make an appointment with your health care provider. Jock itch is often treated by applying an antifungal cream or lotion to the affected area, whereas inverse psoriasis treatment options include corticosteroid creams, topical immunomodulators, phototherapy (light therapy), and biologics (a type of medication that is made from living organisms). A biopsy or skin scraping may be needed to confirm the diagnosis.
“I am living with psoriasis on my hands, scalp, elbows, and forearms, and inverse psoriasis on my armpits and groin,” said one MyPsoriasisTeam member. Another member said, “I have inverse psoriasis on my groin. If I bathe, put on powder, use itch cream, and change underwear halfway through the night, the bleeding in the groin skin folds is manageable.”
Athlete’s foot, or tinea pedis, is a type of ringworm that develops on the feet. Common symptoms include:
Like jock itch, athlete’s foot occurs when dermatophytes have the opportunity to grow in warm, damp places, such as sweaty socks and shoes. It can spread through contaminated floors, towels, clothing, and skin-to-skin contact. Unlike psoriasis, athlete’s foot is contagious. It is also possible to transfer athlete’s foot from one part of your body to another.
Athlete’s foot can be mistaken for palmoplantar psoriasis, a type of plaque psoriasis that affects the feet or hands and may cause itching, scaling, and plaques. Although palmoplantar psoriasis typically affects the soles of the feet, athlete’s foot tends to start between the toes. If you notice issues with your toenails, like pitting, discoloration, or thickening, you might have psoriatic nail disease. Fungus can also infect the nails, leading to thickening and discoloration.
Treating palmoplantar psoriasis can be difficult. Biologics are usually the first option. Psoriatic nail disease (nail psoriasis) may be treated with corticosteroids, phototherapy, and other common psoriasis treatments. For athlete’s foot, your doctor may recommend a topical antifungal, an oral antifungal, or both. Getting an accurate diagnosis is essential.
“I had a dermoscopy last week that proved that I have palmoplantar psoriasis,” said one MyPsoriasisTeam member. “It was misdiagnosed 10 years ago as tinea pedis or athlete’s foot.”
Candida albicans, or Candida, is a fungus that naturally occurs in the mouth, skin, and intestines. It is a type of yeast, and when it grows out of control, it can cause yeast infections like diaper rash and thrush. Symptoms of a Candida skin infection include blisters, itching, and rash.
Some studies suggest that, in addition to causing symptoms similar to psoriasis, Candida infections are more likely to develop in people with psoriasis. Other studies have shown that a specific interleukin-17 inhibitor, a type of biologic used to treat psoriasis, may increase the risk of candidiasis. Despite the possible connection between the two conditions, developing one doesn’t guarantee you’ll develop the other.
Your health care provider will likely treat candidiasis with a topical anti-yeast cream or an oral anti-yeast medication. Psoriasis treatments often include topical creams and ointments, phototherapy, and oral medications.
“After having several doctors tell me I had a yeast infection, I found one who agreed that it was inverse psoriasis,” said one MyPsoriasisTeam member. “So far, all I need is a topical cream.”
Although psoriasis and fungal infections can be mistaken for each other, they can also occur simultaneously. In a study of 289 people with psoriasis, nearly 16 percent also had a fungal infection. Getting an accurate diagnosis is essential so you know if you are dealing with one or both. A diagnosis also matters because:
Although psoriasis or a fungal infection may cause similar symptoms, other health conditions or autoimmune diseases like atopic dermatitis, a common form of eczema, can also cause skin issues. Make sure to consult with a dermatologist to get an accurate diagnosis and appropriate treatment for optimal skin health.
MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 116,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis and psoriatic arthritis.
Were you misdiagnosed with a fungal infection? Have you had psoriasis and a fungal infection at the same time? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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I Have Not Yet Been Diagnosed With Psoriasis Yet.
Kevin Berman, M.D., Ph.D.
is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network.
Learn more about him here.
Suzanne Mooney
writes about people, pets, health and wellness, and travel.
Learn more about her here.
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