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Tinea Versicolor:
Tinea Versicolor is a common skin condition that is caused by an overgrowth of fungus that normally resides on our skin. This overgrowth results in uneven skin color and sometimes scale. It is usually completely without symptoms, but occasionally can be itchy. It most commonly appears as white-to-pink-to-tan-to-dark-brown spots on the skin of the neck, upper back, shoulders, and chest. It is more common in warm/moist seasons and climates. Transplant recipients are more prone to getting Tinea Versicolor due to their immunosuppression. It is generally not an infection that will make you ill. It is diagnosed when examination of a skin scrapping under the microscope shows fungus.

It is treated with either topical or oral medications. In transplant recipients, treatment with oral medication is avoided if possible, secondary to the potential drug interactions with their immunosuppressive medications and side effects of the oral antifungals. Topical selenium sulfide or topical antifungal creams are commonly used and found very effective. Tinea versicolor commonly reoccurs. To prevent recurrences, treatment with topical selenium sulfide once to twice a month is often effective.

Onychomycosis:
This is a fungal infection of the nails. This more commonly affects the toenails than the fingernails. Infected nails appear thick, discolored (often yellow or brown), and with crusty debris under the nail edge or on top of the nail. These nails can be difficult to cut and can cause irritation to the skin around them. This is a very common infection.

Infection of the nails with fungus can be difficult to treat. Treatment often requires an oral antifungal medication. In transplant recipients these medications have to be used with great caution due to their risk of drug interaction with the immunosuppressive medications the transplant recipient is taking, and due to the side effects of the antifungal medication (especially on the liver of liver transplant recipients). Treatment with topical antifungal creams is not effective for treatment of the nail. There are medicated nail polishes available with few side effects.

Recommended steps to control fungus are as follows:

• Wear dry wool or cotton socks (avoid synthetic socks made of nylon)
• Wear shoes that allow the foot to breath, such as leather
• Wear dry shoes
• Apply antifungal powder to shoes

Thick nails can be difficult to care for. It is recommended that the toenails be cut straight across, so as to avoid ingrown nails and pain. Routine toenail trimming by a podiatrist may be very beneficial.

Tinea pedis:
This is a fungal infection of the feet, often referred to as athelete's foot. Affected feet are often itchy. The sole of the foot will appear red with scale and occasional vesicles (small bubbles just under the skin surface). The space between the toes is commonly involved with accumulation of white appearing scale and occasional small sores. It is diagnosed when examination of a skin scrapping under the microscope shows fungus.

This can generally be treated with over the counter antifungal creams used regularly. Some cases will require evaluation and treatment by your physician. Care should be taken to control reinfection. See recommended steps to control fungus, listed above in the onychomycosis section.

Tinea cruris:
This is a fungal infection of the groin. It is characterized by red, scaly skin that can become "raw". It is often very itchy and can burn, if very irritated. It is diagnosed when examination of a skin scrapping under the microscope shows fungus.

It is treated with topical antifungal creams. It is important to keep this area very dry by toweling dry after a shower and then using a cool blow dryer or fan to the area. Loose fitting clothing helps to avoid excess irritation.

International Transplant Skin Cancer Collaborative
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