Fungal Skin Infections in Kota Kinabalu

Sep 14

9 min read

Updated: Sep 29

中文摘要在文末

Let me start with something that might lower your confidence in doctors slightly, but which I think you're entitled to know.

Roughly one in five skin presentations looks like the textbook.

That's it. About twenty percent of the time, someone walks in with the classical picture — every feature present, arranged the way it appears in the pictures we trained on, and the diagnosis is obvious within seconds.

The other four out of five times, it's strange. Features missing. Features that belong to something else. A shape that doesn't fit. And that's not a failing of the patient or the doctor — it's simply what real skin does.

So when a fungal infection is difficult to diagnose, that's the normal situation rather than an unusual one. I'd rather tell you that upfront than have you assume any doctor who hesitates doesn't know what they're doing.

The reason it's usually strange by the time I see you

Here's the thing that makes fungal infections particularly awkward, and it's worth understanding because it affects how you should behave.

By the time most people come to me, they've already tried several things. Something from the pharmacy. Something a relative recommended. Something they read about. Often a cream from another doctor. They come to me because none of it worked.

But in the meantime, the lesion has changed. I describe it to patients as mutating — like the X-Men. What's on your skin today is no longer what was there originally. It's the original problem plus the effects of everything that's been applied to it.

Which is why the single most useful question I ask is often:

"What did it look like the very first time you noticed it?"

Not what it looks like now — I can see that. What was the first lesion? Where was it? What shape?

Did it itch, or scale, or blister? What was happening around the time it appeared?

People are frequently surprised that I care so much about something from six months ago. But the first lesion is the version before anything interfered with it, and it's often the most honest piece of evidence available.

How I actually work it out

Roughly in this order.

The history. Onset, duration, what the first lesion looked like, whether it appeared after any particular event, what's been applied to it and what happened with each thing.

Examination, looking for the features that are specific to one condition and not found in others — the ones we call pathognomonic. If there's something present that only fungal infections do, that settles a lot.

Instruments. Dermatoscopy, different lights, and KOH microscopy, which is the direct one — taking a scraping and looking for fungal elements under the microscope. When there's active scaling to sample, this is genuinely useful.

Treatment as diagnosis. When the picture still isn't clear, we treat for the most likely diagnosis and watch what the skin does. Response is information. This isn't guessing — it's a deliberate step, and I'll tell you when we're doing it.

Biopsy, if all of that fails.

The important part: I'll tell you which stage we're at. If I'm confident, I'll say so. If I'm treating on a best assessment and watching, I'll say that too, because you deserve to know whether you're being given an answer or a hypothesis.

What I actually see in KK, roughly in order

Fungal infection in the skin folds — candidal intertrigo, most commonly the groin. This is the most frequent thing I see, and it's the climate. Warm, humid, folded skin that stays damp is close to ideal conditions.

Nail fungus (onychomycosis) — surprisingly common here, and under-treated because people misunderstand it. Most assume it's a hygiene problem or just something that happens with age. It's neither. Interestingly, the people who seek treatment earliest tend to be younger women who want their nails to look good — appearance brings people in sooner than discomfort does.

The tineas — corporis (body, the classic ringworm), pedis (athlete's foot), manus (hands), and capitis (scalp), which is actually not that common here.

Tinea versicolor — those patches on the chest, back and shoulders that go lighter or darker than the surrounding skin.

Sabah's contribution

The climate matters, but not quite in the way people assume.

Sweat and humidity are genuine drivers — warm, damp, occluded skin is what these organisms want, and we provide it year-round. Skin folds, feet in closed shoes, anywhere clothing traps moisture.

But here's a subtlety I've noticed. I see more fungal patients during hot, humid periods — and it's often not because they caught it then. It's because heat and sweat make an existing infection itch more, and the itch is what finally brings them in. The infection may have been there for months, quietly.

So if something has been mildly annoying for a while and has suddenly become unbearable in the heat, that's not necessarily a new problem. It might be an old one that just got loud.

Occupational exposure matters too. Motorcycle riders. Anyone in boots all day. Food-service workers. Anyone in protective equipment for long shifts. If your work keeps part of you warm and damp for eight hours, that's a relevant piece of history and you should mention it.

About treatment

Topical or oral depends on how widespread it is and on you.

Generally, if it's localised, topical treatment is appropriate. If it's widespread, I lean towards oral where suitable — taking your overall situation into account. In a young patient with no reason to worry about liver function, I'll reach for oral more readily than in someone elderly or with other medical problems.

If oral treatment needs to run for a longer course, we check liver function, because these medications can affect the liver. The chance isn't high, but it's real, and my position is simple: your liver is more important than most fungal skin infections. If liver enzymes rise significantly, we stop and reassess. That's not a difficult decision.

Now the part I want to emphasise most.

Fungal infections are resilient

That's the word I use with patients, and I use it deliberately.

These organisms are stubborn. We can clear something over two months and see it return. Not because the treatment was wrong — because a few survived somewhere, or because you were re-exposed to whatever the source was.

So my standard approach: once the skin looks completely clear, keep applying the topical treatment for another one to two weeks.

I know that sounds unnecessary. The rash is gone. The skin looks normal. Why continue?

Because "looks clear" and "is clear" are different states. Fungal elements persist in skin that appears entirely normal, and stopping the moment it looks better is far and away the most common reason these things recur. That extra week or two is the cheapest insurance available in dermatology.

I'll message you to check you've actually done it, too. Not to nag — because I know how easily "the rash is gone" translates into a tube going back in the drawer.

And they are curable

I want to balance all that with the reassuring part, because people sometimes read the recurrence discussion and get discouraged.

Simple fungal infections are completely curable. This isn't eczema, where the honest framing is "managed, not cured." This isn't melasma, where we reduce and maintain indefinitely. Fungal infections can be genuinely, permanently cleared — you just have to finish the job properly and deal with whatever exposed you in the first place.

You'll usually see improvement within about a week. I'll typically review you at two weeks. So this isn't a long, uncertain road. It's a defined problem with a defined end.

Don't lose sleep over a simple fungal infection.

Reducing your chances of getting it again

A few things that genuinely matter.

Keep the vulnerable areas dry. Dry skin folds properly after showering — properly, not a quick pass. Change out of sweaty clothes rather than sitting in them all evening. This is the single most effective thing in this climate.

Shoes are a reservoir. If you've had a foot infection, the shoes are probably still carrying it. If they're not expensive or precious, my honest advice is to throw them out. If they are worth keeping, treat them — and get proper advice from a shoe shop about how to do that without ruining them.

Wear sandals in shared showers. Gym showers, changing rooms, communal bathrooms — high-risk areas for this and for other things too. Never barefoot.

Change linens and towels weekly, and don't share towels. This is how it moves through a household.

Pets. Fungal infections from animals are quite common here, particularly from cats, and especially strays. Two things worth knowing. First, the distribution gives it away: shins and both hands is a classic pattern, because animals are low to the ground and people pick them up. Second, animal-associated fungal infections often come with a bacterial infection alongside them, so I have a lower threshold for adding an antibiotic in those cases.

Keep pets off the bed and pillows. Their fur stays in bedding for a long time, and it isn't just a skin issue — you're breathing it too.

When to come in

Come if it's spreading, if it isn't responding to something you've tried, if it's in the groin or on the nails or scalp, or — importantly — if a cream made it worse rather than better. That last one is a meaningful signal and I'll explain why in a separate article.

Bring everything you've applied to it. All of it, including the pharmacy tube and the thing your relative gave you. Not so I can judge you — because knowing what's been on the skin often explains why it looks the way it does now.

Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred.

Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.

I'm a GP with a strong interest in skin, not a dermatologist. Where a case needs specialist

assessment, I'll say so and refer.

简要说明

我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。

先说一个可能让你对医生信心稍减、但你有权知道的事实：

大约每五个皮肤病例，只有一个看起来像教科书。 其余四个都是「怪怪的」——某些特征缺席、掺杂了别的病的特征、形状不对。这不是病人或医生的问题，这就是真实皮肤的样子。

为什么你来的时候通常已经「变形」了：多数人来找我之前已经试过好几种东西——药房买的、亲戚推荐的、网上看的、别的医生开的。但在这段时间里，皮损已经改变了，像 X战警里那样「突变」了。你今天皮肤上的东西，已经是原本的问题加上所有擦过的东西的结果。

所以我最有用的问题往往是：「你第一次发现它的时候，它长什么样子？」 第一个皮损是还没被任何东西干扰过的版本，通常是最诚实的证据。

我的判断顺序：病史（发病时间、第一个皮损的样子、发病前有什么事、擦过什么、各有什么反应）→ 检查（找只有这个病才有的特征）→ 仪器（皮肤镜、不同光源、KOH 显微镜直接取鳞屑看真菌）→ 以治疗作为诊断（治疗最可能的诊断然后观察反应，这是刻意的步骤，我会告诉你我们正在这样做）→ 必要时切片。

我会告诉你现在在哪个阶段——我有把握时会说，我是在「先治疗再观察」时也会说。你有权知道你得到的是答案还是假设。

亚庇常见的（大致排序）：皮肤皱褶处的念珠菌感染（尤其腹股沟，最常见，气候使然）；灰指甲（比想像中普遍，很多人误以为是卫生问题或年纪问题，两者都不是；最早求医的常是年轻女性——外观比不适更能促使人及早就医）；各类癣（体癣即金钱癣、足癣即香港脚、手癣、头癣——头癣其实不多）；汗斑（花斑癣）。

沙巴的因素：闷热潮湿确实是诱因。但有个细节——我在闷热时节看到更多真菌病人，往往不是因为那时才感染，而是因为热和汗让原本就存在的感染更痒，痒了才来。所以「本来只是有点烦，最近热到受不了」不一定是新问题。职业暴露也重要：骑摩托车、整天穿靴子、餐饮业、长时间穿防护装备——请主动告诉我。

治疗：范围局限用外用；范围广则视情况倾向口服（年轻、肝功能无虞者我会较放心用）。若口服疗程较长，会检查肝功能——肝比多数皮肤真菌感染重要，指数明显上升就停药重新评估。

真菌很「顽强」——这是我刻意用的词。治好两个月后可能复发。所以我的做法是：皮肤看起来完全好了之后，外用药再继续用一到两个星期。 「看起来好了」和「真的好了」是两回事，真菌可以留在看似完全正常的皮肤里。一好转就停药是复发最常见的原因。 我会传讯息确认你有没有做到。

但它是可以根治的。 这不是湿疹（控制而非根治），也不是黄褐斑（长期维持）。单纯的真菌感染是可以彻底清除的——只要把疗程做完、并处理感染来源。通常一星期内会改善，两星期复诊。不必为单纯的真菌感染太担心。

预防：保持容易受影响的部位干燥（洗澡后确实擦干皱褶、流汗后换衣服——在这个气候里这是最有效的一件事）；鞋子是病菌储藏库（不贵重的建议丢掉，要留的请找鞋店专业处理）；共用浴室穿拖鞋；床单毛巾每周更换、不共用毛巾；宠物——猫（尤其流浪猫）传染的真菌相当常见，典型分布是小腿加双手（因为动物矮、人会抱起来），而且动物来源的真菌常合并细菌感染，我会较早考虑加抗生素。别让宠物上床和枕头，毛会留在寝具很久，不只是皮肤问题，你也会吸进去。