Why India’s booming skincare discourse shouldn’t ignore this ‘itchy’ issue
While 57 million Indians battle fungal infections each year, the subject, often dismissed as poor hygiene, is dangerously overlooked in the country’s booming skincare culture
In India, where beauty and wellness conversations lean toward glowing complexions and anti-ageing serums, one of the most common skin problems is rarely acknowledged: fungal infections.
The country’s hot, humid climate, crowded cities, and close living conditions make it particularly vulnerable to fungal overgrowth. Yet stigma keeps the subject in the shadows. “Many still believe fungal infections are tied to poor hygiene, so people feel embarrassed to discuss them," said Dr Anindita Sarkar, chief medical officer at Clinikally in Gurugram. “And wellness conversations tend to celebrate aspiration—radiance, youth, prevention—not the unglamorous realities of skin health." A 2022 study in Open Forum Infectious Diseases estimated that 57 million Indians—about 4 percent of the population—suffer from serious fungal diseases each year.
The neglect has consequences. “Fungal issues often begin with rashes, nail infections, or itching that people ignore or self-treat," said Dr DK Sharma, senior dermatologist at Kailash Hospital, Noida. “Left unchecked, they can progress into serious infections, especially in people with diabetes or weakened immunity." The World Health Organization (WHO) issued its first report on fungal infections in April this year, warning that drug resistance is rising even as treatment options and diagnostic tools remain dangerously scarce. With mortality rates reaching up to 88 percent for some pathogens, the WHO called for urgent investment in new medicines, faster testing, and global surveillance.
Misdiagnosis compounds the problem. “Because symptoms mimic other conditions and diagnostic facilities are limited, many clinicians treat empirically," says Dr Prachi B Bodkhe, dermatologist at Envi Aesthetics in Mumbai. “I see superficial fungal infections daily, but invasive cases require intensive care. The lack of awareness cuts across both ends of the spectrum."
CONFUSED WITH ACNE, ALLERGIES AND ECZEMA
In her practice, Sarkar routinely sees cases of ringworm, fungal dandruff, and yeast infections in skin folds—conditions that often masquerade as other dermatological problems. “Fungal acne, for example, looks strikingly similar to regular pimples. Ringworm rashes are easily mistaken for allergies. This overlap leads to mistreatment, with patients using the wrong creams or remedies, which only delays recovery."
Bodkhe adds that this problem isn’t limited to skin. Serious fungal diseases in the lungs and sinuses often mimic tuberculosis or even cancer. “Fungal diseases can appear very nonspecific with symptoms like persistent fever, sinus pain, chronic cough, or a non-healing wound. But the complete picture and diagnosis really rests with physicians, who can link the symptoms with the right laboratory tests."
Tinea corporis, or ringworm, is often mistaken for eczema, while fungal folliculitis can resemble acne—confusions that delay treatment and allow infections to spread. “Steroid creams may mask redness but worsen fungal growth, making cases more stubborn and resistant," says Dr Sandeep Arora, a dermatologist at Apollo Spectra Hospital in Delhi. He notes that urban clinics now see 15 to 20 fungal infection patients a day, and smaller towns 8 to 10, a sharp rise over the past five to seven years, especially in chronic and recurrent cases.
While fungal infections spare no one, some groups face a far greater risk," says Arora. They include:
- Children and athletes who sweat, share gear, and play in close contact.
2. People with diabetes or weakened immunity, where infections turn chronic.
3. Elderly and bedridden patients, whose defenses are low.
4. Those in humid climates or with poor hygiene.
5. Patients on long-term steroids, chemotherapy, or organ transplants, who face life-threatening invasive disease.
LIFESTYLE, STEROIDS, SELF-MEDICATION ARE MAKING MATTERS WORSE
Beyond India’s climate, lifestyle choices often add fuel to the fungal fire. Tight synthetic clothing in hot weather, improper drying after bathing, and diets high in sugar create an ideal breeding ground. But perhaps the biggest culprit is over-the-counter steroid creams. “Steroids suppress symptoms temporarily, giving a false sense of improvement, but they drive the fungus deeper into the skin," Sarkar explains. “This not only prolongs infection but makes it harder to treat." The misuse of steroids echoes a larger pattern. According to Bodkhe, “Judicious use of steroids and better diabetes control must be immediate public health priorities. Unchecked steroid use not only worsens fungal infections but also weakens immunity, making patients more vulnerable to invasive disease."
Sharma warns, “In my clinic, I encounter at least 10–15 patients monthly whose fungal infections do not respond to standard azole therapy, indicating a growing resistance that mirrors the national crisis of antifungal overuse."
India already has nearly 90 million adults living with diabetes—a figure expected to soar to 156 million by 2050—fueling a surge in fungal skin infections. “About one in three cases I see are tied to diabetes or poor blood sugar control," says Sharma, noting the weakened immunity also leaves patients vulnerable to dangerous infections like mucormycosis, aka “black fungus."
The risks extend to rural life as well. Farmers walking barefoot face soil-based fungal infections that creep in through small cuts. “Except for mucormycosis, none of these conditions are tracked," notes Dr Bansidhar Tarai, director of microbiology and molecular diagnostics at Max Lab, Delhi. Culturally, many people dismiss fungal infections as minor irritations. “By the time they come to me," says Sarkar, “the infection has spread wider, become chronic, or resistant due to incorrect treatment. Early care makes these infections easy to cure. Delays only complicate matters."
According to Arora, the cost of treating fungal infections poses a steep challenge in India, where most people pay out of pocket for healthcare. Prolonged courses of expensive creams and medicines lead many to delay care, discontinue mid-treatment, or turn to cheaper substitutes, quacks, or home remedies—often worsening the condition. “Affordability directly impacts access, compliance, and outcomes," he notes, adding that without affordable solutions, fungal infections remain a recurring burden on both patients and the healthcare system.
PREVENTION IS THE FIRST LINE OF DEFENSE
What would it take to bring fungal infections into mainstream wellness discourse? Bodkhe believes that prevention and awareness are the best first line of defense. “Public awareness and treatment compliance are crucial. The more openly we talk about fungal infections, the easier it becomes to normalize treatment – which could take months – and prevention as part of everyday wellness." While on solutions, Sarkar shares a list that is strikingly simple to follow:
- Dry skin thoroughly after bathing.
2. Choose loose, cotton clothing over tight synthetics.
3. Avoid sharing towels or personal items.
4. Keep the scalp clean to prevent dandruff.
5. Above all, avoid self-prescribing steroid creams.
“Seen through the lens of wellness, these are not medical chores—they are daily habits that preserve comfort, confidence, and long-term skin health," she says.
Tanisha Saxena is a Delhi-based independent journalist. She writes stories that are on the intersection of art, culture and lifestyle.
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