Skin Diseases During Nepal’s Monsoon Season: Causes, Treatment and Prevention
Nepal’s monsoon arrives in June and typically continues through September, delivering 80% of the country’s annual rainfall in four months. For the skin, this prolonged period of high humidity, reduced UV exposure, persistent dampness of clothing and footwear, and increased contact with contaminated water and soil creates ideal conditions for fungal, bacterial, and parasitic skin infections. Dermatology referrals at A&B International Hospital increase significantly during the monsoon months.
Why Does the Monsoon Season Increase the Risk of Skin Infections?
Fungi thrive in warm, humid environments. Human skin provides an ideal substrate when it remains persistently moist — from sweat, rain, or wet clothing. Fungi responsible for superficial skin infections (dermatophytes) grow on the outer dead layers of skin, and their reproductive capacity is dramatically enhanced when skin hydration and temperature are elevated.
Bacteria also proliferate in these conditions. Skin folds — the groin, armpits, between the toes, under the breasts — trap moisture and heat, and minor abrasions from wet footwear or clothing rubbing against skin provide entry points for bacterial infection.
The monsoon also brings floods and soil contact, increasing exposure to scabies mites in overcrowded shelters, and insect bites that can become infected.
For trekkers and outdoor workers, leech bites — common in Nepal’s wet forests from June through September — create small wounds that can secondarily infect.
What Is Ringworm and How Is It Treated?
Ringworm (tinea) is not caused by a worm. It is a superficial fungal infection caused by dermatophytes — fungi that infect keratinised tissue (skin, hair, nails). The name comes from the characteristic ring-shaped lesion: a spreading, scaly, itchy circle with a clearer centre.
Different body sites produce specific clinical entities: tinea pedis (athlete’s foot — between the toes), tinea cruris (jock itch — the groin), tinea corporis (body ringworm), tinea capitis (scalp ringworm, most common in children), and tinea unguium or onychomycosis (nail infection).
Treatment for localised tinea corporis and pedis is topical antifungal cream (clotrimazole or terbinafine) applied twice daily for 2–4 weeks. Treatment must continue for at least one week after visible clearing, because the fungus persists on the skin even when the lesion appears resolved. Tinea capitis requires systemic antifungal treatment (griseofulvin or terbinafine orally) because topical creams do not penetrate the hair follicle adequately.
A common error is using combined antifungal-corticosteroid preparations (widely available over the counter in Nepal) for tinea. While the steroid reduces itching rapidly, it suppresses the inflammatory response that helps control the infection, leading to tinea incognito — a modified, spreading form that is more difficult to treat. Plain antifungal agents are the correct treatment.
What Is Pityriasis Versicolor?
Pityriasis versicolor is a superficial fungal infection caused by Malassezia furfur, a yeast that is part of normal skin flora. Under conditions of heat and humidity, it overgrows and produces pigment changes — typically hypopigmented (lighter) patches on the trunk, upper arms, and neck in darker-skinned individuals, or hyperpigmented patches in lighter-skinned patients. The patches are fine-scaled and most visible on tanned skin.
It is not contagious. Treatment is with topical antifungal (ketoconazole shampoo applied as a body wash, or selenium sulfide shampoo). Oral fluconazole or itraconazole are used for extensive disease. Pigmentation normalises after months, even after the fungus is cleared.
What Is Bacterial Folliculitis and How Is It Managed?
Folliculitis is infection of the hair follicles, producing small red, pus-filled papules (spots) centred on follicles. It is most commonly caused by Staphylococcus aureus. In the monsoon, sweat and occlusion by wet clothing predispose to folliculitis on the trunk, buttocks, and thighs.
Localised folliculitis responds to topical antibiotics (fusidic acid or mupirocin). Widespread or recurrent folliculitis requires oral antibiotics — flucloxacillin or cefalexin for staphylococcal infection, doxycycline for gram-negative folliculitis (which can follow prolonged antibiotic use or recurrent water exposure). Hot tub folliculitis — caused by Pseudomonas in unchlorinated water — resolves spontaneously without antibiotics in most immunocompetent patients.
How Is Scabies Recognised and Treated?
Scabies is caused by the mite Sarcoptes scabiei, which burrows into the superficial skin layer to lay eggs. It is intensely itchy — characteristically worse at night and after a hot bath. The itching is an immune response to the mite and its eggs and may persist for weeks after successful treatment.
Classic sites are the finger web spaces, wrists, axillae, around the nipples, genitalia, and buttocks. Burrows — tiny serpiginous tracks — are pathognomonic but can be subtle. In infants, the palms and soles are also affected.
Treatment is with permethrin 5% cream applied to the entire body from the neck down (including under the nails and in skin folds), left for 8–14 hours, then washed off. The treatment is repeated after one week. All household contacts must be treated simultaneously, regardless of symptoms, because the mite can be present for up to 6 weeks before symptoms develop.
Clothing and bedding should be washed in hot water on the day of treatment. The mite does not survive off the human body for more than 72 hours, so elaborate environmental decontamination is not necessary.
When Should You See a Dermatologist Rather Than Treat at Home?
Self-treatment with whatever is available at the pharmacy is extremely common in Nepal and is appropriate for mild, localised fungal infections with typical presentations. A dermatologist should be consulted in the following situations: when the rash does not respond after 2–4 weeks of appropriate topical treatment; when the diagnosis is uncertain (tinea, eczema, and psoriasis can look very similar); when the lesion is on the scalp or extensive on the body (requiring systemic treatment); when there is any suspicion of a non-healing skin lesion that could be cancerous; and when skin infection is accompanied by fever, spreading redness, or lymph node swelling (suggesting cellulitis or spreading bacterial infection requiring systemic antibiotics).
How Can Monsoon Skin Disease Be Prevented?
Keep skin dry. Change wet clothing promptly after rain or exercise. Allow footwear to dry between uses — alternating two pairs of shoes is more effective than wearing the same damp pair daily.
Apply antifungal powder (clotrimazole or miconazole powder) to the groin and feet during the monsoon if you are prone to tinea cruris or pedis. Wear loose-fitting, breathable cotton clothing. Avoid sharing towels, clothing, and footwear — tinea spreads directly.
For trekkers in monsoon conditions: wear leech socks or tucked-in trousers to reduce leech bites. Clean any small wounds promptly. Change into dry clothing at camp. Do not use combined antifungal-steroid products on any rash without dermatologist guidance.
A&B International Hospital
Pokhara-02, Bindhyaabasini Way to Sarangkot
Phone: +977 061-412512
Website: abinthospital.com
For persistent or recurrent skin infections, or any rash that is not improving with home treatment, A&B International Hospital’s dermatology department in Pokhara offers accurate diagnosis and evidence-based treatment. ECHS polycards accepted.
