Condition Lookup
Category:
Fungal Infections
Number of Conditions: 19
Fungal Sinusitis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
nasal congestion; facial pain or pressure; nasal discharge (often thick and discolored); loss of smell; headache; fever (in severe cases)
Root Cause:
Fungal growth in the sinuses due to compromised immune function or environmental exposure.
How it's Diagnosed: videos
Nasal endoscopy, imaging studies (CT or MRI), and fungal culture or biopsy.
Treatment:
Surgical debridement of affected tissue, antifungal medications, and management of underlying conditions.
Medications:
Antifungal medications such as amphotericin B (polyene antifungal) or itraconazole (triazole antifungal).
Prevalence:
How common the health condition is within a specific population.
Rare; higher prevalence in immunocompromised individuals or those with uncontrolled diabetes.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Immunosuppression, diabetes, use of corticosteroids, chronic sinusitis, environmental exposure to fungal spores.
Prognosis:
The expected outcome or course of the condition over time.
Good with early diagnosis and treatment, but delays can lead to severe complications.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Orbital cellulitis, cavernous sinus thrombosis, intracranial abscess, and systemic fungal spread.
Histoplasmosis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; cough; chest pain; fatigue; shortness of breath; night sweats; weight loss
Root Cause:
Infection by the fungus Histoplasma capsulatum, commonly through inhalation of spores from contaminated soil or bird/bat droppings.
How it's Diagnosed: videos
Antigen detection in blood or urine, fungal cultures, histopathology, and imaging studies like chest X-rays or CT scans.
Treatment:
Antifungal medications such as itraconazole (first-line for mild cases) or amphotericin B (for severe cases).
Medications:
Itraconazole (triazole antifungal) and amphotericin B (polyene antifungal) for more severe infections.
Prevalence:
How common the health condition is within a specific population.
Endemic in certain areas like the Ohio and Mississippi River valleys in the United States; affects 500,000 people annually in the U.S.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Living in or traveling to endemic areas, immunosuppression, occupational exposure to bird/bat droppings.
Prognosis:
The expected outcome or course of the condition over time.
Favorable in mild cases; chronic or disseminated histoplasmosis can be life-threatening without treatment.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Chronic pulmonary histoplasmosis, disseminated histoplasmosis, pericarditis, or adrenal insufficiency in severe cases.
Blastomycosis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; cough; chest pain; fatigue; night sweats; skin lesions; muscle and joint pain
Root Cause:
Infection caused by the Blastomyces fungus, typically found in moist soil and decomposing organic matter; affects the lungs and can disseminate to other body parts.
How it's Diagnosed: videos
Fungal culture, microscopy of sputum or tissue, urine antigen tests, chest X-rays, and biopsy.
Treatment:
Long-term antifungal therapy; severe cases may require intravenous medications.
Medications:
Itraconazole (antifungal triazole) for mild-to-moderate cases; Amphotericin B (antifungal polyene) for severe or disseminated disease.
Prevalence:
How common the health condition is within a specific population.
Most common in areas near the Great Lakes, Mississippi, and Ohio River valleys; primarily affects people exposed to soil and vegetation.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Occupational or recreational exposure to soil and decomposing wood, immunosuppression.
Prognosis:
The expected outcome or course of the condition over time.
Good if treated early; untreated disseminated blastomycosis can be fatal.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Chronic pulmonary disease, dissemination to the skin, bones, and central nervous system.
Aspergillosis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; cough; shortness of breath; chest pain; fatigue; weight loss; sinus congestion; wheezing
Root Cause:
Infection caused by the Aspergillus fungus, which is found in soil, decaying organic matter, and indoor environments; affects individuals with weakened immune systems or underlying lung conditions.
How it's Diagnosed: videos
Blood tests, imaging studies (CT or X-rays of lungs), sputum cultures, biopsy, galactomannan assay, and PCR for Aspergillus DNA.
Treatment:
Antifungal medications, surgical removal of fungal masses (if necessary), corticosteroids in allergic forms.
Medications:
Voriconazole (antifungal triazole), Amphotericin B (antifungal polyene), Itraconazole (antifungal triazole), and Posaconazole (antifungal triazole).
Prevalence:
How common the health condition is within a specific population.
Rare in the general population; more common in individuals with compromised immune systems or chronic lung diseases.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Immunosuppression, long-term corticosteroid use, chemotherapy, solid organ transplants, hematologic malignancies, and existing lung diseases such as COPD or tuberculosis.
Prognosis:
The expected outcome or course of the condition over time.
Variable; invasive aspergillosis has a high mortality rate without prompt treatment, while allergic forms are manageable with proper therapy.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Respiratory failure, dissemination to other organs, allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis.
Candidiasis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
white patches in the mouth or throat; vaginal itching; discomfort during urination; skin rashes; fatigue; fever in systemic cases
Root Cause:
Overgrowth of Candida species, most commonly Candida albicans, in various body parts due to disrupted microbiota or weakened immunity.
How it's Diagnosed: videos
Clinical examination, culture of affected site, blood tests for systemic candidiasis, and PCR testing.
Treatment:
Antifungal medications applied topically, orally, or intravenously depending on the site and severity.
Medications:
Fluconazole (antifungal triazole), Clotrimazole (topical antifungal), Amphotericin B (antifungal polyene), and Echinocandins like Caspofungin for invasive infections.
Prevalence:
How common the health condition is within a specific population.
Common in individuals with diabetes, on antibiotics, or immunosuppressed. Vaginal candidiasis affects 70-75% of women at least once in their lifetime.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Immunosuppression, recent antibiotic use, diabetes, prolonged use of corticosteroids, and use of invasive devices like catheters.
Prognosis:
The expected outcome or course of the condition over time.
Excellent for localized infections; systemic candidiasis requires aggressive treatment but can have high mortality rates.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Esophagitis, disseminated candidiasis, endocarditis, or septic shock in severe cases.
Chromoblastomycosis
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Subcutaneous Mycoses
Symptoms:
wart-like lesions; ulcerated plaques; skin nodules; itching; secondary bacterial infections
Root Cause:
Chronic fungal infection caused by melanized fungi (e.g., Fonsecaea or Cladophialophora species) entering through skin trauma.
How it's Diagnosed: videos
Clinical examination, biopsy with histopathology showing muriform cells, fungal cultures, and PCR-based methods.
Treatment:
Long-term antifungal therapy combined with surgical excision or cryotherapy for localized lesions.
Medications:
Itraconazole and terbinafine (antifungal agents inhibiting fungal growth). Amphotericin B may be used in severe cases.
Prevalence:
How common the health condition is within a specific population.
Rare, endemic in tropical and subtropical regions, with higher incidence in rural agricultural workers.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Skin trauma, barefoot walking in endemic areas, and immunosuppression.
Prognosis:
The expected outcome or course of the condition over time.
Good with early treatment, though chronic cases may require prolonged therapy. Without treatment, progression can lead to disfigurement.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Chronic infections, secondary bacterial infections, and squamous cell carcinoma in long-standing lesions.
Coccidioidomycosis and Valley Fever
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Endemic Mycoses
Symptoms:
fever; cough; chest pain; fatigue; headache; rash; joint pain
Root Cause:
Infection caused by Coccidioides species (C. immitis or C. posadasii) through inhalation of fungal spores, leading to localized or disseminated disease.
How it's Diagnosed: videos
Serologic testing (IgM and IgG antibodies), fungal cultures, histopathology, or PCR-based diagnostics.
Treatment:
Mild cases may resolve without treatment; moderate to severe cases require antifungal therapy, such as azoles or amphotericin B.
Medications:
Fluconazole or itraconazole for most cases. Amphotericin B is used for severe or disseminated disease. These drugs are systemic antifungal agents targeting fungal growth or membrane integrity.
Prevalence:
How common the health condition is within a specific population.
Endemic in the southwestern U.S., northern Mexico, and parts of Central and South America; incidence rates vary but are increasing with climate change.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Residing or working in endemic areas, soil disturbance, immunosuppression, and pregnancy (third trimester).
Prognosis:
The expected outcome or course of the condition over time.
Most cases are self-limited; severe or disseminated cases have variable outcomes, with mortality up to 30% in untreated disseminated infections.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Dissemination to skin, bones, or meninges; chronic pulmonary disease; and meningitis.
Cryptococcosis
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Opportunistic Mycoses
Symptoms:
fever; headache; nausea; vomiting; altered mental status; neck stiffness in meningitis; cough; chest pain
Root Cause:
Infection by Cryptococcus neoformans or Cryptococcus gattii, typically through inhalation of spores, often affecting immunocompromised individuals.
How it's Diagnosed: videos
India ink staining, cryptococcal antigen testing, fungal cultures, or molecular diagnostics.
Treatment:
Induction therapy with amphotericin B and flucytosine, followed by maintenance therapy with fluconazole.
Medications:
Amphotericin B (polyenes), flucytosine (antifungal antimetabolite), and fluconazole (azole antifungal). These target fungal membranes or DNA synthesis.
Prevalence:
How common the health condition is within a specific population.
Common opportunistic infection in HIV/AIDS patients, with significant global burden in low-resource settings.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
HIV/AIDS, organ transplantation, corticosteroid use, and other immunosuppressive conditions.
Prognosis:
The expected outcome or course of the condition over time.
Early treatment significantly improves outcomes, though CNS involvement can lead to high mortality (up to 70% in severe untreated cases).
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Cryptococcal meningitis, hydrocephalus, vision loss, and neurological deficits.
Cutaneous Cryptococcus
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Opportunistic Mycoses
Symptoms:
skin lesions ranging from papules to ulcers; nodules; plaques; secondary bacterial infections
Root Cause:
Localized or disseminated infection with Cryptococcus neoformans or Cryptococcus gattii involving the skin, often in immunocompromised patients.
How it's Diagnosed: videos
Skin biopsy, fungal cultures, or antigen testing.
Treatment:
Antifungal therapy (similar to systemic cryptococcosis); surgical excision in some localized cases.
Medications:
Amphotericin B, flucytosine , and fluconazole as per systemic cryptococcosis guidelines.
Prevalence:
How common the health condition is within a specific population.
Less common than systemic cryptococcosis; often associated with disseminated disease in immunosuppressed individuals.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Immunosuppression, HIV/AIDS, and direct fungal exposure in endemic areas.
Prognosis:
The expected outcome or course of the condition over time.
Favorable for isolated cutaneous lesions; prognosis depends on systemic involvement and immune status.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Progression to systemic infection, particularly in untreated or immunocompromised patients.
Fungal Endophthalmitis
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Ocular Mycoses
Symptoms:
eye pain; decreased vision; redness; floaters; photophobia; swelling
Root Cause:
Infection of the intraocular structures by fungi, commonly Candida species or filamentous fungi following surgery, trauma, or systemic dissemination.
How it's Diagnosed: videos
Clinical examination, vitreous or aqueous fluid sampling, fungal cultures, and PCR.
Treatment:
Intravitreal or systemic antifungals, with or without vitrectomy.
Medications:
Amphotericin B (intravitreal ), voriconazole , or fluconazole for systemic infections. These drugs inhibit fungal growth or disrupt fungal membranes.
Prevalence:
How common the health condition is within a specific population.
Rare; often occurs as a complication of intraocular surgery or systemic candidiasis.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Ocular surgery, trauma, IV drug use, and systemic fungal infections.
Prognosis:
The expected outcome or course of the condition over time.
Early treatment can preserve vision, but prognosis is poor for delayed cases.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Vision loss, glaucoma, and retinal detachment.
Fungal Keratitis
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Ocular Mycoses
Symptoms:
eye pain; redness; blurred vision; photophobia; tearing; discharge
Root Cause:
Infection of the cornea by fungi, commonly Fusarium, Aspergillus, or Candida species, often following trauma or use of contact lenses.
How it's Diagnosed: videos
Corneal scraping with microscopy, fungal cultures, and molecular diagnostics.
Treatment:
Topical antifungal therapy; surgical interventions like debridement or keratoplasty in severe cases.
Medications:
Natamycin (topical polyene antifungal), voriconazole (topical or systemic), or amphotericin B in severe cases.
Prevalence:
How common the health condition is within a specific population.
More common in tropical and subtropical regions; associated with agricultural injuries and contact lens use.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Corneal trauma, contact lens wear, steroid use, and tropical climates.
Prognosis:
The expected outcome or course of the condition over time.
Good with early treatment, though advanced cases may result in corneal scarring or vision loss.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Corneal perforation, endophthalmitis, and vision impairment.
Majocchi Granuloma
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
red or scaly patches; swelling or nodules in the skin; itchiness; pain in affected areas
Root Cause:
Fungal infection caused by dermatophytes invading deeper skin layers, often associated with trauma or immunosuppression.
How it's Diagnosed: videos
Clinical examination, fungal culture, skin biopsy, and histopathology.
Treatment:
Systemic antifungal therapy combined with topical treatments.
Medications:
Oral terbinafine (allylamine antifungal) or itraconazole (triazole antifungal). Topical antifungal creams such as clotrimazole (imidazole antifungal) may also be used.
Prevalence:
How common the health condition is within a specific population.
Rare; seen more frequently in immunocompromised individuals or those with repeated skin trauma.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Trauma to the skin, immunosuppression, chronic steroid use.
Prognosis:
The expected outcome or course of the condition over time.
Good with appropriate antifungal therapy, but recurrence is possible if underlying conditions persist.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Persistent infection, scarring, and secondary bacterial infections.
Mucormycosis (Zygomycosis)
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
facial pain or swelling; black or necrotic tissue in nasal passages; fever; headache; vision changes; sinus congestion or discharge
Root Cause:
Aggressive fungal infection caused by Mucorales species, often associated with compromised immune function or poorly controlled diabetes.
How it's Diagnosed: videos
Histopathology, fungal culture, and imaging studies (CT or MRI).
Treatment:
Aggressive surgical debridement and systemic antifungal therapy.
Medications:
Amphotericin B (polyene antifungal) as the first-line treatment, followed by posaconazole or isavuconazole (triazole antifungals) for maintenance therapy.
Prevalence:
How common the health condition is within a specific population.
Rare; more common in immunocompromised individuals or those with uncontrolled diabetes or post-COVID-19 complications.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Diabetes, immunosuppression, organ transplant, iron overload, prolonged corticosteroid use.
Prognosis:
The expected outcome or course of the condition over time.
Poor if not treated early; mortality rates are high due to rapid progression and complications.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Orbital cellulitis, cavernous sinus thrombosis, intracranial involvement, systemic fungal dissemination.
Paracoccidioidomycosis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; weight loss; chronic cough; skin lesions; oral ulcers; lymphadenopathy; difficulty breathing
Root Cause:
Caused by inhalation of spores from Paracoccidioides brasiliensis or Paracoccidioides lutzii, leading to systemic fungal infection.
How it's Diagnosed: videos
Microscopic examination of sputum or tissue biopsies, fungal culture, serologic tests (e.g., immunodiffusion), and imaging studies (e.g., chest X-ray or CT).
Treatment:
Long-term antifungal therapy, typically lasting several months.
Medications:
Azole antifungals like itraconazole (first-line treatment) or amphotericin B for severe cases. Itraconazole is a triazole antifungal; amphotericin B is a polyene antifungal.
Prevalence:
How common the health condition is within a specific population.
Endemic to South and Central America, particularly in rural areas; incidence varies but is most common in agricultural workers.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Male gender, rural occupation, environmental exposure to soil, weakened immune system.
Prognosis:
The expected outcome or course of the condition over time.
Good with early diagnosis and treatment, but untreated cases can be fatal.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Pulmonary fibrosis, chronic lung disease, adrenal insufficiency, and systemic dissemination.
Pneumocystis Jiroveci Pneumonia (PJP)
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; dry cough; shortness of breath; fatigue; chest pain; hypoxia
Root Cause:
Opportunistic fungal infection caused by Pneumocystis jiroveci, primarily affecting immunocompromised individuals.
How it's Diagnosed: videos
Microscopic identification of Pneumocystis jiroveci in respiratory samples (e.g., sputum, bronchoalveolar lavage); PCR and beta-D-glucan assays; chest X-rays or CT scans.
Treatment:
Antifungal therapy with adjunctive corticosteroids in severe cases to reduce inflammation.
Medications:
Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment. Alternatives include pentamidine , atovaquone , or clindamycin with primaquine . TMP-SMX is an antibiotic with antifungal properties; pentamidine is an antiprotozoal and antifungal agent.
Prevalence:
How common the health condition is within a specific population.
Common among HIV/AIDS patients and other immunosuppressed populations; incidence decreases with antiretroviral therapy (ART).
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
HIV/AIDS, organ transplantation, cancer chemotherapy, chronic corticosteroid use.
Prognosis:
The expected outcome or course of the condition over time.
High mortality if untreated but generally good with early treatment.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Respiratory failure, pneumothorax, acute respiratory distress syndrome (ARDS), and systemic infections.
Sporotrichosis
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
painless skin nodules; ulcerative lesions; lymphangitis; swelling at infection site
Root Cause:
Infection with Sporothrix schenckii complex through skin inoculation, leading to cutaneous or lymphocutaneous disease.
How it's Diagnosed: videos
Fungal culture of tissue or pus, histopathology, and PCR testing.
Treatment:
Long-term antifungal therapy, usually several months.
Medications:
Itraconazole is the first-line treatment for most cases. For disseminated or severe infections, amphotericin B may be used. Potassium iodide is an alternative for cutaneous forms. Itraconazole is a triazole antifungal; amphotericin B is a polyene antifungal.
Prevalence:
How common the health condition is within a specific population.
Common in tropical and subtropical regions, particularly in individuals handling soil, plants, or decaying vegetation.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Gardeners, agricultural workers, and those with skin injuries.
Prognosis:
The expected outcome or course of the condition over time.
Excellent for cutaneous forms with treatment; disseminated forms have a poorer prognosis.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Osteoarticular involvement, systemic dissemination, and chronic lesions.
Trichosporon Infections
Specialty: Infectious Diseases
Category: Fungal Infections
Symptoms:
fever; sepsis-like syndrome; skin lesions; organ dysfunction in severe cases
Root Cause:
Opportunistic infection caused by Trichosporon species, often in immunocompromised hosts.
How it's Diagnosed: videos
Blood cultures, fungal cultures from infected tissues, and molecular identification (e.g., PCR).
Treatment:
Antifungal therapy tailored to susceptibility testing.
Medications:
Azoles like voriconazole or fluconazole are preferred. Amphotericin B can be used in resistant cases. Voriconazole is a triazole antifungal; amphotericin B is a polyene antifungal.
Prevalence:
How common the health condition is within a specific population.
Rare but increasing in immunosuppressed populations; nosocomial outbreaks have been reported.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Hematologic malignancies, neutropenia, broad-spectrum antibiotic use, indwelling catheters.
Prognosis:
The expected outcome or course of the condition over time.
Variable; high mortality in disseminated infections despite treatment.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Disseminated infection, septic shock, and organ failure.
Noncandidal Fungal Infections of the Mouth
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Oral Conditions
Symptoms:
painful oral lesions; difficulty swallowing; red or white patches; ulcers that don't heal
Root Cause:
Caused by fungi such as Aspergillus, Histoplasma, or Cryptococcus; often in immunocompromised individuals.
How it's Diagnosed: videos
Clinical examination, fungal culture, biopsy, and imaging.
Treatment:
Antifungal therapy tailored to the causative organism.
Medications:
Amphotericin B (polyenes), fluconazole or itraconazole (triazoles) depending on the fungus involved.
Prevalence:
How common the health condition is within a specific population.
Rare but occurs globally, especially in people with weakened immune systems.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Immunosuppression (e.g., HIV/AIDS, chemotherapy), prolonged corticosteroid use, organ transplantation.
Prognosis:
The expected outcome or course of the condition over time.
Good with early treatment, but severe cases may lead to systemic dissemination.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Disseminated fungal infection, airway obstruction, secondary bacterial infections.
Piedra
Specialty: Infectious Diseases
Category: Fungal Infections
Sub-category: Hair Conditions
Symptoms:
hard nodules on hair shafts; hair brittleness; hair breakage
Root Cause:
Infection of the hair shaft by fungi; Trichosporon causes white piedra, and Piedraia hortae causes black piedra.
How it's Diagnosed: videos
Microscopic examination of hair shafts, fungal culture.
Treatment:
Hair shaving, antifungal shampoos, and oral antifungal medications in persistent cases.
Medications:
Ketoconazole shampoo (topical antifungal), itraconazole or terbinafine (oral antifungals in severe cases).
Prevalence:
How common the health condition is within a specific population.
Rare; more common in tropical and subtropical regions.
Risk Factors:
Factors or behaviors that increase the likelihood of developing the condition.
Poor hygiene, warm and humid climates, sharing hair care tools.
Prognosis:
The expected outcome or course of the condition over time.
Good with appropriate treatment, but recurrence is possible if predisposing factors persist.
Complications:
Additional problems or conditions that may arise as a result of the original condition.
Cosmetic concerns and hair damage.