1- Fungal Skin Infection and Foot Disorders Flashcards
What is tinea cruris?
groin, jock itch
What is tinea corporis?
body, ringworm
What is tinea pedis?
feet, athletes foot
What is tinea capitis?
scalp
What is tinea unguium?
nails
What are the stages of fungal infections?
-inoculation
-incubation
-enlargement
What are the risk factors for fungal infections?
-diabetes
-immunodeficiency conditions (HIV)
-impaired circulation
-poor nutrition or hygiene
-trauma to skin
-skin occlusion
-warm humid climate
-immunosuppressive medications (glucocorticoids)
What is the presentation of ring worm?
on smooth bare skin +/- vesicles or pustules and itching, small circular, red, and scaly
What is the presentation of jock itch?
erythematous and well demarcated lesions with possible elevation
When would jock itch be referred to a physician?
erythematous and poorly demarcated
What is the treatment for ring worm and jock itch?
good skin hygiene and keep dry and use topical antifungal agents
What is the presentation of athlete’s foot?
-fissures, scaling, maceration, malodor, itch, sting
-involves lateral web toes
-may spread to foot sole/instep
-aggravated by warmth and humidity
-mild inflammation and diffusing scaling
-moccasin-like distribution on the soles and lateral/medial aspect
What are the risk factors for athlete’s foot?
-high impact activities
-public pools or showers
-non-porous footwear
-wearing socks and shoes and sweating from extended wear
What are the treatment goals for athlete’s foot?
provide symptomatic relief of pain, scaling, itching, and inflammation and eradicate infection and prevent further infection
What are the exclusions for athlete’s foot?
-cause is unclear
-unsuccessful treatment or condition worsens
-nails or scalp involved
-face, mucous membrane, or genitalia involved
-secondary bacterial infection (oozing at the site)
-excessive, seriously inflamed or debilitating condition
-fever and/or malaise
-diabetes, systemic infection, pregnant, or immunodeficiency
What are nonpharmacologic treatment options for athlete’s foot?
-wash feet daily and keep them dry
-avoid infected individuals
-wear open toe shoes and keep feet cool
-use wooden or rubber sandals at public facilities
-don’t share personal items
-change socks and shoes daily
What are common adverse effects of topical antifungal agents?
itching, redness, irritation, burning, dryness, stinging
What is the MOA of clotrimazole/miconazole?
damage fungal cell walls and cause cellular necrosis
What is the preferred topical antifungal products in pregnancy?
clotrimazole/miconazole
What is the indication of tolnaftate?
prevention and treatment of dry/scaly lesions
What is the age indication for 1st gen antifungals?
2yo+
What is the dosing regimen for clotrimazole?
apply 2x day for 4 weeks
What is the dosing regimen for miconazole?
2x day for 4 weeks (pedis/corporis) or 2 weeks (cruris)
What is the dosing regimen for tolnaftate?
2x a day for 4 weeks (pedis/corporis) or 2 weeks (cruris)
What is the MOA of 2nd gen antifungals?
squalene epoxidase inhibitors
What is the age indication for 2nd gen antifungals?
12yo+
What is the use of aluminum salt?
astringent for inflammatory relief of tinea pedis (athletes foot)
Describe the different aluminum salts?
-aluminum acetate= for acute inflammation or wet/soggy, apply for 15-30mins up to 3 times a day as soak or wet dressing, use up to 1 week
-aluminum chloride= for wet/soggy, apply 2x daily until odor, wetness, and whiteness abate
What is the use of undecylenic acid?
antifungal fatty acid with astringent activity to decrease rawness and irritation for tinea pedis or corporis
When should a patient seek medical attention for fungal infections?
-product causes itching or swelling or if infection worsens
-condition does not improve or persists past appropriate treatment duration
-if infection worsens or fails to respond in 1 week
What is the cause of warts (verrucae)?
human papillomavirus (HPV)
What are the risk factors for warts?
-depressed immune system
-chronic skin conditions
-previous wart
-bite fingernails
-walks barefoot (especially wet surfaces)
-use swimming pools/public showers
Describe the signs of common wart
-skin color brown
-scaly, rough papules/nodules alone or could be in groups
-rough, cauliflower-like/domed appearance
-present on face, hands, fingers, feet
Describe the signs of plantar wart
-callous-like lesions on feet due to pressure
-asymptomatic if small, but could be painful, uncomfortable, and debilitating if weight bearing such as heel or ball of foot
-thick skin and heaped
What are the exclusions for self care for warts?
-pregnant or breast feeding
-physical or mental impairment (cannot follow directions)
-chronic, debilitating diseases affecting sensitivity or hand and feet circulation (diabetes, PVD, neuropathy)
-immunocompromised
-large or multiple warts
-painful plantar warts
-warts in atypically areas
What are the treatment goals of warts?
-eliminate signs and symptoms of wart
-remove the wart with no scarring to skin
-no treatment is 100% effective
-prolonged treatment increases risk of autoinoculation
What are the important counseling points for wart treatment?
-wash hands before and after treatment and if wart has been touched
-cover wart
-use specific towel for drying area
-do not cut, shave, or pick wart
-use lamb wool/moleskin for plantar wart discomfort
-never share personal items
-avoid skin-to-skin contact and do not walk barefoot
What is the preferred treatment for warts on hands and feet?
salicylic acid
What is the dosing for salicylic acid liquid/gel?
wash area and soak in warm water for 5 minutes, apply 2 times daily, apply 1 drop until covered and hardened, attempt to restrict medication to wart (avoid healthy skin and wash off any product on healthy skin), cover with tape, requires consistent application with visible benefits in 1-2 weeks
What is the duration of therapy for salicylic acid?
up to 12 weeks
What is the dosing for salicylic acid plaster/disc/pads/sticks?
wash area and soak in warm water for 5 minutes, trim plaster to fit wart and cover with occlusive tape, requires consistent application with visible benefits in 1-2 weeks
Describe Cryotherapy
dimethyl ether and propane (DMEP) or nitrous oxide (NO) from pressurized can to freeze skin tissue to create microthrombi that leads to ischemic necrosis
if treatment is successful in 10 days a blister will form below the wart and it will fall off
may reapply every 2-3 weeks- may repeat 3 times
What are the precautions of cryotherapy?
-avoid <4yo
-treat only one wart of a time
-SE: buring, scarring, hyperpigmentation
-only use applicator once
-flammable
What are the treatment goals for calluses and corns?
-provide symptomatic relief
-removal of corn or calluses
-prevent recurrence by correcting underlying cause
What are the exclusions for self care of corn and calluses?
-diabetes, circulatory disease
-lesions hemorrhaging or oozing
-anatomic defect or fault in body weight distribution
-excessive, ainfun, or debilitating with redness and irritation
-unsuccessful self care despite following directions
What are the signs/symptoms of calluses?
-broad base with relatively even thickening of skin (bottom of feet)
-size can vary
-located on joints or weight bearing areas
-raised and yellow
-severe sharp pain
What is the difference between discrete-nucleated or diffused-shearing?
-discrete-nucleated= most common, painful, small with localized translucent center and central, keratin plug
-diffuse-shearing= large surface area, no central core, not painful
What are the signs and symptoms of corns?
-small, raised, sharp demarcated hyperkeratotic lesion with hard central core
-flesh, white, or yellowish gray
-severe and sharp or dull pain
-hard corn (most common) v soft corn
What is the main cause of corns?
tight fitting shoes (mostly affects women)
What are the nonpharmacological recommendations for calluses and corns?
-may soak corn/callus in warm water for 5 minutes and use rough towel, callus file, or pumice stone
-avoid sharp knives or razor blades to remove skin
-use cushioning skin to decrease pressure (moleskin)
-wear well fitting shoes
What is the first line therapy for calluses/corns?
salicylic acid
What are the nonpharmacological recommendations for ingrown toenails?
-soak in warm water for 10-20 minutes several times a day to soften area and nail
-properly fitting shoes
-cut toenails straight across
-use NSAIDs for pain and swelling
-place cotton wisps or dental floss under the edge of ingrown nail for pain relief
What medication may be used for ingrown toenails?
sodium sulfide
What is the MOA of sodium sulfide?
relieve pain by softening nail or hardening nail bed, apply retainer ring then apply gel within ring and place bandage over ring, apply 2x daily for 7 days
