Ch 3.2 - Athlete's Foot & Warts/Verruca Flashcards
Describe the appearance of athlete’s foot (mild fungal infection)
Usually itchy, flaky skin in the web spaces between the toes
Flakes or scales of skin become white and peel off. Underneath skin is usually reddened and may be itchy and sore. Skin may be dry and scaly OR moist and weeping
When should you refer a patient with athletes foot?
- Severe, affecting other parts of the foot
- Diabetic patients
- Signs of bacterial infection
- Unresponsive to appropriate treatment within 2 weeks
- Involvement of toenails
What are some of the treatment options for athlete’s foot?
Creams, powders, sprays, solutions
Topical Allylamines e.g. Terbinafine
Azoles e.g. Miconazole, clotrimazole, ketoconazole
Undecenoic acid
Tolnaftate
What activity do Azoles have and how long should ketoconazole be used?
Azoles have anti fungal and antibacterial activity (useful as secondary infections can occur)
1 week treatment
What formulations does Terbinafine come in and how to use it?
Come in a cream and spray
Cream applied once or twice daily for 1 week for athelets foot and 2 weeks for jock itch.
Spray used for 1 week.
evidence - terbinafine better to prevent recurrence compared to azoles.
Who can’t use terbinafine?
Children
Spray can’t be used in those under 16
What formulation does Tolnaftate come in and how long should it be used?
Available in powder, cream, aerosol and solution formulations
should be applied twice daily and treatment
should be continued for up to 6 weeks
Why would a pharmacist not recommend hydrocortisone for the treatment of athletes foot?
although it would reduce inflammation, it would not deal
with the fungal infection, which might then worsen.
Combination products maybe - limited to 7 days use
Non-pharmacological advice on athletes foot
Allow feet to breathe - leather shoes
Avoid shoes that are too tight or made from synthetic material
- Cotton socks
- Feet should be washed and carefully & thoroughly dried
- Wear footwear in public baths, swimming, changing rooms to avoid transmission
What virus causes warts and verrucaes?
Human Papilloma Virus
What are the differences in appearances between warts and verrucaes?
Warts - raised lesions and roughened surface that are flesh coloured
Verrucae - occur on weight-bearing areas of sole and heel. so flat inward looking lesions.
How long do warts last without treatment?
6 months - 2 years
Any changes in the appearance of wart- treated with suspicion and referral
Why should Diabetic patients not use OTC wart/verrucae products?
Impaired circulation can lead to delayed healing, ulceration or even gangrene.
Peripheral neuropathy may mean that even extensive damage to the skin many not provoke sensation of pain
When to refer someone with wart/verrucae?
- Changed appearance of lesions, size, colour
- Bleeding
- Itching
- Genital warts
- Facial warts
- Immunocompromised patients
What is the treatment scale for warts/verrucae?
3 months - if not then referral