Cuntaneous Fungal Infections Flashcards
objectives of self treatment of fungal infections
provide symptomatic relief
eradicate existin infection
prevent future recurrent infections
refer if infection widespread, systemic, recurrent, or persistent
activity of clotrimazole or miconazole what they are used for
fungistatic with broad spectrum of activity to treat dermatophyte and yeast infections
application of clotrimazole or miconazole
thin layer morning and evening
adverse effects of clot and micon
local skin irritation
hypersensitivity
preparations of imadazole or azoles available in canada
clotrimazole- cream
miconazole- cream, spray, powder
activity of tolnaftate and uses
narrow spectrum antifungal
only for dermatophyte infectiosn
application of tolnaftate
apply mornign and evenign
adverse effects of tolnaftate
local skin irritation
activity and uses of undecylenic acid
unknown
used for dermatophyte infections
application adn adverse effects of undecylenic acid
twice daily
itching, burning, stinging
activity of nystatin and uses
fungistatic or cidal
only for candidal infections
application and adverse effects of nystatin
2-3 times daily
rarely irritation
activity of ciclopirox
antimycotic agent
effective against dermatophytes, yeast, and some bacteria
application and adverse effects of topical ciclopirox
itch, burn, red
apply twice daily for 4 weeks
time of effects for topical ciclopirox
first week relief of itchign and other symptoms
reevalute if not improvement after 2 weeks
two types of ciclopirox
loprox- 1%cream/lotion
stieprox 1.5% shampoo 2-3 times per week for seborrheic dermatitis
activity of terbinafine
fungicidal to dermatophytes
fungistatic to candida
application adn adverse effects of topical terbinafine
once daily for one week
itch, burn, rash, dryness
uses of oral terbinafine
fungal nail infections
severe tinea skin infections failed with topical
adverse effects of oral terbinafine
interfere with cytp450 so hepatic failure, gi disturbances, rash, headache
ketaconazole activity
broad spectrum
oral ketoconazole adverse effects
fatal liver toxicity so only for life threatening infections
why are dermatophytes restricted to scalp, nails, and superficial skin
requires keratin for growth/proliferation
how are dermatophytes spread
contact with infected person, soil, animal, indirectly from fomites
most common dermatophytes in skin infection
trichophyton
microsporum
epidermophyton
risk factors of tinea corporis
children in daycare/school
exposure to contaminated soils, peoples, animals
warm moist environment
shared towels or clothing
signs and symptoms of tinea corporis
oval ring red scaly patches reddened edges with sharp margins inner area clear sometimes itching
when to refer tinea cirporis
younger than 2
immunocomprimised
large part of body
…… reading
treatment of tinea corporis and cruris
imidaxole twice daily for 4 weeks
apply to normal skin 2 cm around infected to prevent spread
what areas are affected by tinea cruris
bilateral thighs
inguinal folds
butt
anal cleft
risk factors for tinea cruris
wam and humid multiple layers of clothing immunicompromised obesity men
sign and symptoms of tinea cruris
well marginated red half moon plaque small vesicles itchy bright red lesion chronic more hyperpigmented
when do you refer tinea cruris
reading…..
risk factors for tinea pedis
hot and damp occlusive footwear public bathing facilities high impact sports sharing footwear prolonged steroid application sweat
signs of tinea pedis
toe webs interdigital maceration fissuring and scaling itching or stinging malodour
refer tinea pedis
risk of delayed wound healing
less than 12
lesion inflamed oozing painful - may be bacterial
toenail affected
chronic interdigital tinea pedis
fissures scaling maceration
between 3rd/4th or 4/5 toes
vesicular type
itchy vesicles on instep of feet
moccasin tinea pedis
off white scaling
red lesions on soles and side of feet
acute ulcerative tinea pedis
macerated weepy lesions on soles of feet
non pharms for tinea pedis
proper footcare/hygiene
avoid occlusive footweat
changes to dry socks
dry between toes bid and affter showering
products pharmacists can prescribe for tinea pedis
topical ciclopirox twice daily for 4 weeks
topical terbinafine once daily for a week
why is important to promptly treat tinea pedis
prevent development of tinea unguium or infections of toenails
how do you treat onychomycosis
oral terbinafine tonail 12-16 weeks fingernail 6 weeks risk of liver injury so closely monitored ciclopirox nail lacquer takes 48 weeks
tinea capitis
hair follicles
visible black dots
often in children
tinea manuum
one hand two feet
tinea unguium
nails brittle opaque yellow thick
tinea incognito
suppresion of inflammatory response
cause of pityriasis versicolor
infection of stratum corneum by malassezia
highest risk of pityriassis versicolor
tropical environments
adolescents and young adults
signs and symptoms of pityriassi versicolor
change in cutaneous pigementation- hyper/hypopigmented
lesions on back, chest, upper arms, coalesce to for large patches
fine scale present
cosmetic issue no itching
piityriasis versicolor treatment
selenium sulfide 2.5% shampoo- apply 10 min and wash off once daily for 1-2 weeks
topical azole cream bid for 2 week
ketaconazole 2% shampoo- leave on for 5 minutes and wash off one time
risk factors of candida intertrigo
diabetes mellitus immunosuppression tropical environment poor hygiene psoriasis contact dermatitis obesity hands in water lots overuse of cornstarch
areas that can be affected by candida intertrigo
groin armpit gluteal region under breasts skin folds hand
signs of candid intertrigo
bright red
moist skin surface
scaling border and satellit papules
when to refer candida intertrigo
unsuccessful treatment worsens unknown cause extensively seriouslt inflamed systemic or recurrent secondary bacterial infection - discharge immunocompromised under 2
treatment of cutaneous candidiasis
keep dry with non medicated powder
imidazole or nystatin bid 2-3 weeks
sever combinaton of topical antifungal and topical corticosteroid
tea tree oil as complimentary treatment
must be used bid for 6 months and not guaranteed
which products can be used in pregnancy/breast feeding
clotrimazole
miconazole
nystatin
general non pharms
use separate wash cloth/towel for area
hair dryer to dry area towel cant
socks on before underwear
launder contaminated towel and clothing separate in hot water
cleanse skin daily with soap and water and pat dry
avoid clothing that keep skin wet - wool
allow shoes to dry before using again
protective footwear in public showers and pools
how long should treatment continue and why
1-2 weeks after symptoms resolution to ensure full eradication and prevent relapse
monitoring parameters
relief of symptoms in 1-2 weeks
monitor daily for infection
no improvement or worsens refer
lesions should resolve within treatment timeframe
