Cutaneous Fungal Infections Flashcards

Question

How do you differentiate ring worm of the body from other cutaneous conditions (eczema, psoriasis, contact dermatitis, bacterial skin infections)?

Answer 1

Clearning in the centre Clear, sharp edges Psoriasis has silvery plaques; here scaling is fain with small skin pieces Contact dermatitis is typically less circular Location: fungal infections occur in areas that collect excess moisture, contact dermatitis and bacteria skin infections is anywhere

Answer 2

Fungal skin infection may be wet/soggy, malodorous, thicker skin, rash, redness, scaling, round, inflamed, cracks/fissures Contact dermatitis presents as lesions from raised wheals to fluid filled vesicles Bacterial skin infections present as lesions or ulcers, may be red with pustules, may be warm to the touch, may have a foul door, coloured yellow/green discharge

Answer 3

Patients experiencing an infection with unclear aetiology Immunocompromised patientss (e.g., immunosuppresants, uncontrolled diabetes, AIDS) Experiencing tinea capitis, tinea barbae or tinea unguinium for systemic therapy Responding poorly or are intolerant to topical therapy Experiencing excessive, disabling, multifocal or inflammatory disease Widespread Affecting daily life

Answer 4

Prevention: use general non-drug measures Topical antifungal (OTC): imidazoles are first line of treatment, BID for 4 weeks (AM and HS), apply to normal skin 2 cm beyond the affected area Symptoms should improve after one week. The area should be clear after second week. Continue to apply for at least a week Tolnaftate and undecylenic acid are also options Refractory or resistant cases: allylamines or oral agents

Answer 5

Affected areas are bilateral thighs (upper), ingunial folds (groin), buttocks, gluteal (anal) cleft (less common) Scrotum and penis are usually spared Can affect external vaginal area in females (but less common If the scrotum, penis or internal vaginal area are involved, suspect cutaneous (or vaginal) candidiasis

Answer 6

Warm and humid condition or increased sweating Wearing wet or multiple layers of clothes Immunocomprised individuals (atopic individual, AIDS) Obesity Prevalence is greater in men than in women (rarely affects children)

Answer 7

Well marginated erthymatous half-moon plaque Small vesicles may be seen, especially at the margin Quite pruritic Acute lesions are bright red Chronic cases tend to have more of a hyper pigmented appearance, fine scaling may be present

Answer 8

They are both in the groin area Jock itch will be scaly, itchy irregular shaped or round erythematous patches (consider history, i.e., recent athelete's foot) Lice is itchy, erythematous area, lice may appear as yellow/brown, skin may appear bluish and spotted

Answer 9

Referal: same as tinea corpis Topical antifungal is first line (imidazoles BID for 2-4 weeks). Apply to normal skin 2 cm beyond the affected area Tolnaftate and undecylenic acid are also options Allylamines or oral agents are for refractory cases Prevention strategies: loose fitting clothes, boxer shorts, poweder to reduce moisture (not cornstarch), caution with regards to towels (use two different towels to reduce spread

Answer 10

More common in males Most common in adults (children under 12 should be referred) Often associated with concomitant jock itch infection (groin inoculated with patient's hand/towels)

Answer 11

Heat and dampness Occlusive foot wear (winter boots, cleats and skates, steal-toed boots) Use of public bathing facilities (pools, gyms, dorms) High impact sports (marathon runners) Sharing footwear, towels or other clothing with the infected individuals Prolonged application of topical steroid Hyperhidrosis (excessive sweating)

Answer 12

Commonly affects toe webs, especially between the 4th and 5th toes In some cases between the 3rd and 4th toes May spread to soles of fee Toenails may be involved (referral)

Answer 13

Interdigital maceration at web space Fissuring and scaling Pruritis and/or stinging sensation Malodour (may be sign of infection)

Answer 14

Patient is a risk of delayed wound healing (i.e., has diabetes, cancer, peripheral vascular disease, immunocompromised, elderly, or malnourished Children less than 12 years old The lesion is weeping or severely inflamed, oozing, eczematous, painful Toenail is affected

Answer 15

Chronic interdigital type Vesicular type Moccasin (sandal) Acute ulcerative type

Answer 16

Most common type of infection (fissures, scaling, maceration) Generally self treatable Occurs between third/fourth and/or fourth/fifth toes May be seasonal in nature

Answer 17

``` Pruritic vesicles on the instep of the one or both feet Some scales between tow webs May be painful to some patients Most prevalent during the summer months Likely a referral ```

Answer 18

Off-white scaling (red) lesion of the soles and on the sides of feet Generally found on both feet Often involves nails (refer)

Answer 19

Macerated, weepy lesions on soles of the foot | Often involved a secondary infection with gram negative bacteria (refer)

Answer 20

Referred to as "two feet-one hand syn1drome"

Answer 21

Emphasize proper footcare/hygiene Avoid occlusive footwear Change to dry socks 2-3 times daily (cotton socks) Dry between the toes BID and after showering Change or alternate shoes Topical antifungal is first line (imidazole) BID for up to 4 weeks. Apply to area and 1-2 cm surrouding. Tolfnaftate and undecylenic acid is also an options Refractory cases (or nail infections) may or will require prescription treatment

Answer 22

Ciclopirox: apply to affected area twice daily for 4 weeks Terbinafine: apply to affected area once daily for 1 week

Answer 23

To prevent individuals from developing tinea unguium or infections in the toe nails

Answer 24

Referral to physician is required. Diagnosis is confirmed through nail clippings, scapings under the nail and deep nail samples

Answer 25

Oral terbinafine if first line. Toenail requires 12-16 weeks of treatment Fingernail requires 6 weeks Risk of severe liver injury, therefore it requires close monitoring Ciclopirox nail laquer has limited penetration into the nail. Slightly more effective than placebo. Requires daily application for 48 weeks

Answer 26

``` Tinea capitis (scalp - involves scalp hair follicles; may extend to the eyebrows, eye lashes and beard. There are visible black dots. Occurs most often in children) Tinea manuum (infrequent infection; "one hand two feet" presentation) Tinea unguium (onchomycosis; nails become opaque, yellow, thick and progressively brittle and crumble) Tinea nigra (must be differentiated from other hyper pigmentation conditions) Tinea incognito (suppression of inflammatory response) ```

Answer 27

It's an infection of the stratum corner by Malassezia The upper trunk is a common area of occurrence (sebaceous glands) Highest incidence in tropical envionrments, adolescents and young adults Refer if causation is unclear

Answer 28

Change in cutaneous pigmentation, lesions may be hypo pigmented or hyper pigmented Lesions occur on back, chest and upper arms Individual lesions are small but can coalesce to form larger patches Fine scale presents Cosmetic issue only No itching associated

Answer 29

Selenium sulfide 2.5% shampoo - apply for 10 minutes, then wash off once daily for 7 to 14 days. Then use once or twice a month for prevention Topical azole creams (apply BID for 2 weeks) Ketoconazole 2% shampoo (one time application or once daily for 3 days. Leave on for 5 minutes then wash off Recurrence is common (60-80%)

Answer 30

Candida albicans is the main organism

Answer 31

``` Diabetes mellitus Immunosuppression Tropical environment Poor hygiene Psoriasis/contact dermatitis Obesity Individuals who have hands in water excessively Overuse of "cornstarch" products/powders ```

Answer 32

``` Groin Axillae (armpit) Gluteal region Under breasts Skin folds (i.e., abdominal region) Hands ```

Answer 33

Bright red Moist skin surface Scaling borders and satellite papule or pustules

Answer 34

Unsuccessful initial treatment (persistent infection) or condition worsens; causative factor unknown Condition extensive, seriously inflamed or debilitating Systemic or recurrent infection Signs of secondary bacterial infection (presence of purulent discharge) Immunocompromised patient Patient less than 2 years old

Answer 35

Keeping the area dry (non-medicated powder; avoid cornstarch) Topical antifungal OTC (imidazoles BID 2-3 weeks or nystatin cream/ointment BID-TID 2-3 weeks) In mores severe cases, may use combination therapy: OTC topical anti fungal and topical corticosteroid, prescription treatment or oral therapy

Answer 36

Non-presciption antifungal agents should be limited to superficial condition Minimal area; no predisposing illnesses Imidazoles are considered mainstay of superficial dermatophyte infections; but can also be effective for candida/mixed Nystatin only useful in candida infections Early clinical improvement (1-2 weeks) with relief of pruritus (monitoring parameter) Full course of therapy should be followed to reduce the possibility of recurrence

Answer 37

Clotrimazole is considered compatible with pregnancy and breastfeeding Miconazole is considered compatible with pregnancy. There is no human data in regards to breastfeeding and it is considered probably compatible Nystatin is considered compatible with pregnancy and breastfeeding

Answer 38

Clotrimazole, miconazole, tolnaftate and undecylenic acid can be used in children over 2 years

Answer 39

Drysol (armpits), dehydral (feet) for hyperhydrosis Fungal nail revitalizers/athlete's foot wipes Burosol (Burow's solution = ammonium acetate) - use for 1 week to dry out wet athlete's foot at least 10 minutes prior to using anti fungal agent (AF) - antiseptic, anti-inflammatory, drying agent Hydrocortisone Athlete's foot wipes (tea tree oil/aloe vera) are not treatment options but may relieve symptoms

Answer 40

It can be applied anywhere

Answer 41

For drying the area out (under the skin fold). But it's difficult to keep in the area. It is also good for drying out a shoe, but the problem with that is if it's cornstarch-based, the powder builds up and the moisture causes it to congeal and the fungus continues to grow

Answer 42

May be good for areas that are difficult to apply

Answer 43

Use separate wash cloths and towels to wash/dry the affected area or wash that area last (pat dry thoroughly) Do not share towels Use hair dryer at low heat to dry intertriginous spaces (helps remove excess water) that towels cannot get to Put socks on before underwear to avoid spreading tinea to the groin in the case of athlete's foot Launder contaminated towels and clothing in hot water to prevent spreading of the infection Cleanse the skin daily with soap and water and thoroughly pat dry to remove oils that may support fungal growth Avoid wearing clothing and shoes that allow the skin to stay wet. Wool and synthetic material fabrics prevent optimal air circulation If possible, allow shoes to dry thoroughly before wearing them again Wear protective footwear in public or in community showers/pools/saunas

Answer 44

How to apply the product and how often Wash hands before and after application of antifungal agent/avoid getting into eyes Do not apply any dressings to area (occlusion) Use necessary hygienic measures to prevent the spread of the fungal infection Other measures to prevent future infection Key monitoring parameters What to expect and when Duration of treatment OTC

Answer 45

Some relief of symptoms within 1-2 weeks Monitor daily for infection (pus, redness, swelling) - see doctor if it occurs Lesions should clear within treatment timeframe If no improvement in 1-2 weeks or condition worsens, see physician