David Taylor Flashcards
When can terbinafine not be used?
> 12 years old only.
How can ringworm be treated?
Topical azoles.
Topical corticosteroids can be added.
When would oral therapy be considered for ringworm?
Topical failure, Immunocompromised, Widespread infection. Griseofulvin is rarely given. Terbinafine 250mg daily. (2-4wks in T.cruris, 4wks T.corporis)
What doses of itraconazole should be given orally for ringworm?
100mg daily for 15 days
OR
200mg daily for 7 days.
How should Tinea Capitis be treated?
Orally plus shampoos.
- terbinafine creams twice weekly.
Griseofulvin 1g daily or in divided doses for 8-10 weeks (and 2 weeks after symptoms improve). [microsporum]
Terbinafine 250mg daily for up to 4 weeks. (unlicensed) [trichophyton]
In what patients is griseofulvin contraindicated?
Patients with severe liver disease and systemic lupus erythematous. (SLE)
Breast feeding.
Avoid during pregnancy and for one month after treatment stops, men should not father children for 6 months after treatment ends.
AVOID IN LIVER FAILURE/DISEASE
What dose of terbinafine should be given orally for ringworm treatment?
250mg daily.
2-4wks in T. cruris, 4wks T. corporis
Why are long courses of griseofulvin needed?
Does not persist in keratinous tissue after end of therapy.
Narrow therapeutic window.
What dose of terbinafine is given for Tinea Capitis?
250mg daily for up to 4 weeks.
How does the use of terbinafine to ringworm vary?
Terbinafine 250mg daily (2-4wks in T. cruris, 4wks T. corporis)
What effect does griseofulvin have on alcohol?
Potentiates it, may impair driving ability.
Take with or after fatty food.
What is the first line treatment of athletes foot?
Imidazole cream for 2-4 weeks
Terbinafine cream for 1 week in over 12s.
What dose of griseofulvin should be given orally for severe athletes foot?
500mg daily or in divided doses for 4-8 weeks.
And for 2 weeks after symptoms are resolved.
In what patients should the use of terbinafine be avoided?
Pregnancy, liver disease, severe renal impairment.
Why dose terbinafine concentrate in the dermis, epidermis and adipose tissue?
Lipophilic drug.
With what should griseofulvin be taken?
Take with or after fatty food.
What is the first step to treating onchomycosis?
Nail clippings or scrapings.
What is the first line treatment for onchomycosis via dermatophytes?
Terbinafine 250mg daily for 6 weeks to 3 months for finger nails and 3-6 months for toe nails.
Itraconazole (pulse therapy) 200mg BD for 7 days, subsequent courses at 21 day intervals, 2 pulses for finger nails, 3 pulses for toenails.
Amorolfine is used for
Only suitable for mild and superficial disease in up to 2 nails, OR people who cannot take systemic agents.
Apply once or twice weekly, 6 months finger nails, 9-12 months toe nails
What is Pityriasis versicolor?
Multiple macules and/or patches of variable appearance (hypopigmented, hyperpigmented, dark brown or erythematous) surrounded by normal skin are the typical lesions of pityriasis versicolor. The extension and severity of the lesions tend to be worse in tropical climates. Affected areas include the back, chest, abdomen, neck, and upper limbs. However, classically the back carries more lesions. The face is an area commonly affected in children and it is the forehead showing mostly hypopigmented macules that is found.
What is a useful, rapid and easy way to confirm the diagnosis of pityriasis versicolor?
Wood’s lamp. Yellow to yellow-green fluorescence is characteristic of fine scales taken from active lesions. Although the sensitivity of this procedure is reduced when patients have taken a recent shower.
How is pityriasis versicolor treated topically?
Ketoconazole shampoo
Selenium sulphide shampoo [unlicensed]
Clotrimazole, econazole, ketoconazole or miconazole creams if infection is mild and small area affected
How is pityriasis versicolor treated systemically?
If topical fails or infection is widespread
Itraconazole 200mg daily for 7 days
OR fluconazole 50mg daily for 2 to 4 weeks
Miconazole oral gel for 7 days is to treat:
Oropharyngeal candidia
Polyene antifungals like nystatin suspension are 2nd line for
Oropharyngeal candidia
7 days
What oral therapies are there for Oro-Candida?
Fluconazole
50mg daily for 7-14 days.
14 days for atrophic with dentures.
Topical imidazoles for what duration are effective for uncomplicated vuvlvovaginal candidiasis?
Clotrimazole
Econazole
Miconazole
1-3 day
Oral treatment for vuvlvovaginal candidiasis?
fluconazole (150mg stat) or itraconazole (200mg BD for one day)
Fluconazole at what dose is for ORPC?
50mg daily for 7-14 days.
Treatment options for head lice: [3]
Wet combing
Physical insecticide
Chemical insecticide
What products are first-line for head lice?
Silicone based
Works to physically immobile the lice and disrupt water regulatory processes.
Examples:
Dimeticone 4% [Hedrin]
Dimeticone 92% [NYDA]
Full Marks Solution [isopropyl myristate and cyclomethicone]
What is Malathion?
Organophosphate anti-headlice treatment - concerns over resistance.
What is Permethrin?
Lyclear cream rinse - synthetic pyrethroid, 10 minute application - not recommended.
How is scabies diagnosed?
Skin scrappings of the affected area.
Norwegian scabies is common in who?
It is a hyperinfestion - presents with hyperkeratotic crusts. Common in immuno-compromised patients.
How can Norwegian scabies be treated?
Ivermectin - unlicensed and for named-patient treatment.
Works by blocking the action of GABA.
How should crab lice be treated?
Permethrin 5% cream or Malathion are effective.
How should eye lash crabs be treated?
Inert occlusive eye ointment such as simple eye ointment or an insecticidal shampoo or lotion.
