Foot care [completed] Flashcards
What is athlete’s foot?
Athletes foot or tinea pedis is a fungal skin infection of the foot
What are the most common fungi responsible for athlete’s foot?
Trichophyton rubrum
T. interdigitale
Epidermophyton floccosum (less common)
Is athletes foot more common in men or women?
TWICE as common in men
What age group is athletes foot most common in?
Adults aged 15-40
Risk increases with age.
What are some risk factors for developing athletes foot?
- Having damp feet
- Walking barefoot in communal areas
- Sharing bed linen, towels or shoes with an infected person
- Immunocompromised
- Working in hot, humid climates or in high temperatures
What are the symptoms of athletes foot?
Itchiness/redess between toes
Dry flaky skin
maceration (skin is white and soggy)
Splitting/fissures
Burning, inflammation and pain
Unpleasant smell
What is usually the first symptom to occur in athletes foot?
A rash between the 4th and 5th toe.
Is athletes foot superficial?
Yes
Why does athletes foot need to be treated quickly?
Can spread to the soles and sides of the foot as well as the nailbeds (ONYCHOMYCOSIS)
What is moccasin-type athletes foot?
Affects the whole sole and sides of feet. sole is covered in silvery fine scales and skin is inflamed.
Most patient with moccasin-type athletes foot will also have….
onychomycosis
Why does mocassin-like athletes foot need to be referred to the GP?
Usually resistant to topical antifungals
What is vesicular/vesicubullous-type athletes foot?
Small hard blisters on the instep/arches and soles of feet due to an allergic reaction to the fungal infection.
What should we do if a patient presents with vesicular/vesicobullous athletes foot
Refer when severe.
Terbinafine 1% cream for athletes foot
Licensed in 12+ only
Apply thinly to the affected area once or twice a day for up to 7 days.
Clotrimazole 1% cream for athletes foot
Apply to the affected area 2–3 times a day and continue for at least 4 weeks. A strip of cream about half a centimetre long is enough to treat an area about the size of the hand.
Miconazole 2% cream for athletes foot
LICENSED IN ADULTS AND CHILDREN
Apply to the affected area twice a day for 2–6 weeks depending on the severity of the lesions, and continue for 10 days after all skin lesions are healed.
Econazole 1% cream
Apply to the affected area twice a day and continue until all skin lesions are healed.
What drug interaction IS RARE with topical miconazole and econazole?
Oral anticoagulants as antifungals are being applied topically. Use with caution
When may hydrocortisone 1% cream be supplied?
If there is an associated marked inflammation and no other contraindications - to be applied ONCE DAILY FOR SEVEN DAYS
THEN SWITCH BACK TO JUST ANTIFUNGAL
What treatments are not recommended in athletes foot?
Tea tree oil
How can athletes foot be prevented?
Wash feet regularly and dry thoroughly especially between toes
Wear sandals in communal areas
Keep feet dry and cool
Wear cotton socks and change them regularly
Do not wear tight fitting occlusive shoes for long periods of time
Change shoes every 2-3 days
Antifungal powders can be put into shoes
Keep toenails clean and short
Do not scratch infected areas - wash hands after touching
Do not share towels and wash them frequently
What is a verruca?
Wart at the bottom of the foot or on toes with a black dot in the middle.
What are veruccas caused by?
HPV
How may a verruca feel when patient walks?
Pressing, sharp pain
Does a verucca always have to be treated?
No as they can resolve spontaneously although this can take up to 2 years with most patients and 5-10 years for some.
What is the common active ingredient in many verucca treatments?
Salicylic acid
Name some salicylic acid containing products?
Duofilm
Bazuka
Salactol
Scholl medicated plasters
Who should not use topical salicylic acid?
Children under 2
Children or teenagers who have just had a viral infection
Topical salicylic acid should not be used on:
The face.
Intertriginous or anogenital regions.
Moles or birthmarks.
Mucous membranes.
Warts with hair growing out of them, red edges, or an unusual colour.
Open wounds, irritated or reddened skin, or any area that is infected.
Areas of poor healing, such as neuropathic feet, or in those with impaired blood circulation.
Topical salicylic acid should not touch healthy skin as it can cause burning. How can this be avoided?
Applying a thin layer of vaseline around the verucca to protect the skin.
Salactol contains lactic acid. What does this do?
Softens the skin of the verucca
How is topical salicylic acid applied to veruccas?
Usually once a day at night
Debride verucca with emery board and soften skin by soaking in warm water
Peel off any film from the previous application
Protect surrounding area with vaseline
What reactions may topical salicylic acid cause?
Chemical burns
Skin irritation
Allergic dermatitis
Skin discolouration
What is cryotherapy?
When the verucca is frozen off using liquid nitrogen by a healthcare professional.
How many cycles of cryotherapy will a person need?
Differs from person to person but usually every 2-3 weeks up to 6 cycles.
Who should not receive cryotherapy?
People with an uncertain diagnosis or a possible malignancy.
Young children (who may find it too painful).
Distal extremities in people with:
Raynaud’s syndrome.
Peripheral vascular disease.
Peripheral neuropathy.
Periungual sites — this is painful and there is a risk of subungual haemorrhage and nail deformity.
For warts that are over tendons or near superficial nerves