Fungal infections

Question 1

What are fungal infections?

Answer 1

Infection that thrives in moist, humid, warm environments
More prevalent in sub/tropical areas.

Question 2

What causes skin infections

Answer 2

Dermatophytes (tinea): fungus affecting stratum cornea of epidermis and appendages. Contagious, classified on area.

• microsporum, epidermophyton, and trichophyton.
  Yeasts: candida or malassezia

Question 3

Signs and symptoms of tinea pedis (athletes foot)

Answer 3

Located on feet
Itchy, flaky, redness, moist
May have an unpleasant odour

Question 4

Signs and symptoms of tinea corporis

Answer 4

Located on trunk, legs, arms, neck
Pink or red scaly lesion, slightly elevated, well defined border
Active outer edge and clear centre
Mild to moderate itch
Singular, numerous, or overlapping lesions
Chronic form in skin folds

Question 5

Signs and symptoms of tinea unguium

Answer 5

Located on nails
Early signs: distal and lateral yellow/white discolouration
Later: nail thickens, plate lifts off bed
Nail becomes brittle and crumbles away/falls off

Question 6

Signs and symptoms of tinea capitis

Answer 6

Located on head
Asymptomatic or slightly itchy
Red and scaly, broken hair
Inflamed / pus-filled
In severe, fungal abscess may occur

Question 7

Signs and symptoms of tinea cruris

Answer 7

Located on the groin
Scaly red margin from groin to inner thighs
Defined, raised patches w/ small pustules
Clear centre
Mildly itchy

Question 8

Signs and symptoms of tinea manuum

Answer 8

Located on hands
Scaly, annular (round/circular) rash w/ active border

Question 9

Signs and symptoms of pityriasis versicolour

Answer 9

Commonly on upper trunk.
Discoloured patches (light-brown, patchy hypopigmentation)
Superficial light scaling if scratched
Normally asymptomatic, sometimes mild itch
No sun: red-brown circle lesions
Sun: infected lesions do not tan
Not infectious but is recurrent

Question 10

Signs and symptoms of oral candidiasis

Answer 10

White, creamy patches in mouth, easily wiped off
Red and sore under white coat
Infants- uncomfortable sucking
Adults- taste changes

Question 11

Signs and symptoms of vaginal candidiasis

Answer 11

Thick, white discharge
Non-offensive odour
Itch or soreness
Painful sexual intercourse
External dysuria

Question 12

Signs and symptoms of napkin candidiasis

Answer 12

Skin folds
Clusters of red papules and plaques
Demarcated lesions

Question 13

Topical treatment of fungal infections

Answer 13

Topical imidazoles (ketoconazole, miconazole) - creams, lotions, solutions. Continue for 14 days after symptoms resolve.

Terbinafine (Lamisil) - Cream, gel, solution. Rapid, once daily application, short use- 1 week, continue for 2-3 days after symptoms resolve.

Tolnaftate (tinaderm) - spray, powder. less effective.

Question 14

Topical treatment for tinea unguium

Answer 14

Amorolfine 5% nail lacquer (Loceryl)
- once to twice weekly for 6 months fingers, 9-12 mths for toes
- continue until nails are cured and regrown

Bifonazole 1% and Urea 40% (Canestan fungal nail)
- Intended for mild-moderate infection.
- Phase 1: weeks 1-3
keratinolytic agent that softens impacted nail to leave non-infected part intact. apply od for 2-3 wks.

Question 15

Explain systemic treatment of tinea

Answer 15

Indicated for nails, hairy areas, palms, soles.
If widespread
If unresponsive to topical.
If recurrent or previously treated w/ corticosteroids

Must confirm w/ microscopy and culture
Expensive and serious ADRs

Question 16

Tinea systemic treatment

Answer 16

Oral terbinafine (250mg) - od for 2-6weeks, up to 12 weeks. First line.

Fluconazole - 150mg once weekly for 4 weeks OR 50mg od for 2-6 weeks. Higher dose for nails, up to 52 weeks. Use if resistant to topical.

Itraconazole - 200mg bd after food for 1 week
3-4 mths toes
2 mths fingers
Use if terbinafine not tolerated. Monitor liver function.

Griseofulvin - feet/nails - 1g od until regrown, other areas - 500mg od 8-12weeks
Less effective, less tolerated, long duration.

Question 17

Pityriasis versicolor treatment

Answer 17

Topical antifungals- econazole 1% solution, ketaconazole 2%, micaonazole 2% (dose depending on brand)

Anti-infectives - selenium sulfide 2.5% shampoo.

Fluconazole 400mg - if topical unresponsive. Not PBS approved.

Itraconazole 200mg - prophylactic therapy.

Question 18

Oral candidiasis treatment

Answer 18

Miconazole 2% gel:
birth-2= 1.25ml
>2 yrs= 2.5ml
use 4 times daily after food for 7-14 days.

Nystatin oral suspension - 1ml in mouth swallowed 4 times daily after food for 7-14 days

Amphotericin lozenges - 1 4 times daily after food for 7-14 days

Continue treatment for several days after symptoms resolved

Question 19

Vulvo vaginal candidiasis treatment

Answer 19

Intravaginal antifungals - clotrimazole, miconazole, nystatin

Oral fluconazole - 150mg single dose. not for pregnant.

Boric acid 600mg - isolated w/ C.glabrata

Question 20

Male partner management

Answer 20

Not necessary = not sexually transmitted
Symptomatic = swab and treat
relieve discomfort w/ imidazole cream w/ 1% hydrocortisone

Question 21

Napkin candidiasis treatment

Answer 21

Topical corticosteroids:
hydrocortsione 1%
cause skin irritation
Used for 3-5 days for inflammation and discomfort

Severe:
methylprednisolone aceponate 0.1%
triamcinolone acetonide 0.02%

Topical antifungals +/- zinc oxide:
miconazole, clotrimazole, nystatin
treat for 14 days after symptoms resolve

Question 22

Referral of fungal infections

Answer 22

Unsure diagnosis
Severe
Unresponsive
Recurrent/chronic episodes

Question 23

Lifestyle changes for fungal infections

Answer 23

Keep skin dry and clean
Use separate towel for infected areas to prevent spread
Wear breathable/natural fabrics
Avoid wearing tight clothes
Don’t share clothes, towels, combs, hats.