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Dermatology > Fungal infections > Flashcards

Fungal infections Flashcards

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Dermatology Board Prep flashcards
1
Q

What is a mycid?

A

A mycid is a hyperergic reaction that develops from a remote localized infection with no detectable fungus in the lesions.

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2
Q

What is a dermatophytid?

A

A dermatophytid is a type of mycid caused by a dermatophyte infection elsewhere in the body.

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3
Q

What are the criteria for diagnosing a dermatophytid?

A

Criteria for a dermatophytid include:

Proven dermatophytosis elsewhere
No fungal elements in the lesions
Initial worsening under systemic antimycotics
Clearing after treating the dermatophytosis

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4
Q

What is the most common type of dermatophytid?

A

The most common dermatophytid is a symmetrical dyshidrotic mycid of the hands, often associated with inflammatory mycotic infections of the feet, especially by Trichophyton mentagrophytes.

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5
Q

What treatments are effective for dermatophytids?

A

Effective treatments include systemic antimycotic therapy, short-term oral glucocorticosteroids, and a topical combination of an antifungal and glucocorticosteroid.

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6
Q

What is the overtreatment phenomenon?

A

The overtreatment phenomenon is a flare-up reaction that can occur with the initiation of systemic antifungal therapy, which can be managed with topical and systemic treatments.

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7
Q

What is the first-line topical treatment for tinea corporis?

A

An imidazole cream or Whitfield’s ointment applied twice daily for a minimum of 4 weeks.

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8
Q

How long should treatment for tinea corporis continue after symptoms have cleared?

A

Treatment should continue for one week after symptoms have cleared.

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9
Q

What is the systemic treatment for multiple, widespread lesions of tinea corporis in adults?

A

Griseofulvin 500 mg once daily for 2 to 6 weeks.

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10
Q

What is the dosage of griseofulvin for children with tinea corporis?

A

Griseofulvin 10–15 mg/kg once daily for 2 to 6 weeks.

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11
Q

What alternative systemic treatments are available for tinea corporis in adults?

A

Ketoconazole 200 mg once or twice daily or itraconazole 200 mg (2 tabs) once daily for 2 to 4 weeks.

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12
Q

What can be added to the treatment regimen if there is severe itching with tinea corporis?

A

A mild steroid may be added to the treatment regimen.

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13
Q

What is the first-line oral treatment for tinea capitis in adults?

A

Griseofulvin 500 mg once daily for 8-12 weeks.

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13
Q

What is the recommended dosage of griseofulvin for children with tinea capitis?

A

Griseofulvin 10-15 mg/kg once daily for 8-12 weeks.

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14
Q

What topical treatments can be added for tinea capitis?

A

Whitfield’s ointment or miconazole applied twice daily for 4 weeks.

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15
Q

What should be done if tinea capitis does not clear after 12 weeks of treatment?

A

Continue treatment if the infection has not cleared completely after 12 weeks.

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16
Q

What are the alternative systemic treatments for tinea capitis in adults

A

Ketoconazole 200 mg twice daily, terbinafine 250 mg once daily, or itraconazole 200 mg once daily for 4-8 weeks.

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17
Q

What should be done to prevent the spread of tinea capitis?

A

Check for signs of infection in siblings, friends of affected children, pets, or farm animals (bald patches, rash) and treat them.

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18
Q

How should a bacterial superinfection associated with tinea capitis be treated?

A

Use antiseptics and/or antibiotics to treat bacterial superinfection.

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19
Q

What is the usual treatment for thickened toenails due to tinea unguium?

A

Usually, no treatment is required. Thickened toenails may be softened using Whitfield’s ointment or urea 10-40% ointment and then thinned with a stone or a file.

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20
Q

When is systemic treatment indicated for infected toenails in tinea unguium?

A

Systemic treatment is indicated when there is pain or when the patient is young.

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21
Q

What is the recommended systemic treatment for infected toenails in adults with tinea unguium?

A

Griseofulvin 500 mg once daily until the affected nails have grown out completely, which may take a year or longer.

22
Q

What is the treatment duration for griseofulvin in fingernail infections?

A

Continue griseofulvin treatment until the affected nails have grown out completely, which may take 4-9 months.

23
Q

What should be considered if there is no improvement in fingernail infection after 2-4 months of griseofulvin treatment?

A

There may be a mixed infection or resistance to griseofulvin, and a systemic azole like ketoconazole, itraconazole, or terbinafine should be considered.

24
Q

What is the alternative treatment for tinea unguium if griseofulvin is ineffective?

A

Ketoconazole 200 mg once daily until symptoms clear, or itraconazole 200 mg once daily for 3 months, or itraconazole 200 mg twice daily for 1 week per month during 3 months, or terbinafine 250 mg once daily for 6-16 weeks.

25
Q

How should chronic paronychia be managed?

A

Keep the area dry, adapt work conditions if necessary, bathe in betadine or potassium permanganate solution, apply an imidazole cream or GV paint twice daily, and massage the nailfold with a mild steroid to decrease swelling.

26
Q

What is the mechanism of action of Griseofulvin?

A

Griseofulvin works by inhibiting microtubule function in fungal cells, disrupting mitosis, and acting as a fungistatic agent. It is deposited in keratin-rich tissues (skin, hair, nails), making them resistant to fungal invasion. Griseofulvin is selective for dermatophytes, such as Trichophyton, Microsporum, and Epidermophyton species.

27
Q

What is athlete’s foot?

A

Athlete’s foot is a condition characterized by itchy, often macerated whitish scaling lesions and inflammation of the skin in the interdigital spaces of the foot, most commonly between the 4th and 5th toe

28
Q

What causes athlete’s foot?

A

Athlete’s foot can be caused by fungi or bacteria. It is often seen in people wearing rubber boots or rubber/plastic shoes.

29
Q

What is the key management strategy for athlete’s foot?

A

Keep the space in-between the toes dry by drying thoroughly after washing, exposing to air, using betadine scrub, GV paint, wearing cotton socks, and avoiding tight or hot shoes.

30
Q

How can one prevent re-infection of athlete’s foot?

A

Prevent re-infection by changing socks daily and keeping the feet dry.

31
Q

What topical treatments are recommended for athlete’s foot?

A

Use an imidazole cream or Whitfield’s ointment twice daily until a week after symptoms have cleared, usually a minimum of 4 weeks.

32
Q

What is pityriasis versicolor?

A

Pityriasis versicolor is a common, chronic, superficial fungal infection caused by the yeast Pityrosporum, usually resulting in cosmetic complaints.

33
Q

What factors can make Pityrosporum pathogenic?

A

Factors include warmth and humidity, pregnancy, serious underlying disease, or genetic predisposition.

34
Q

How does pityriasis versicolor typically present?

A

It presents as dandruff on the scalp, with the infection spreading to the neck and upper trunk.

35
Q

What is a key step in managing pityriasis versicolor?

A

Scrubbing the skin with a brush to remove infected scales

36
Q

What should be avoided when treating pityriasis versicolor?

A

Avoid using Vaseline, olive oil, or palm oil.

37
Q

What topical treatments are recommended for pityriasis versicolor?

A

Use an imidazole cream twice daily on affected areas for 4 weeks, and consider selenium sulfide shampoo or ketoconazole 2% shampoo for widespread lesions or recurrences.

38
Q

What oral treatments are recommended for severe recurrent cases of pityriasis versicolor?

A

Ketoconazole 400 mg stat, ketoconazole 200 mg once daily for 5 days, or itraconazole 200 mg once daily for 1 week.

39
Q

How do you determine if the treatment of pityriasis versicolor is complete?

A

The treatment is complete when all the scales have disappeared. Test by stretching affected skin; if scales appear, the infection is still active.

40
Q

How should large oozing lesions from candidiasis be treated?

A

Treat with potassium permanganate dressings or baths for 10 minutes twice daily, and keep the lesional skin dry.

41
Q

What is recommended for treating mucosal or smaller wet lesions in candidiasis?

A

Paint the lesions with Gentian Violet solution once daily until healed.

42
Q

How is oral candidiasis treated with nystatin?

A

Use nystatin oral suspension, 1 ml swirled around the mouth four times daily until two days after clinical cure.

43
Q

What is the treatment for vaginal candidiasis?

A

Use nystatin pessaries nightly for 2 weeks.

44
Q

What topical treatment is recommended for skin infections caused by candidiasis?

A

Use an imidazole cream twice daily.

45
Q

How should oral thrush be treated with miconazole?

A

Use miconazole oral gel, 5 ml four times daily for 1 week.

46
Q

What is the treatment for nappy rash caused by candidiasis?

A

Apply an imidazole cream and cover with zinc oxide cream or ointment.

47
Q

What systemic antifungal treatments are recommended for severe cases like esophageal thrush?

A

Use ketoconazole 200 mg twice daily for 1-2 weeks, itraconazole 100 mg once daily for 2 weeks, or fluconazole 50-200 mg once daily for 1-2 weeks

48
Q

What is the recommended treatment for smaller mycetoma lesions?

A

Smaller lesions that can be surgically removed without causing disability should be radically excised.

49
Q

How should the origin of mycetoma be determined before starting drug therapy?

A

Determine whether the mycetoma is of fungal or bacterial origin through direct microscopy of pus containing grains and culture. Eumycetomas show hyphae, while actinomycetomas show small slender filaments.

50
Q

What is the primary difference between eumycetoma and actinomycetoma?

A

Eumycetoma is caused by fungi, whereas actinomycetoma is caused by bacteria.

51
Q

What is the success rate of antifungal treatment for eumycetoma?

A

Antifungal treatments like itraconazole, fluconazole, ketoconazole, miconazole, and griseofulvin have a success rate of less than 30% for eumycetoma.

52
Q

hat medications are used to treat actinomycetoma?

A

Dapsone or cotrimoxazole combined with streptomycin are used to treat actinomycetoma. Streptomycin can be substituted by amikacin, and sulfonamides by rifampicin.

53
Q

What is often the last resort for treating mycetoma when drug therapy fails?

A

Radical surgery or amputation is often the only option when drug therapy fails.

Dermatology (41 decks)

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