Fungal Infections

Question 1

What commonly causes fungal infections on the skin, hair and nails?

Answer 1

Dermatophytes, yeast (Candida, Malassezia)

Question 2

How are fungal infections spread?

Answer 2

Direct contact from other people, animals, soil and from formites

Question 3

What are the most common genres of dermatophytes?

Answer 3

Trichophyton, Microsporum, Epidermophyton

Question 4

What parts do fungus target?

Answer 4

Stratum corner of epidermis and nail keratin

Question 5

Where does tinea pedis most commonly occur?

Answer 5

Between the toes (can spread to instep or sole)

Question 6

What is the recommended frequency and duration for treatment of tinea pedis/cruris/corporis?

Answer 6

OD-BD, 2-6 weeks + ≥1 week after sx resolved

Question 7

How many days should combination of antifungal and corticosteroid be used for?

Answer 7

7-10 days, then use antifungal alone

Question 8

Why does tinea capitis require systemic treatment?

Answer 8

Dermatophytes are found at the hair follicle root, which is not accessible by topical treatments

Question 9

Adjunctive tinea capitis treatment? and duration

Answer 9

Selenium sulfide (1-2.5%), ketoconazole (2%), povidone iodine for the first 2 weeks

Question 10

Is oral or topical treatment better for onychomycosis? Why?

Answer 10

Oral (systemic)
Topical penetrate poorly to the nail bed

Question 11

What is monotherapy of topical lacquers most suitable for?

Answer 11

Distal subungual onychomycosis affecting <50% of nail without involvement of lunula, white superficial onychomycosis and when less than 3 nails are affected

Question 12

How often should you apply clotrimazole powder? Can it be used as main treatment?

Answer 12

BD-TDS, continue for 2 weeks after disappearance of symptoms

Only used as adjunct to cream or prophylactic in preventing new or recurrent infection (not rubbed into skin -> less effective)

Question 13

Administration and frequency of nystatin suspension?

Answer 13

Swish and swallow QDS, up to 14 days

Question 14

Nystatin is a P+ drug. What are the requirements and maximum dose and duration?

Answer 14

Indication: treatment of oral candidiasis

Minimum age: 6 months

Maximum daily dose:
· Infants and children 6 months and older: 400,000 units
· Adults: 2.4 million units

Maximum supply: 2 weeks

Question 15

Frequency of topical itraconazole, ketoconazole, clotrimazole, miconazole, sertaconazole?

Answer 15

Itraconazole: OD
Ketoconazole: OD
Clotrimazole: BD (powder: BD-TDS)
Miconazole: BD-TDS (powder: BD but OD if used with cream; oral gel QDS)
Sertaconazole: OD-BD

Question 16

Frequency and duration of topical tolnaftate, terbinafine?

Answer 16

Tolnaftate: BD for 2-4w
Terbinafine: OD for 7 days

Question 17

Frequency and duration of topical combination of anti fungal and corticosteroid?

Answer 17

OD-BD, 7 days (if symptoms still persist, continue with steroid-free preparation)

Question 18

Frequency and duration of amorolfine for nail fungus infection?

Answer 18

1-2 times per week
6 months for fingernails
9-12 months for toenails

Question 19

Fluconazole is a P+ drug. What are the criteria for purchase?

Answer 19

· Indication: Vaginal Candidiasis
· Maximum daily dose: 150mg
· Maximum supply: 1 tablet (150mg)
· Min age: 16 years. Not recommended in adults older than 60 years of age. (max)

Question 20

How to differentiate between bacterial vaginosis, trichomoniasis and candidiasis?

Answer 20

Bacterial: off-white / discoloured discharge (green, grey, tan), sometimes foamy, fishy smell, no itch
Trichomoniasis: scanty to profuse yellow greenish discharge (frothy), offensive smell, itch
Candidiasis: thick curdish discharge, non-offensive smell, itch & soreness