Fungal Infections

Question 1

What products would you recommend for ringworm, athletes foot and jock itch?

Answer 1

Athlete’s Foot/ringworm: first line, pregnant women:
Daktarin®
- Miconazole 2% cream
- Apply a thin layer twice a day
- Use Daktarin Powder® inside shoes
- Use lotion for infections of the body

Jock itch:

• Resolve Jock Itch®
• Miconazole 2% cream

Athlete’s foot: Patients for whom compliance is likely to be a problem:
Lamisil®
- Terbinafine 1%
- Apply a thin layer once or twice a day (for at least 1 week for interdigital athlete’s foot)

Athlete’s foot: Patients who want a quick-fix:
Lamisil Once®
- Terbinafine 1%
- Apply once to both feet (covering entire foot), allow to dry for 1-2 mins, wash off 24 hours later

Question 2

What are the treatment options for onychomycosis (fungal nail infection)?

Answer 2

Available treatment options:
- Systemic tx more effective than topical tx
- Systemic treatment: for proximal nail disease or severe nail-bed involvement
o Terbinafine
o Itraconazole/fluconazole
o Griseofulvin
- Topical treatment (amorolfine) for superficial infection or infection involving distal ends of nails

Amorolfine
- Loceryl Nail Lacquer® (5%)
- Not effective when the nail matrix is involved
- Pregnancy: No
- Breastfeeding: No
- Children: No
- Apply once or twice a week for:
o 6 months for finger nails
o 12 months for toe nails
(Continue use until the nails are completely cured and regrown. This should take roughly the period of time stated above)

• Directions for use:
  o File down the infected areas on the infected nail. Dispose of the nail file afterwards (do not use on a healthy nail)
  o Clean and degrease the nail surface with the cleaning pad provided
  o Dip the spatula into the lacquer
  o Paint over the entire nail surface
  o Close the bottle tightly
  o Allow 3-5 minutes for the nail/s to dry
  o Clean the spatula and the neck of the bottle with the same cleaning pad
  o Be careful not to let the lacquer contact skin
• Do not use cosmetic lacquers, artificial nails or occlusive dressings during treatment
• Adverse effects: erythema, itch, burning

Non-drug measures

• Treat any tinea at the first sign of symptoms, as it may progress to involvement of the nail
• Avoid passing on the infection to other toe nails

What self-care card can be given
- Tinea

When to refer

• Severe/resistant fungal nail infections should be referred to the doctor for systemic oral treatment, or removal of the nail
• Diabetics