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Integumentary > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

Define: dermatophytoses

A

superficial mycotic infections of the skin

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2
Q

Where do fungi live?

A

Within keratin layers of the epidermis, in nails, and in hair

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3
Q

What typically causes fungal infections?

A
  1. Trichophyton
  2. Epidermophyton
  3. Microsporum
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4
Q

What are the three main reservoirs for exposure to fungal infections?

A
  1. Humans
  2. Animals
  3. Soil
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5
Q

What are the risk factors for fungal infections?

A
  1. Sweating/sweaty clothing
  2. Many skinfolds
  3. High humidity
  4. Not bathing regularly
  5. Sedentary lifestyle
  6. Bed confinement
  7. Compromised immune system
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6
Q

Describe the general appearance of fungal infection

A

central clearing surrounded by advancing red, scaly, elevated border

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7
Q

Describe the general appearance of fungal infections of the nail

A

chalky, dull, yellow or white discoloration, and thick but brittle nail

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8
Q

What are the diagnostic tools?

A

KOH test or fungal cultures (usually for when systemic meds are needed)

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9
Q

What is tinea pedis?

A

Athlete’s foot

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10
Q

What is the most common type of external fungal infection?

A

Athlete’s foot

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11
Q

What are the common sources of tinea pedis?

A

locker room floors and occlusive footwear

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12
Q

What are the four different types of tinea pedis?

A
  1. interdigital type (most common)
  2. chronic hyperkeratotic
  3. Vesiculobulous
  4. Acute ulverative
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13
Q

What is the general treatment for athlete’s foot?

A

topical therapies for 2-4 weeks for mild cases

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14
Q

About what percentage of tinea pedis cases reoccur?

A

About 70%

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15
Q

Preventative measures for tinea pedis

A
  1. avoid heat, moister, and maceration
  2. dry areas thoroughly
  3. talc or antifungal powder
  4. loose and non-occlusive footwear
  5. frequent laundry with hot water
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16
Q

What is tinea manuum?

A

involves palmar surface of hands

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17
Q

What is the treatment for tinea manuum?

A

similar to tinea pedis

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18
Q

What is tinea cruris?

A

jock itch

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19
Q

What is the treatment for jock itch?

A

topical treatment for 1-2 weeks after symptom resolution (usually 2-4 weeks)

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20
Q

What is tinea corporis?

A

ringworm

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21
Q

What is the treatment for tinea cruris?

A

Similar to jock itch

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22
Q

Which topical fungals may better prevent recurrence?

A

butenafine, terbinafine, and naftifine

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23
Q

Which antifungal can only be used for athlete’s foot?

A

Sertaconazole

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24
Q

Which antifungals can’t be used for tinea versicolor?

A

Luliconazole, naftifine, and sertaconazole

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25
Q

What is tinea capitis?

A

infection of the scalp, hair follicles, and surrounding skin

26
Q

What are the two presentations of tinea capitis?

A

Grey patch and black dot

27
Q

What type of therapy is recommended for tinea capitis?

A

Topical plus oral therapy

28
Q

What are the oral therapies for tinea capitis?

A
  1. griseofulvin
  2. terbinafine
  3. itraconazole
  4. fluconazole
29
Q

What has been the gold standard for treatment of tinea capitis?

A

griseofulvin

30
Q

What are the side effects of griseofulvin?

A

photosensitivity, HA, and GI upset

31
Q

What does griseofulvin do to metabolism?

A

strong inducer of CYP450

32
Q

Which type of fungus is griseofulvin more effective in compared to terbinafine?

A

microsporum

33
Q

Which type of fungus is terbinafine more effective in compared to griseofulvin?

A

trichophyton

34
Q

What are the shampoos used to treat tinea capitis?

A

selenium sulfide, zinc pyrithione, povidone iodine, and ketoconazole

35
Q

What is tinea barbae

A

infection of facial hair

36
Q

What is the treatment of tinea barbae?

A

similar to tinea capitis

37
Q

What is tinea versicolor?

A

chronic, asymptomatic, superficial fungal infection

38
Q

What fungus causes tinea versicolor?

A

malassezia

39
Q

What is the treatment for tinea versicolor?

A

topical treatment applied from neck to waist

40
Q

What are the topical treatments for tinea versicolor?

A
  1. selenium sulfide shampoo applied for 10-15 minutes followed by a shower for a week
  2. ketoconazole 2% shampoo applied to affected area for 10-15 minutes for a week
  3. antifungal creams
41
Q

What is tinea unguium?

A

fungal infection of the nail

42
Q

What are the risk factors for tinea unguium?

A
  1. age > 40
  2. family hx
  3. immunodeficiency
  4. diabetes
  5. psoriasis
  6. PVD
  7. smoking
  8. nail trauma
  9. tinea pedis
43
Q

What is the clinical presentation of tinea unguium?

A

yellow or white, thickened nails. starts on the distal edge and progresses. the nail becomes brittle and begins to crumble

44
Q

When is it ok not to treat onychomycosis?

A

when minimal toenail is involved and there are no associated symptoms

45
Q

What are the first line options for onychomycosis?

A

itraconazole and terbinafine

46
Q

What is the black box warning on ketoconazole?

A

hepatotoxicity

47
Q

What is the PK profile of itraconazole?

A

fungiostatic, lipophilic, and keratinophilic

48
Q

How long does itraconazole stay in the nail after therapy?

A

27 weeks

49
Q

When is itraconazole contraindicated?

A

heart failure

50
Q

What are the adverse effects of itraconazole?

A

N/V/D, abdominal pain, edema, rash, HA, abnormal LFTs

51
Q

What are the adverse effects of fluconazole?

A

HA, N/V, abdominal pain, diarrhea, and dyspepsia

52
Q

When do you reduce the dose of fluconazole by 50%?

A

In CrCl < 50 mL/min

53
Q

What is the MOA of terbinafine?

A

blocks the synthesis of ergosterol via squalene epoxidase

54
Q

When is terbinafine not recommended?

A

in active hepatic disease or CrCl < 50 mL/min

55
Q

What has terbinafine been known to cause?

A

hepatic failure, neutropenia, and serious skin reactions

56
Q

What are the adverse effects of terbinafine?

A

rash, pruritus, diarrhea, dyspepsia, abdominal pain, nausea, HA, liver enzyme abnormality, and taste disturbance

57
Q

What two labs should be used to monitor terbinafine?

A

a CBC and serum transaminase

58
Q

What are the three topical options for onychomycosis?

A

ciclopirox, efinaconazole, and tavaborole

59
Q

What is the MOA of tavaborole?

A

inhibits aminoacyl-transfer ribonucleic acid synthetase which inhibits fungal protein synthesis

60
Q

What are the adverse effects of tavaborole?

A

erythema, dermatitis, and ingrown toenails

61
Q

What is the adverse effect of efinaconazole?

A

dermatitis

62
Q

What is the adverse effect of ciclopirox?

A

erythema

Integumentary (5 decks)

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