Fungal infections and warts Flashcards
tinea refers to
dermatophyte infections
____ of the US population suffer from a tinea infection at any one time
10-20%
what increases risks of fungal infections
trauma to the skin; esp. if it produces blisters
transmission of fungal infections
through contact with infected people. animals, soils, or fomites
inoculation of fungus
penetration of fungus into the skin
incubation of fungus
growth of infection inside stratum corneum
fungal growth rate must be
greater than two times epidermal turnover rate or the fungus will be shed quickly
involution of fungus
resolution of infection after an adequate immune response
signs and symptoms of fungal infection
- mild itching and scaling
- denudation: losing outside layer of skin
- fissuring: break in skin
- crusting
- discoloration
risk factors for fungal infections
- age (more common in children)
- contact sports
- restrictive clothing and shoes
- weak immune system (diabetes, HIV)
- sex (more often in men)
- race (AA female children)
- poor hygiene
tenia pedis location and characteristics
- location: feet
- Characteristics: chronic intertriginous
chronic intertriginous
toe webs, scaling, fissures, maceration of interdigital spaces, malodor, pruritus, and stinging sensation
tinea corporis location and characteristics
- location: any smooth and bare skin
- characteristics: start as small circular, erythematous, scaly areas; spread peripherally, borders may contain vesicles or pustules
tinea cruris location
medial and upper parts of thigh and pubic area (more common in males)
tinea cruris characteristics
bilateral, pruritic, scaly lesions
acute lesions: bright red
chronic lesions: hyperpigmented appearance
pain may occur with sweating
tinea capitis location
scalp
4 kinds of tinea capitis
- non-inflammatory
- inflammatory
- black dot
- favus variant
non-inflammatory tinea capitis
- small papules
- spread centrifugally
- some scaling
- hair in lesions (dull gray color)
inflammatory tinea capitis
- pustules or kerion (weeping lesions)
- pruritis
- fever
- pain
- regional lymph node enlargement
black dot tinea capitis
- broken hair shaft (hair loss) –> black dots
- inflammation
- scaling
favus variant tinea capitis
- patchy hair loss
- scutula (yellow crust and scales)
- lesions can merge
- can lead to secondary bacterial infections
tinea unguium location and characteristics
location: nails
characteristics: opaque, thick, rough, yellow and friable nails (may separate from nail bed if infection progresses)
treatment goals for fungal infxn
- symptomatic relief
- eradicate infection
- prevent future infections
tinea types for self-treatment
tinea pedis, tinea corporis, tinea cruris
fungal nail revitalizer
(for unguium, WILL NOT TREAT)
- reduces discoloration and smooths out nail
- contains calcium carbonate and urea
- apply over infected nail and scrub with nail brush for 1 min, wash and dry (daily for three weeks)
exclusions for self treatment of fungal infxn
- causative factor unclear
- unsuccessful initial treatment or worsening of condition
- nails or scalp involved
- face, mucous membranes, or genitalia involved
- signs of possible bacterial infection
- excessive and continuous oozing
- condition extensive, seriously inflamed, or debilitating
- diabetes, systemic infection, immune deficiency
- fever and/or malaise
non pharm treatment of fungal infxn
- keep skin clean and dry
- avoid sharing personal articles
- wash contaminated towels
- do not wear clothing or shoes that causes skin to stay wet
- dust shoes with foot powder to keep them dry
- avoid contact with people who have infection
topical antifungals
- clotrimazole
- miconazole nitrate
- terbinafine HCl
- butenafine HCl
- tolnaftate (prevention too)
- undecylenic acid, clioquinol
considerations when using topical antifungals
- creams or solutions are most effective
- sprays and powders more prophylactic
- symptom relief within 1 week but complete therapy
- recommended treatment for at least 1-4 weeks
duration of tx for tinea pedis and tinea corporis
4 weeks
duration of tx for tinea cruris
2 weeks
application of topical antifungal
mostly twice daily (except butenafine and terbinafine)
butenafine application
tinea pedis: BID for 1 week or 1 QD for 4 weeks
tinea cruris/corporis: 1 qd for 2 weeks
terbinafine application
1 qd for 1 week
potential adverse effects of topical antifungals
mild skin irritation, redness, itching, burning/stinging
active ingredient
- lotrimin AF cream and solution
- lotrimin spray and powder
- lotrimin ultra
- clotrimazole 1%
- miconazole nitrate 2%
- butenafine HCl
salts of aluminum useful when
in combo with topical antifungals for wet, soggy tinea pedis lesions or inflammatory type
salts of aluminum serves two purposes
astringent action and antibacterial activity to prevent secondary bacterial infections (at concentrations > 20%)
apply salts of aluminum before or after antifungal?
before and can be used up to 1 week
if no fissures then use
- aluminum acetate solution
- 20-30% aluminum chloride solution
apply bid until odor or wetness goes away then 1 qd for 1 week
if deep fissures are present then use
lower concentration 10% aluminum acetate or chloride
apply bid until fissures heal; then higher concentrations
______ percent of general population have warts
7-10
peak incidence of warts
12-16 years old
percentage of warts that clear in
- two months
- three months
- two years
- 23%
- 30%
- 65-78%
warts are caused by
HPV, type of HPV dictates type of wart and location
infection of wart occurs
through person to person contact, autoinoculation, or fomites
common wart type
verruca vulgaris
found on hands. typically skin or brown colored; dome shaped papules with a rough cauliflower-like appearance and painless. common in children
plantar warts
verruca plantaris
found on feet. skin colored, flat, callous-like papules; may be painful, esp. if in a weight-bearing location; common in adolescents and young adults
May be difficult to distinguish from calluses or malignant growth
If multiple closely grouped – considered “mosaic” type
flat warts
verruca plana
found on face. smooth, flat-topped, yellow-brown papules; common in children
periungal warts
found on nails; thickened, fissured, cauliflower-likes skin around nail plate
filiform warts
found on face; rapidly growing, thread-like projections
goals of treatment for warts
eliminate signs and symptoms, remove wart without scarring, prevent recurrence, and prevent spread of HPV
exclusions for self treatments of warts
- less than 4 y/o
- pregnancy or breast-feeding
- conditions that affect blood circulation to hands or feet
- large or multiple warts located on one area of the body
- painful plantar warts
- warts on face, breasts, armpits, fingernails, toenails, anus, genitalia, or mucus membranes
to avoid spread of warts
- avoid cutting, shaving or picking at warts
- wash hands before and after touching warts
- keep feet clean and dry
- use specific towel to dry area
- avoid sharing items (towels, razors..)
- avoid walking barefoot
self-treatment options of warts
salicylic acid and cryotherapy
salicylic acid products for warts
- salicylic acid 40% in plasters/pads/strips
- salicylic acid 17% liquid/gel
- salicylic acid 15% patch in karaya gum vehicle
cryotherapy
pressurized spray can or foam applicator
cryotherapy ingredients
dimethyl ether and propane
other wart therapies
duct tape occlusion, vitamin a, dietary zinc, garlic, essential oils
