fungal skin infections

Question 1

To prevent relapse, local antifungal treatment should be continued for ….. after the disappearance of all signs of infection.

Answer 1

1-2 weeks

Question 2

dermatophyte infections aka

Answer 2

ringworm or tinea

Question 3

discuss use of antifungal dusting powders in dermatophyte/ringworm/tinea infections

Answer 3

Antifungal dusting powders are of little therapeutic value in the treatment of fungal skin infections and may cause skin irritation; they may have some role in preventing re-infection.

Question 4

Antifungal treatment may not be necessary in asymptomatic patients with tinea infection of the nails. If treatment is necessary, a systemic antifungal is more effective than topical therapy. However, topical application of these 2 may be useful for treating early onychomycosis when involvement is limited to mild distal disease, or for superficial white onychomycosis, or where there are contra-indications to systemic therapy.

Answer 4

amorolfine or tioconazole

Question 5

Pityriasis (tinea) versicolor can be treated with these shampoos (2)

Answer 5

ketoconazole shampoo
alt: selenium sulfide shampoo (unlicensed) can be used as a lotion (diluting with water can reduce irritation)

Question 6

Pityriasis (tinea) versicolor can be treated with ketoconazole shampoo. Alternatively, selenium sulfide shampoo [unlicensed indication] can be used as a lotion (diluting with a small amount of water can reduce irritation). How long would you use the SS shampoo?

Answer 6

left on the affected area for 10 minutes before rinsing off; it should be applied once daily for 7 days, and the course repeated if necessary.

Question 7

alternatives to ketoconazole and selenium sulfide shampoo for pityaris versicolour

Answer 7

Topical imidazole antifungals such as clotrimazole, econazole nitrate, ketoconazole, and miconazole, or topical terbinafine are alternatives, but large quantities may be required.

If topical therapy fails, or if the infection is widespread, pityriasis versicolor is treated systemically with a triazole antifungal (itraconazole, alt fluconazole).

Question 8

is relapse common for pityaris veriscolor

Answer 8

yes esp in immunocompromised

Question 9

candidal skin infections can be treated with topical imidazole antifungal (e.g. clot, econ, keto, miconazole). name two alternatives

Answer 9

topical terbinafine is an alternative. Topical application of nystatin is also effective for candidiasis but it is ineffective against dermatophytosis.

Question 10

topical application of nystatin is effective for candidiasis but not for …

Answer 10

dermatophyte infections (ringworm, tinea)

Question 11

refractory candidiasis requires systemic treatment generally with …

Answer 11

triazole e.g. fluconazole

Question 12

can you give systemic treatment with terbinafine for refractory candidiasis

Answer 12

no not appropriate

Question 13

discuss use of combination of imidazole and mild HC

Answer 13

may be of value in the treatment of eczematous intertrigo and, in the first few days only, of a severely inflamed patch of ringworm.

Combination of a mild corticosteroid with either an imidazole or nystatin may be of use in the treatment of intertrigo associated with candida.