Fungal skin infections

Question 1

What are dermatophyte skin infections? Are they contagious?

Answer 1

Atheletes foot (tinea pedis)
Groin and thighs infection (Tinea Cruris) - “jock itch”
Ringworm of the skin (Tinea Corporis)
Scalp infection (Tinea Capitis)

YEs

Question 2

Where are fungal infections most commonly found?

Answer 2

feet, scalp, arms, private parts

Question 3

What is athletes foot characterised by?

Answer 3

itching, flaking, fissuring of the skin, will appear white and soggy due to maceration of the skin
feet often smell
usually affects the toe webs
under skin is red, itchy, sore

Question 4

What is tinea corporis?

Answer 4

infection of the major skin surface that do not involve the face, hands, feet, groin or scalp

Question 5

how does tinea corporis usually present?

Answer 5

itchy rash that forms partial or complete rings
the centre can be red, flat or slightly raised, sometimes scaly
Has a distinctive ‘active border’ that looks red and scaly
This appearance is led to the term ringworm

Question 6

When to refer a pt with tinea corporis?

Answer 6

• Symptoms of a secondary bacterial infection e.g. yellow crusts, weeping
• Symptoms spreading
• Toenails also infected in athletes foot
• Diabetics or pts who are immunosuppressed
• unresponsive to tx

Question 7

What tx options would you consider for pt with tinea corporis?

Answer 7

1. Topical imidazole antifungal preps such as clotrimazole, ketoconazole, miconazole
2. Topical preps combing antifungal with steroid (licensed for 20 years and up)
3. Terbinafine (Lamisil)
4. Griseofulvin

Question 8

What are some S/E that can occur with imidazoles?

Answer 8

mild burning, or itching

Question 9

What are the age restrictions of using Lamisil? What can it be used to treat?

Answer 9

Can only use >16 years

Athletes foot
Groin infection
Tinea corporis

Question 10

Which formulations can treat only tinea corporis (ringworm), athletes foot, tinea cruris?

Answer 10

All can treat athelets foot and tinea cruris

spray and gel can treat ringworm

Question 11

How long should antifungal treatment be continued after symptoms have subsided?

Answer 11

at least 7 days

Question 12

What other counselling points should be told to pts about tinea corporis?

Answer 12

Avoid tight shoes or clothing, accumulation of sweat and heat and avoid sharing of towels

Wash regularly, change socks, towels and fungicidal powder can be used as prophylactic measure

Tinea infection is easily transferred from contact with pets and animals.

Question 13

What does amorolfine 5% nail lacquer treat?

Answer 13

tx of mild cases of fungal infection caused by dermatophytes, yeasts, moulds

Question 14

What age can pts begin to use amorolfine?

Answer 14

18 years with no underlying medication conditions that predispose them to fungal infection (e.g immunocompromised and diabetics)

Question 15

What is amorolofine licensed to treat?

Answer 15

ONLY 2 nails and only beneath tips or sides of nails

licensed for infections affecting the upper half (distal) or sides (lateral) of the nail, where there is no damage to the nail itself

Question 16

What are the clinical features?

Answer 16

nail thickens and distorts and as the infection spreads and worsens, the nail becomes brittle and crumbles away or falls off

Question 17

Any contra-indication with its use?

Answer 17

• pts who have shown hypersensitivity in the past to tx
• pregnancy or BF
• pts under age of 18 years

Question 18

When to refer a pt with fungal nail infections?

Answer 18

refer when there is a predisposing condition such as diabetes, peripheral circulatory problems and immunosuppression

Question 19

How does amorolfine work?

Answer 19

Antifungal - penetrates into and diffuses through the nail plate and is thus able to eradicate poorly accessible fungi in the nail bed

Question 20

How to administer amorolfine?

Answer 20

apply to the affected fingernails or toenails ONCE WEEKLY
before you apply, the affected areas of the nail need to be filed down
cleanse the nail and degreased using one of the disposable cleaning pads
Must be applied regularly until all of the affected nail tissue has grown out.

Question 21

How long should a pt use amorolfine?

Answer 21

9- 12 months for toenails and 6 months for fingernails

Question 22

what are side effects that can occur with amorolfine?

Answer 22

nail discoloration, broken or brittle nails and skin irritation has been reported

Question 23

What are clinical features of hair loss (andogenetic alopecia)?

Answer 23

thinning of the hair and frontal receding hairline that might or might not be accompanied with hair loss at the crown

Question 24

When to refer a pt with hair loss?

Answer 24

• pts under 18 years old
• sudden onset
• suspected iron deficiency anaemia
• fungal infection of the scalp
• possible endocrine cause

Question 25

What tx is offered in pts with hair loss?

Answer 25

Minoxidil - promotes hair growth

Question 26

What s/e can occur ? which pts should you avoid giving minoxidil?

Answer 26

skin irritation, headache

Cardiovascular pts

Question 27

What occurs if a pt stops treatment? Should a pt discontinue minoxdil if it doesnt appear to work?

Answer 27

If a pt stops tx, any hair growth achieved will be lost within 6-8 weeks on discontinuation of therapy and baldness returns to pretreatment levels

• it can take 4 months to show any evidence of hair growth but users should discontinue if no improvement after 1 year