Infestations Flashcards
1
Q
What is the common name for Enterobius vermicularis, and where does it primarily reside in the human body?
A
Threadworm or pinworm (Enterobius vermicularis) primarily resides in the upper part of the colon.
2
Q
Who is most commonly affected by threadworm infections, and what are the factors contributing to its prevalence in children?
A
Threadworm infections most commonly affect children due to their poor attention to personal hygiene. High rates of infection can occur in residential homes.
3
Q
What symptoms are caused by the irritant mucus and eggs laid by female threadworms, and how does reinfection typically occur?
A
Symptoms include intense itching and scratching caused by the irritant mucus and eggs laid by female threadworms. Reinfection occurs when eggs are ingested from contaminated hands.
4
Q
How can confirmatory diagnosis of threadworm infection be made, and what are the danger symptoms associated with heavy infestation?
A
Confirmatory diagnosis is usually made by sighting the worms around the perianal area, most easily seen at night. Danger symptoms include secondary bacterial infection, appetite loss, weight loss, insomnia, irritability, and enuresis.
5
Q
What are the differential diagnoses for perianal itching in adults, and when might referral be necessary?
A
In adults, perianal itching may be due to haemorrhoids, eczema, or irritants such as deodorants. Referral might be necessary if other parasitic worm infections are suspected.
6
Q
What is the recommended treatment of choice for threadworm infections in adults and children older than two years, and how does it act on the worms?
A
Mebendazole (Ovex®) is the treatment of choice for threadworm infections in adults and children older than two years. It acts by inhibiting the uptake of glucose by the worms, causing immobilization and death.
7
Q
What hygiene measures can be taken as an alternative to drug treatment, and what precautions should be followed when using anthelmintics in a household?
A
Hygiene measures alone can be considered when drug treatment is not wanted or recommended. If followed for six weeks, these measures can eliminate worms from the intestine. When using anthelmintics, all household members should be treated simultaneously.
8
Q
What is the primary action of Mebendazole in treating threadworm infections, and what potential side effects may occur during its use?
A
Mebendazole acts by inhibiting the uptake of glucose by the worms, causing immobilization and death. Transient abdominal pain or diarrhea can occasionally occur, especially in people with heavy infestations.
9
Q
What practical tips are provided in the extract to prevent and manage threadworm infections at home?
A
Practical tips include wearing closefitting pyjama bottoms, bathing or showering first thing in the morning, emphasizing good hygiene, cutting fingernails short, and daily laundering of bedding and towels to avoid spreading eggs.
10
Q
What is the size and color of the head louse (Pediculus capitis)?
A
The head louse is grey/brown and about 3 mm long.
11
Q
How do head lice feed?
A
Head lice feed by sucking blood from the scalp of their host.
12
Q
Where do female lice lay their eggs, and how are they attached?
A
Female lice lay eggs on the hair shaft near the scalp surface, and the egg’s shell is firmly attached to the hair.
13
Q
How long does it take for lice eggs to hatch, and what are the empty shells called?
A
Eggs hatch in about seven days, and the empty shells are called nits.
14
Q
Can eggs, whether hatched or unhatched, be proof of an active infection?
A
No, eggs attached to hairs are not proof of active infection, as they may retain a viable appearance for weeks after death.
15
Q
How is a conclusive diagnosis of head lice made?
A
A conclusive diagnosis is made by finding live lice.
16
Q
Who is more likely to get head lice, and what factors increase the risk?
A
Infestation is more likely in school children, with increased risks in those with more siblings, longer hair, and lower socioeconomic status.
17
Q
How are lice transmitted?
A
Lice are transmitted through close headtohead contact.
18
Q
What are the potential differential diagnoses for head lice?
A
Seborrhoeic scales, hair casts, and hair spray may be confused with nits.
19
Q
What are the recommended treatment options for head lice?
A
Two applications of insecticide seven days apart, each left on the hair for 2 hours, and examination after 4 days to determine cure.
20
Q
Why might treatment failure occur, and how much insecticide is needed for an average head of hair?
A
Treatment failure may occur with one application or insufficient product. An average head of hair needs 50ml of insecticide.
21
Q
What should be done if treatment failure is suspected?
A
If treatment failure is suspected, a different insecticide should be used at least three weeks after the last application.
22
Q
How can observation of lice samples on plain white paper with sticky tape provide useful information?
A
It helps identify lice resistance if lice of all ages are seen after insecticide treatment.
23
Q
What is the preferred type of lotion for head lice treatment, and why should caution be taken during application?
A
Alcoholic lotions are preferred; caution is needed as they are flammable.
24
Q
What is the preferred strategy if reinfestation occurs?
A
If reinfestation occurs, a different insecticide should be used in a mosaic strategy.
25
How does wet combing differ from insecticide treatments, and when is it a useful option?
Wet combing involves using a plastic detection comb plus conditioner every four days; it is useful for pregnant or breastfeeding individuals or children under two.
26
How does Hedrin® lotion act, and what is its recommended application process?
Hedrin® lotion disrupts lice by covering them physically and must be left on for eight hours, with treatment repeated after seven days.
27
19. Are head lice repellents effective for treating existing infestation?
No, head lice repellents are not intended for treating existing infestations.
28
20. Is there evidence supporting the use of herbal and essential oils or electric combs for head lice?
No, there is no evidence supporting their use; electric combs may kill lice but not eggs, and oils have no proven efficacy.
29
2 . What is the effectiveness of wet combing compared to malathion and permethrin in cases of high insecticide resistance?
In cases of high insecticide resistance, wet combing was found to be more effective than malathion or permethrin in one trial.
30
22. How does wet combing with conditioner render lice motionless, and how often should it be performed?
Wet combing with conditioner renders lice motionless; it should be performed every four days over at least a twoweek period until no lice are seen on three consecutive sessions.
31
3. What is the mechanism of action for Hedrin® lotion, and how does it disrupt lice?
Hedrin® lotion disrupts lice by covering them physically and disrupting their ability to manage water balance.
32
24. What caution should be taken during the application of alcoholic lotions for head lice treatment?
Patients should be warned not to use a hair dryer, as alcoholic lotions are flammable.
33
25. In head lice treatment, what is the recommended strategy if resistance is suspected after using one insecticide?
A different insecticide should be used at least three weeks after the last application if treatment failure is suspected.
34
26. Why is malathion lotion preferred over permethrin in some studies, and what is a common misconception about treatment failure?
Malathion may increase lice eradication compared with permethrin. Treatment failure is commonly mistaken by patients as treatment resistance.
35
How does hedrin lotion work?
Physically works to cover the lice and disrupt their ability to manage water balance. Must be left on for eight hours and repeated after 7 days.
36
28. What is the suggested interval for using a different insecticide if treatment failure is suspected?
A different insecticide should be used at least three weeks after the last application if treatment failure is suspected.
37
29. Are head lice repellents intended for routine prophylactic use, and do they treat existing infestations?
Head lice repellents are not intended for routine prophylactic use, and they do not treat existing infestations.
38
What are some practical tips for headlouse
• Regular detection combing is the best way to control head lice infestation, so that treatment can be initiated as soon as infestation is detected.
• Long hair should be worn tied up and fringes tucked away when there is an outbreak at a school or nursery.
• Bedding and clothes do not need specific laundering since lice cannot live for very long away from the heat and blood of the head.
39
1. What causes scabies, and what is the main symptom?
Scabies is caused by the mite Sarcoptes scabiei. the main symptom is extreme itching, especially at night, accompanied by a rash.
40
2. Where does the scabies rash commonly appear, and what are secondary lesions?
the rash appears between fingers and toes, on wrists, ankles, around nipples, buttocks, and genitals. Secondary lesions can occur due to excoriation.
41
3. What are scabies burrows, and how are they identified?
Burrows are fine, silvery lines, 2 5 mm in length, often with the mite at the closed end. They may appear as dark points.
42
4. How is the rash caused, and what is the average life span of the mite?
The rash is caused by the female mite burrowing into the skin and laying eggs. The mite dies after 46 weeks.
43
5. How is scabies transmitted, and why is it important to treat all close contacts?
Scabies is transmitted by close physical contact. Treating all close contacts is crucial, as symptoms may not appear until two weeks after infestation.
44
6. When should children under two years of age with scabies symptoms be referred for treatment?
Children under two years of age should be referred for treatment under medical supervision.
45
7. What are the possible differential diagnoses for scabies?
Eczema, contact dermatitis, or insect bites may have a similar appearance.
46
8. How should scabies be treated, and why is it important to treat all household members simultaneously?
Permethrin 5% w/w cream is a firstline option. All household members and close contacts should be treated simultaneously to prevent reinfestation.
47
9. Why is malathion 0.5% aqueous liquid recommended for pregnant or breastfeeding women?
Malathion is recommended for pregnant or breastfeeding women as it is poorly absorbed and eliminated rapidly.
48
10. What are practical tips for preventing reinfestation and managing scabies at home?
Wash clothes, towels, and bed linen at a temperature of at least 50°C. Treat the whole household.
49
11. What is Norwegian (crusted) scabies, and who is particularly susceptible to it?
Norwegian Scabies is characterized by crusted lesions and scaly plaques. Immunocompromised patients are particularly susceptible.
50
2. How is Norwegian scabies different from typical scabies, and why is it more resistant to standard treatment?
Norwegian Scabies has crusted lesions and scaly plaques, making it more resistant to standard treatment. it may have hundreds to thousands of female mites, making it easily transmitted.
51
3. What additional considerations are important for immunocompromised patients with scabies?
Immunocompromised patients are particularly susceptible to Norwegian Scabies, a rare and more resistant form of the condition.
52
14. What are danger symptoms in scabies, and when should children under two be referred for treatment?
Danger symptoms include extreme itching, especially at night, and a rash. Children under two should be referred for treatment under medical supervision.
53
15. What are the potential differential diagnoses for scabies?
Eczema, contact dermatitis, or insect bites may have a similar appearance.
54
16. How long does it take for scabies symptoms to appear after infestation, and why is simultaneous treatment for all close contacts important?
symptoms may not appear until two weeks after infestation. Simultaneous treatment for all close contacts is crucial to prevent reinfestation.
55
17. What is the firstline option for scabies treatment, and how should it be applied?
Permethrin 5% w/w cream is generally the firstline option. Apply over the whole body (including scalp, neck, face, and ears) and wash off after 8 to 2 hours.
56
18. Why is malathion 0.5% aqueous liquid recommended for pregnant or breastfeeding women?
Malathion is recommended for pregnant or breastfeeding women as it is poorly absorbed and eliminated rapidly. it should be removed from the nipple before feeds and reapplied afterward.
57
19. What additional treatment options are available for relieving skin irritation in scabies?
Crotamiton cream or liquid (Eurax®) may help soothe and relieve skin irritation. A sedative antihistamine for nighttime use may be helpful to relieve itching.
58
20. How long does itching often persist after scabies treatment, and why is it important to continue preventive measures?
itching often persists for up to three weeks after treatment. Preventive measures, such as washing clothes and bedding at a high temperature, are crucial to avoid reinfestation.
59
2 . What is Norwegian (crusted) scabies, and why is it more resistant to standard treatment?
Norwegian Scabies is characterized by crusted lesions and scaly plaques. it may have hundreds to thousands of female mites, making it more resistant to standard treatment.
60
22. What special considerations are important for immunocompromised patients with scabies?
Immunocompromised patients are particularly susceptible to Norwegian Scabies, a rare and more resistant form of the condition. crusted lesions and scaly plaques are prominent, and transmission is more likely.
61
3. What is the importance of treating all close contacts simultaneously in scabies?
Treating all close contacts simultaneously is crucial to prevent reinfestation, even if they are asymptomatic. symptoms may not appear until two weeks after infestation.
62
24. Why is it important not to apply scabies treatment after a hot bath?
Applications should not take place after a hot bath, as this increases the likelihood of systemic absorption of the treatment.
63
25. What are the recommended intervals for reapplying scabies treatment after the initial application?
the application should be repeated after seven days to ensure complete treatment.
64
26. How can crotamiton cream or liquid (Eurax®) contribute to scabies management?
Crotamiton may help soothe and relieve skin irritation, although it has poorer efficacy compared to Permethrin for Scabies treatment.
65
27. What are practical tips for preventing reinfestation and managing scabies at home?
Wash clothes, towels, and bed linen at a temperature of at least 50°C to kill all mites and prevent reinfestation. It is necessary to treat the whole household.
66
28. What is the role of a sedative antihistamine in scabies management?
a sedative antihistamine for nighttime use may be helpful to relieve itching, especially if the skin is becoming excoriated. itching often persists for up to three weeks after treatment.
67
What is the association between Herpes Simplex Type and Type 2?
Type is associated with cold sores, while Type 2 is associated with genital herpes.
68
What triggers the reactivation of the herpes simplex virus after a primary infection?
Possible triggers include sunlight, stress, colds, and menstruation.
69
Describe the prodromal signs of cold sores (herpes labialis).
Early signs include tingling, itching, or numb feelings, followed by the development of small red fluidfilled vesicles that may burst and crust over.
70
How long does the recovery from cold sores typically take?
Recovery usually takes 1014 days.
71
What are the differential diagnoses for lesions inside the mouth resembling cold sores?
Lesions may be confused with aphthous ulcers. Axial cheilitis, with similar appearance, is more common in the very young and the elderly.
72
What are the treatment options for cold sores?
Topical antiviral agents like aciclovir and penciclovir can speed up healing if applied during the prodromal phase.
73
How should aciclovir be applied for cold sores treatment?
Aciclovir should be applied five times daily for five days.
74
What danger symptoms indicate a potential bacterial infection in cold sores?
Weeping pustules may indicate a secondary bacterial infection, requiring antibiotic treatment.
75
What practical tips can help manage cold sores?
Use lip balm to limit drying and cracking. Wash hands after touching lesions, avoid sharing face cloths, and apply sunscreen to prevent sun exposure.
76
0 Why should immunocompromised patients be referred for routine appointments?
0 They may need additional care due to the risk of complications from herpes simplex infections.
77
1 What is the most common secondary infection associated with cold sores?
1 Impetigo is the most common, identifiable by spreading golden crusting or erythema.
78
2 When are oral antiviral treatments indicated for cold sores?
2 Oral antivirals are indicated in exceptional circumstances, where recurrence is frequent and severe.
79
3 How can the spread of herpes simplex infection be prevented?
3 Wash hands after touching lesions, avoid touching the eyes, and do not share face cloths or towels. Avoid oral sex to prevent genital herpes.
80
4 What precautions should be taken for sun exposure in individuals prone to cold sores?
4 Apply sunscreen to the lips or sensitive areas, especially during activities like holidaying or skiing.
81
5 What is the pharmacist's role in managing cold sores?
5 Pharmacists should be alerted to the possibility of impetigo as a secondary infection and provide appropriate advice on overthecounter treatments.
82
6 How can topical anaesthetics or oral analgesics help with cold sores?
6 They may provide relief from the pain associated with cold sores.
83
7 What are the recommended applications for penciclovir in cold sores treatment?
7 Penciclovir should be applied at twohour intervals, up to eight times daily, for four days.
84
8 What side effects might be experienced with topical aciclovir or penciclovir?
8 Mild drying or flaking of the skin may be experienced.
85
9 Why are oral antiviral treatments for cold sores considered only in exceptional circumstances?
9 They are reserved for cases of frequent and severe recurrence.
86
0 What are the key preventative measures to limit the pain of cold sores?
0 Using lip balm can help limit drying and cracking of the lips, reducing pain.
87
1 Why is it crucial to avoid oral sex during an active cold sore outbreak?
1 It helps prevent the transmission of herpes simplex to the genital area, causing genital herpes.
88
2 What is the role of sunlight exposure in triggering cold sores?
2 Sunlight exposure is a potential trigger for reactivating the herpes simplex virus.
89
3 How long should topical antiviral agents be applied to reduce healing time?
3 Trials have shown that applying aciclovir for five days and penciclovir for four days can reduce healing time compared to placebo.
90
4 What is the significance of the prodromal phase in cold sores treatment?
4 Applying topical antivirals during the prodromal phase is crucial for their effectiveness in reducing symptoms and speeding up healing.
91
5 When should patients be referred for definite diagnosis and systemic antiviral treatment?
5 Patients with lesions inside the mouth resembling cold sores should be referred for a definite diagnosis and consideration of systemic antiviral treatment.
92
6 Why is hand hygiene emphasized in managing cold sores?
6 Cold sores are highly infectious, and handwashing helps prevent the spread of the infection.
93
7 What is the GP's comment regarding impetigo in relation to cold sores?
7 Impetigo is the most common secondary infection, identifiable by specific characteristics, and pharmacists should be alerted to this possibility.
94
8 How can simple protective agents like lip balm contribute to cold sore management?
8 Lip balm can help limit drying and cracking of the lips, reducing pain associated with cold sores.
95
9 Why is it important to consider oral analgesics for relief of painful cold sore lesions?
9 Oral analgesics can provide relief from pain associated with cold sores, enhancing patient comfort.
96
0 What should be the approach for managing cold sores in immunocompromised patients?
0 Immunocompromised patients should be referred for routine appointments, as they may require additional care due to the increased risk of complications.
97
What is PHN
Postherpetic neuralgia
98
What causes shingles (herpes zoster)?
Shingles is caused by the reactivation of the varicella zoster virus, the same virus that causes chickenpox.
99
When does the varicella zoster virus become dormant, and when is it reactivated?
The virus remains dormant after an episode of chickenpox in childhood and is reactivated later in life.
100
What are potential triggers for the reactivation of the varicella zoster virus?
While precise triggers are unknown, reactivation is more common in the elderly and those who are immunosuppressed due to disease, medication, or stress.
101
What are prodromal symptoms of shingles, and how long do they last?
Prodromal symptoms may include headache, flulike symptoms, local throbbing pain, and paraesthesia. They can last for 4872 hours or more before the rash appears.
102
How does the shingles rash typically present and evolve?
The rash appears as red spots that turn into blisters containing the virus. New blisters may develop for up to a week, and they burst and crust over within fiveseven days.
103
What is postherpetic neuralgia (PHN), and how long can it last?
PHN is severe pain that can persist for months after the shingles rash disappears.
104
What are the differential diagnoses for prodromal pain in shingles?
Prodromal pain can be confused with conditions like myocardial infarction, cholecystitis, or renal colic, but the rash helps distinguish shingles.
105
Why should patients with shingles involving or approaching the eye be urgently referred?
There is a risk of severe complications, and prompt treatment is crucial.
106
What is the recommended treatment for shingles within 72 hours of onset?
Oral antiviral agents like aciclovir, valaciclovir, or famciclovir are recommended to reduce severity, duration of pain, and the incidence of PHN.
107
0 What are danger symptoms in shingles that warrant urgent referral?
0 Immunocompromised patients are at greater risk of severe complications. Eye involvement also requires urgent referral.
108
1 What are the firstline treatments for shingles, and how long should they be administered?
1 Aciclovir 800mg five times a day for 710 days is usually the first line. Valaciclovir and famciclovir are also effective.
109
2 When is oral prednisolone considered in shingles treatment?
2 In severe cases, oral prednisolone may be added to reduce the severity and duration of acute symptoms, but it does not affect PHN incidence.
110
3 What OTC analgesics can be recommended for shingles pain relief?
3 Paracetamol and ibuprofen may provide adequate pain relief, depending on individual contraindications.
111
4 How can tricyclic antidepressants contribute to shingles management?
4 Lowdose amitriptyline can effectively treat acute pain and may reduce the incidence or severity of PHN.
112
5 What practical tips can help manage shingles symptoms?
5 Keep the affected area clean and dry, change cloths and towels regularly, cover the rash to minimize virus spread, wear loosefitting clothes, use calamine lotion for itching, and apply cold compresses up to 20 min at a time to weeping blisters.
113
What are the two groups of organisms causing human fungal infections?
• Dermatophytes (Trichophyton, Microsporum, Epidermophyton) • Yeasts (Candida albicans, pityriasis (tinea) versicolor)
114
What factors increase the likelihood of transmission of fungal skin infections?
• Skin moisture, sweating, friction, and maceration • Occurs in hot, humid climates and with skin occlusion by footwear, clothing, dressings, or casts
115
What is the most common dermatophyte infection, and how does it typically present?
• Tinea pedis (athlete's foot) • Begins with scaling and itching, usually between the fourth and fifth toe, and may spread across other toes
116
Where is athlete's foot commonly acquired, and what are the common symptoms?
• Acquired in communal places like public swimming pools • Symptoms include scaling, itching, maceration, and dry, scaly soles
117
What are the differential diagnoses for athlete's foot?
• Candidal infection, bacterial infection, eczema, psoriasis
118
What are the firstline topical treatments for athlete's foot?
• Imidazoles (clotrimazole, ketoconazole, miconazole) or terbinafine • Terbinafine may produce a more rapid response
119
How long should local antifungal treatment be continued to prevent relapse?
• Treatment should continue for one week after the disappearance of all signs of infection
120
What are the practical tips for managing athlete's foot?
• Good foot hygiene • Wearing open, nonocclusive shoes • Changing socks daily • Using protective footwear in communal areas • Avoiding scratching to prevent infection spread
121
When is referral for a routine appointment required in athlete's foot management?
• Referral is needed for severe or extensive cases, moccasintype infections, or when topical therapy fails
122
0 How does diabetes affect susceptibility to fungal infections?
0 • Hyperglycemia predisposes diabetic patients to skin, nail, genital tract, and urinary tract fungal infections
123
1 What are danger symptoms indicating a need for urgent attention in athlete's foot?
1 • Secondary bacterial infection, especially if cracked skin acts as a portal of entry
124
2 What are potential complications of using potassium permanganate solution in fungal foot soaks?
2 • Cosmetic limitations (skin and nail staining) • Skin irritation if used repeatedly • Not suitable for dry skin conditions
125
3 What is the role of antifungal dusting powders in the treatment of fungal skin infections?
3 • Little therapeutic value • May be used to prevent reinfection, particularly in shoes
126
4 How can individuals with athlete's foot avoid spreading the infection?
4 • Avoid scratching affected skin • Practice good foot hygiene • Use protective footwear in communal areas
127
5 What are the considerations for referral in the case of athlete's foot?
5 • Referral is warranted for severe or extensive cases, moccasintype infections, or when topical therapy is ineffective
128
6 What are the common causes of fungal infections in individuals with diabetes?
6 • Hyperglycemia (high blood sugar) • Predisposes to skin, nail, genital tract, and urinary tract fungal infections
129
7 What are the danger symptoms indicating a need for urgent attention in fungal skin infections?
7 • Secondary bacterial infection, such as cellulitis, especially if cracked skin acts as a portal of entry
130
8 What is the recommended treatment duration for local antifungal treatment to prevent relapse?
8 • Treatment should continue for one week after the disappearance of all signs of infection
131
9 Why is referral required for routine appointments in severe or extensive cases of athlete's foot?
9 • To assess and manage moccasintype infections • When topical therapy has proven ineffective
132
0 How can individuals manage athlete's foot in communal areas to prevent spreading the infection?
0 • Use protective footwear such as flipflops or plastic shoes • Avoid scratching affected skin, which may spread infection
133
1 What are the potential complications of using potassium permanganate solution in fungal foot soaks?
1 • Cosmetic limitations (skin and nail staining) • Skin irritation if used repeatedly • Not suitable for dry skin conditions
134
2 What are the considerations for using antifungal dusting powders in the treatment of fungal skin infections?
2 • Little therapeutic value in treatment • May be used to prevent reinfection, especially in shoes
135
3 How can good foot hygiene contribute to the management of athlete's foot?
3 • Wash feet daily and dry thoroughly, especially between the toes • Changing socks daily helps prevent recurrence
136
4 What are the characteristics of moccasintype athlete's foot, and when is referral recommended?
4 • Dry, scaling skin on the sole of the foot caused by Trichophyton rubrum • Referral recommended for severe or extensive cases
137
5 Why is it important to avoid scratching affected skin in fungal infections?
5 • Scratching may spread the infection to other sites on the body
138
6 What is onychomycosis?
6 • Fungal nail infection involving dermatophytes, moulds, and yeasts • Often preceded by a fungal skin infection
139
7 What are the signs of onychomycosis?
7 • Infected side of the nail turns brown, yellow, or white • Subungual debris accumulates under the nail • Thickened, discolored, and elevated nail with subungual hyperkeratosis
140
8 What factors predispose individuals to onychomycosis?
8 • Increasing age • Male gender • Nail trauma • Diabetes • Peripheral vascular disease • Poor hygiene • Athlete's foot
141
9 What are the danger symptoms requiring referral for onychomycosis?
9 • Patients with immunosuppression, diabetes, and peripheral circulatory disorders should be referred for a routine appointment with their GP
142
0 What are the types of onychomycosis, and how do they manifest?
0 • Distal or lateral subungual onychomycosis (DLSO) starts at the hyponychium, involves the whole nail bed and plate • White superficial onychomycosis affects superficial layers of the nail plate • Proximal subungual onychomycosis affects the matrix at the base of the nail
143
What are the potential differential diagnoses for onychomycosis?
• Psoriasis (fine pitting on the nail surface, may be present at other skin sites) • Lichen planus (itchy, flattopped papules, commonly seen on wrists and lower legs) • Contact dermatitis (likely previous contact with irritants) • Nail trauma (normal nail bed appearance) • Yellow nail syndrome (associated with lung disorders, affects all nails)
144
How challenging is the treatment of fungal nail infections, and what are the options?
• Notoriously difficult to treat • Topical treatment works best when less than 30% of the nail plate is affected • Amorolfine lacquer is OTC for mild DLSO, applied weekly, with continuous use until the infected part grows out (six months for fingernails, nine months for toenails)
145
3 What practical tips can help manage onychomycosis?
3 • Exercise good nail care • Wash and dry feet daily • Avoid tight, occlusive shoes • Rest shoes periodically to limit exposure to infectious fungi • Use antifungal powders to keep shoes pathogenfree
146
4 When is oral antifungal treatment recommended for onychomycosis?
4 • Recommended if more than two nails are involved, depending on symptoms, thickness of infection, and positive culture • Terbinafine is the most effective oral agent, usually prescribed for at least three months
147
5 What precautions should individuals take during topical treatment for onychomycosis?
5 • Avoid nail polish and artificial nails while using treatment • Regular (three monthly) monitoring of the condition is required, with referral if there is no improvement
148
6 What is the licensing status of amorolfine lacquer for onychomycosis treatment?
6 • Amorolfine lacquer is licensed for OTC supply for the treatment of mild (not more than two nails) DLSO in patients aged 8 years or over
149
7 How is amorolfine lacquer applied, and what is the recommended treatment duration?
7 • Applied once a week after filing and cleaning the infected nail surface • Continuous use is necessary until the infected part of the nail has grown out (six months for fingernails, nine months for toenails)
150
8 Why should nail polish and artificial nails be avoided during amorolfine lacquer treatment?
8 • To ensure the efficacy of the treatment, these cosmetic applications should be avoided
151
9 What are the monitoring requirements during topical treatment for onychomycosis?
9 • Regular (three monthly) monitoring of the condition is required, with referral if there is no improvement
152
0 When is oral antifungal treatment considered in onychomycosis, and what is the preferred oral agent?
0 • Considered if more than two nails are involved, based on symptoms, thickness of infection, and positive culture • Terbinafine is the most effective oral agent, usually prescribed for at least three months
153
1 Why may patients with onychomycosis feel selfconscious, and what symptoms may they experience?
1 • Patients may feel selfconscious about the appearance of their nails • Symptoms may include pain, discomfort, and brittleness of the affected nails
154
2 How can individuals exercise good nail care to prevent onychomycosis?
2 • Wash and dry feet daily • Avoid tight, occlusive shoes • Rest shoes periodically to limit exposure to infectious fungi
155
3 What are the challenges in topical treatment effectiveness for onychomycosis?
3 • Topical treatment works best when less than 30% of the nail plate is affected, and its efficacy decreases with thicker nails
156
4 What are the considerations for referral in onychomycosis management?
4 • Referral is necessary if there is no improvement despite continuous topical treatment
157
5 What are the factors predisposing individuals to onychomycosis?
5 • Increasing age, male gender, nail trauma, diabetes, peripheral vascular disease, poor hygiene, and athlete's foot
158
6 What is tinea corporis, and how does it manifest?
6 • Circular, red, scaly lesion • Often with less scaling and erythema in the center • Itchy with a clearly defined edge
159
7 How is body ringworm (tinea corporis) transmitted, and what are its danger symptoms?
7 • Transmitted by direct contact with a human or animal host • Danger symptoms Candidal superinfection and secondary bacterial infection, especially in the groin area
160
8 What characterizes groin infection or tinea cruris ('jock itch')?
8 • Scaly, erythematous lesions inside the thighs and inguinal folds • Often bilateral • Common in young men, may coexist with athlete’s foot
161
9 What are the danger symptoms and differential diagnoses for groin infections?
9 • Danger symptoms Candidal superinfection, secondary bacterial infection (cellulitis) • Differential diagnoses Candidal infection, bacterial infection, eczema, psoriasis, pityriasis versicolor, or pityriasis rosea
162
0 What distinguishes dermatophyte groin infections from candidal infections in the scrotum?
0 • Dermatophyte groin infections usually do not involve the scrotum, whereas candidal infections often do
163
1 What causes pityriasis versicolor, and how does it manifest?
1 • Caused by the yeast Malassezia furfur • Appears as small areas of hyper or hypopigmented skin with mild scaling • More noticeable on tanned skin
164
2 What are the treatment options for tinea corporis and groin infections?
2 • Topical antifungal preparations Imidazoles (clotrimazole, econazole, miconazole) or terbinafine • Compound benzoic acid ointment (Whitfield’s ointment) can be used, but it is cosmetically less acceptable
165
3 How should topical treatment with clotrimazole and miconazole be used during pregnancy?
3 • Considered safe for use in pregnancy and breastfeeding
166
4 What are practical tips for managing tinea corporis and groin infections?
4 • Avoid scratching affected skin to prevent spreading • Change underwear daily in groin infections, treat athlete’s foot to reduce reinfection risk
167
5 What GP comment is relevant to treating pityriasis (tinea) versicolor?
5 • Ketoconazole shampoo, a POM indication, may be used and prescribed by a GP • Selenium sulphide shampoo is effective, although unlicensed for this indication
168
6 What is the recommended application method for selenium sulphide shampoo in treating pityriasis versicolor?
6 • Applied as a lotion (diluted with water to reduce irritation) • Left on for at least 30 minutes or overnight • Applied two to seven times over two weeks, with the course repeated if necessary
169
7 What are the alternatives for treating pityriasis versicolor with topical imidazole antifungals?
7 • Topical imidazole antifungals are an alternative, but large quantities may be required
170
8 What is intertrigo (sweat rash), and in whom does it typically occur?
8 • Occurs in adults • Infection develops between opposing skin surfaces (e.g., under breasts, groin, armpits, hands in water) • More likely with existing skin conditions like psoriasis
171
9 How does intertrigo manifest, and what are the characteristics of Candida infection in sweat rash?
9 • Red skin, may be macerated and odorous • Candida infection may result in pustules, easily ulcerating and leaving raw areas • Candidal skin infections appear bright red, moist, with scaling borders, and satellite lesions
172
0 What factors increase the risk of candidal skin infections in intertrigo?
0 • Systemic antibiotics, skin maceration, and obesity increase the risk of candidal skin infections
173
1 When should patients with intertrigo be referred, and what are the danger symptoms?
1 • Refer patients with diabetes, peripheral circulatory disorders, or immunocompromised conditions • Refer if symptoms of secondary bacterial infections are present, especially with cracked skin as a portal of entry
174
2 What are the potential differential diagnoses for intertrigo?
2 • Dermatophyte skin infections • Bacterial skin infections • Eczema • Flexural psoriasis
175
3 What are the suitable firstline treatments for intertrigo?
3 • Imidazoles (clotrimazole, econazole, miconazole)
176
4 What practical tips can aid in managing intertrigo?
4 • Dry the skin thoroughly after washing, especially in skin folds • Avoid skin occlusion to aid healing and prevent recurrence • Do not share towels, and wash towels frequently
177
9 What is impetigo, and what bacteria commonly cause it?
9 • Superficial bacterial infection of the skin • Commonly caused by Staphylococcus aureus, with Streptococci also implicated
178
0 Who is commonly affected by impetigo, and where does it typically present in children?
0 • Common in infants and young children • Often presents around the nose and mouth
179
1 Describe the presentation of impetigo and its contagious nature.
1 • Weeping, golden, crusted eruption on an erythematous base • May extend over 35cm • Highly contagious, transmitted by direct contact or contaminated towels/clothes
180
2 What are the differential diagnoses for impetigo?
2 • Cold sores (herpes simplex), more common in adults with prodromal symptoms • Atopic dermatitis • Fungal skin infections
181
3 How long does impetigo usually take to resolve spontaneously, and why is treatment considered?
3 • Usually resolves within two to three weeks spontaneously • Treatment is appropriate to prevent transmission due to high contagion
182
4 What OTC treatment is indicated for topical treatment of primary and secondary superficial skin infections caused by organisms sensitive to hydrogen peroxide?
4 • Crystacide cream® (1% hydrogen peroxide)
183
5 What is the efficacy of Crystacide cream® according to recent Cochrane review findings?
5 • Cochrane review found a lack of evidence to support its use
184
6 What are the danger symptoms in impetigo, and when is urgent referral required?
6 • More serious bacterial infections like cellulitis or septicaemia • Scalded skin syndrome (urgent referral required)
185
7 What is the recommended treatment for impetigo, and how is fusidic acid 2% cream applied?
7 • Fusidic acid 2% cream is usually effective • Applied three times a day until resolved
186
8 When should patients be referred to a GP for impetigo treatment?
8 • If infection worsens despite treatment • If no response to fusidic acid within seven days • For alternative topical or oral treatment if needed
187
9 What practical tips are recommended for personal hygiene to avoid impetigo transmission?
9 • Wash hands after contact with the lesion • Do not share flannels and towels • Keep fingernails short • Avoid scratching the skin • Children should not attend nursery or school while being treated for impetigo
188
0 What additional step is recommended before applying topical treatment for impetigo lesions?
0 • Lesions should be soaked in warm soapy water and washed away prior to application of topical treatment
189
1 What serious condition may develop from eczema infected with Staphylococcus impetigo, and what are its characteristics?
1 • Scalded skin syndrome may develop • Presents as an extremely tender red area where the superficial layer of skin peels away as if scalded
190
2 When is urgent referral required for scalded skin syndrome, and who can be affected by it?
2 • Urgent referral required • Not exclusive to eczema sufferers
191
3 What are the recommended care steps with personal hygiene to prevent impetigo transmission?
3 • Wash hands after contact with the lesion • Do not share flannels and towels • Keep fingernails short • Avoid scratching the skin • Children should not attend nursery or school while being treated for impetigo
192
4 How should lesions be prepared before applying topical treatment for impetigo?
4 • Lesions should be soaked in warm soapy water and washed away prior to application of topical treatment
193
5 What are boils and carbuncles, and how do they differ in terms of hair follicle involvement?
5 • Infections of hair follicles by Staphylococcus aureus • Boil infection of one hair follicle • Carbuncle involves a cluster of adjacent follicles
194
6 Where are common sites for boils and carbuncles, and what may be discharged from them?
6 • Common sites back of the neck, buttocks, trunk, thigh • Pus is usually discharged from a head or point
195
7 How is scarring caused by boils, and what traditional remedy was used for boils?
7 • Boils can cause scarring • Magnesium sulphate paste was traditionally used to 'draw' a boil or carbuncle
196
8 What is acute paronychia, and what is its most common cause?
8 • Infection of the skin and soft tissue of the proximal and lateral nail fold • Most commonly caused by Staphylococcus aureus
197
9 What factors can lead to acute paronychia, and how does it manifest in terms of redness and tenderness?
9 • Originates from minor trauma nail biting, finger sucking, aggressive manicuring, hangnail, penetrating trauma • Red, hot, and tender skin and soft tissue of the proximal and lateral nail fold
198
0 What is Staphylococcal whitlow (felon), and how does it manifest in the finger pulp?
0 • Purulent infection or abscess involving the bulbous distal pulp of the finger • Rapid onset of pain, redness, swelling, and extreme tenderness
199
1 What may be helpful in mild paronychia, and when is referral for oral antibiotic treatment required for both paronychia and whitlow?
1 • Warm soaks three to four times a day in mild paronychia • Referral for oral antibiotic treatment if an abscess has formed in paronychia or for whitlow
