Skin Fungal Infections

Question 1

When a patient presents with scaling, itching skin lesions which are suspected to be fungal infection, what are the PATIENT FACTORS (not red-flags) that warrant a referral to the HCP?

Answer 1

1. Diabetes
2. Immunocompromised

Question 2

Red flags of skin fungal infections which warrants a referral to the doctor?

Answer 2

1. Signs of systemic illness (SIRs)
2. Large areas of skin involved
3. Scalp lesions
4. Incomplete clearance after previous episode of infection
5. NIL improvement after two weeks of appropriate anti-fungal treatment
6. Mucous membrane or genitalia involved

Question 3

Main non-pharmacological treatments of skin fungal infectionz?

Answer 3

1. Keep area dry
2. Avoid scratching
3. Hygiene of infected area

Question 4

Can topical antifungals and corticosteroids be used in tinea capitis?

Answer 4

No.

• Tinea capitis infection at root of hair follicle which is inaccessible from outside
• Will require oral antifungal agent

Question 5

In Tinea unguium, state a topical antifungal that can be used. When must a systemic antifungal be used in tinea unguium?

Answer 5

• Topical antifungal: Amorolfine 5% nail lacquer 1-2 times a week
• Systemic treatment if: > 2 nails involved

Question 6

General clinical presentation of fungal infections?

Answer 6

• Erythema
• Scaling
• Pustules
• Itching/burning sensation

Question 7

General treatment strategy for fungal infection (not nail infections)

Answer 7

• Antifungal +/- steroid BD with non-pharmacologicals
• Treat for 7 days
• Antifungal cream for another 1-3 weeks

Question 8

Duration of treatment for nail fungal infections

Answer 8

• Fingernails: 6 months
• Toenails: 9-12 months

Question 9

Counselling points for applying cream to affected areas in fungal infection?

Answer 9

• Clean affected areas with soap and water
• Dry thoroughly before applying medication
• Massage the medication into the skin
• Apply the fungal cream for 2 more weeks even after symptoms disappear
• Avoid contact of creamwith eyes and mouth

Question 10

Treatment duration of tinea pedis?

Answer 10

Up to 4 weeks (instead of usual 2 weeks)

Question 11

Treatment duration of tinea cruris and tinea corporis?

Answer 11

Usually 2 weeks

Question 12

Name two P-only combination antifungal-steroid cream

Answer 12

1. Miconazole 2%/ Hydrocortisone 1% (Daktacort, zaricort)
2. Clotrimazole 1%/ Hydrocortisone 1% (Canesten, Candacort)

Question 13

Classifications of most antifungal creams found in Singapore?

Answer 13

GSL or P only (so most has no supply limit)

Question 14

Counselling points for antifungal powder use for tinea pedis?

Answer 14

• Sprinkle in between toes and feet
• Sprinkle into socks and shoes