Skin OTC - Fungal Nail Infection

Question 1

What are the main features of fungal nail infection?

Answer 1

Nail becomes thickened, discoloured, flaky and may separate from the nail bed.
Toe and finger nails can be affected.
Associated with nail trauma, Immunocompromised, diabetes, psoriasis and athlete’s foot.
Refer - diabetes, PVD and immunocompromised.

Question 2

What are the tx options for fungal nail infection?

Answer 2

Amorolfine 5% nail lacquer: (Curanail)
- Max 2 nails OTC
- Weekly application
- Use for up to 12 months
- 1 pack lasts 3 months
- When supplying a new pack - check progress of infection.
- C/I in pregnancy/breasfeeding
- Not for px < 18 yrs.

Question 3

What are the main features of Athlete’s foot?

Answer 3

Infection likes soft moist conditions.
Presents as red, itchy between toes.
Then become white, soggy and sore.
May spread over the rest of the foot (sides and soles of feet, small vesicles on instep)

Question 4

What are the symptoms warrant referral for athlete’s foot?

Answer 4

Weeping sores

Question 5

What are the symptoms of ringworm?

Answer 5

Tines corporis:
- Any part of body, mainly trunk, limbs
- Red, inflamed, well define ring like pattern.
- Itchy

Question 6

What are the main features of Dhobie’s itch?

Answer 6

Groin area

Question 7

What are the tx options for ringworm and Dhobie’s itch?

Answer 7

Imidazole antifungals: Clotrimazole 1% (Canesten), Clotrimazole + Hydrocortisone, Miconazole (Daktarin range), Ketoconazole (Daktarin Gold), Bifonazole (Canesten AF OD)
Lamisil AT >16+
Lamsil Once >18+

Question 8

What counselling points is given for fungal nail infection?

Answer 8

Hygiene
Wash feet BD and dry throughly
Apply cream widely to include infected area and about 2 inches all around to tx any spores.
Don’t share towels.
Avoid wearing same pair of shoes daily .
If area is hot and/or red = Refer! Bacterial infection
If nail is affected = treat with Amorolfine if appropriate.