Superficial fungal infections

Question 1

What are the factors can contribute to fungal infections occurring

Answer 1

skin trauma
diabetes
immune system suppression
decreased circulation
malnutrition
poor hygiene
skin occlusion
warmth and humidity

Question 2

How are fungal infections transmitted

Answer 2

person to person
animals
soil
fomites

Question 3

What are the presenting symptoms of tinea

Answer 3

pruritis/scaling
fissure, crack or discoloration of the skin

Question 4

What are the 4 types of tinea pedis that can occur

Answer 4

1. cracks, scaling and maceration between toes. Pain and/or itching can occur
2. mild inflammation with diffuse scaling on bottoms of feet
3. vesicles or small pustules with scaling at instep area
4. macerated, weeping ulcerations on bottom of foot, odorous and painful

Question 5

What is tinea unguium

Answer 5

opaque, thickened nails

Question 6

What is tinea corporis

Answer 6

ringworm that occurs anywhere on the body
red, scaly, raised border
ring-shaped

Question 7

What is tinea cruris

Answer 7

ringworm of the groin
middle and upper aspect of the thighs and pubic area
bright red and raised with well-defined ring shape
vesicles on outer aspect
scaling
itchy

Question 8

What is tinea capitus

Answer 8

papules around the hair shafts which spread
scalp scaling or pruritic pustules form

Question 9

Which types of tinea are not treated OTC

Answer 9

tinea unguium
tinea capitus

Question 10

What are the exclusions for self-treatment?

Answer 10

uncertain of cause or description
initial treatment ineffective or symptoms worsen
nails of scalp affected
face, mucous membranes or genital areas are affected
symptoms of bacteria infection
significant inflammation
affects body function
diabetes, systemic infection, immune deficiency present
fever and/or body aches

Question 11

What is the general treatment approach when it comes to superficial fungal infections

Answer 11

ID lesions as consistent with tinea and they are amenable to self-care
Topical antifungal recommended
*product based on infection type AND patient preference
**acute inflammatory: treat with astringent first
**not acute: powder, spray, cream or solution

Question 12

What are complementary and non-pharmacologic options

Answer 12

1. dedicated towel for affected area
   2.avoid sharing towels or clothing with others
   3.wash and dry towels on high heat
   4.wash skin daily with soap and water
   5.avoid occlusion of skin
   6.allow shoes to dry thoroughly before wearing again
   *try a dusting a medicated powder into shoes to help
   7.Wear foot protection to avoid exposing other people to infection
   8.stop nonrx product and contact prescriber if infection worsens or new symptoms begin
2. contact prescriber if problem continues beyond recommended OTC duration

Question 13

What OTC treatment options are available for tinea infections

Answer 13

clotrimazole
miconazole
terbinafine
butenafine
tolnaftate
undecylenic acid

Question 14

What is the MOA of clotrimazole and miconazole

Answer 14

inhibit biosynthesis of sterols and damage fungal cell membrane
bacteriostatic

Question 15

What is the MOA of butenafine and terbinafine

Answer 15

inhibit squalene epoxidase
squalene builds up in fungal cell and kills it

Question 16

What is the MOA of tolnaftate

Answer 16

stunts mycelial growth of fungi(?)

Question 17

What is the MOA of undecylenic acid

Answer 17

interacts with cell membrane
fungistatic

Question 18

How often should you apply topical antifungal treatments

Answer 18

twice day for a duration of 4 weeks
*usually see resolution in 1-3 weeks

Question 19

What is the MOA of aluminum salts

Answer 19

astringent
reduces cell membrane permeability and decreases swelling, exudate production and inflammation

Question 20

What is the indication of aluminum salts

Answer 20

inflammatory and wet/soggy types of tinea pedis
dries out the area

Question 21

What is the “dosing” for aluminum salts

Answer 21

Aluminum acetate: dilute with 10-40 parts water use for up to 1 week

Aluminum chloride solution: Use 2 times a day until odor, wetness and maceration resolve(up to 1 week) then DAILY for 4 weeks.

Question 22

What is the treatment recommendation for the groin area

Answer 22

Well-define lesions: Apply antifungal twice a day for 2 WEEKS combined with non drug care

Poorly defined lesions: REFER

Question 23

What is the treatment option for round lesions on other parts of the body

Answer 23

Apply antifungal twice a day for 4 WEEKS combined with nondrug care

Question 24

What is the treatment recommendation for tinea pedis where inflammation is present

Answer 24

Soak feet with aluminum acetate solution 2-3 times a day for 1 WEEK then apply antifungal twice a day for 4 weeks

Question 25

What is the treatment recommendation for tinea pedis where small vesicles and scaling are present but there is not inflmmation

Answer 25

Apply antifungal up to 2 times a day for 4 weeks combined with nondrug care

Question 26

What is the treatment recommendation for tinea pedis where there are wet/soggy lesions but no fissures

Answer 26

Soak feet in aluminum chloride solution twice a day for 1 week and then daily until there is no more wetness.
Apply antifungal twice a day for 4 weeks in combination with nondrug therapy

Question 27

What is the treatment recommendation for tinea pedis with wet/soggy lesions AND deep fissures

Answer 27

Soak feet with aluminum chloride 10% solution twice a day for 1 week until fissures are healed
THEN 20-30% aluminum chloride solution 2 times a day for 1 week and then daily until no more wetness
apply antifungal topically to area once dried off from soak daily for 4 weeks in combination with nondrug care