Superficial fungal infections Flashcards
What are the factors can contribute to fungal infections occurring
skin trauma
diabetes
immune system suppression
decreased circulation
malnutrition
poor hygiene
skin occlusion
warmth and humidity
How are fungal infections transmitted
person to person
animals
soil
fomites
What are the presenting symptoms of tinea
pruritis/scaling
fissure, crack or discoloration of the skin
What are the 4 types of tinea pedis that can occur
- cracks, scaling and maceration between toes. Pain and/or itching can occur
- mild inflammation with diffuse scaling on bottoms of feet
- vesicles or small pustules with scaling at instep area
- macerated, weeping ulcerations on bottom of foot, odorous and painful
What is tinea unguium
opaque, thickened nails
What is tinea corporis
ringworm that occurs anywhere on the body
red, scaly, raised border
ring-shaped
What is tinea cruris
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
What is tinea capitus
papules around the hair shafts which spread
scalp scaling or pruritic pustules form
Which types of tinea are not treated OTC
tinea unguium
tinea capitus
What are the exclusions for self-treatment?
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
What is the general treatment approach when it comes to superficial fungal infections
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
What are complementary and non-pharmacologic options
- 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 - contact prescriber if problem continues beyond recommended OTC duration
What OTC treatment options are available for tinea infections
clotrimazole
miconazole
terbinafine
butenafine
tolnaftate
undecylenic acid
What is the MOA of clotrimazole and miconazole
inhibit biosynthesis of sterols and damage fungal cell membrane
bacteriostatic
What is the MOA of butenafine and terbinafine
inhibit squalene epoxidase
squalene builds up in fungal cell and kills it
What is the MOA of tolnaftate
stunts mycelial growth of fungi(?)
What is the MOA of undecylenic acid
interacts with cell membrane
fungistatic
How often should you apply topical antifungal treatments
twice day for a duration of 4 weeks
*usually see resolution in 1-3 weeks
What is the MOA of aluminum salts
astringent
reduces cell membrane permeability and decreases swelling, exudate production and inflammation
What is the indication of aluminum salts
inflammatory and wet/soggy types of tinea pedis
dries out the area
What is the “dosing” for aluminum salts
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.
What is the treatment recommendation for the groin area
Well-define lesions: Apply antifungal twice a day for 2 WEEKS combined with non drug care
Poorly defined lesions: REFER
What is the treatment option for round lesions on other parts of the body
Apply antifungal twice a day for 4 WEEKS combined with nondrug care
What is the treatment recommendation for tinea pedis where inflammation is present
Soak feet with aluminum acetate solution 2-3 times a day for 1 WEEK then apply antifungal twice a day for 4 weeks
What is the treatment recommendation for tinea pedis where small vesicles and scaling are present but there is not inflmmation
Apply antifungal up to 2 times a day for 4 weeks combined with nondrug care
What is the treatment recommendation for tinea pedis where there are wet/soggy lesions but no fissures
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
What is the treatment recommendation for tinea pedis with wet/soggy lesions AND deep fissures
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
