Superficial Fungal Infections Flashcards
Tinea Pedis Interdigital
Toe Web Infection
- Most common, maceration appearance (soggy and wet), dry scaly fissure appearance
- Itching
- Must determine that bacteria is not the cause
Tinea Pedis Moccasin
Affects the soles of the feet
Appears: hyperkeratotic (thickening of soles), erthema, white and silver scales, entire sole is involved
- Hard to distinguish from xerosis, psoriasis, eczema
Tinea Pedis Inflammatory or bullous
Rare Resembles allergic dermatitis Starts as a web infection Vesicles form on the soles of the feet --> bullae Risk of secondary infection
Tinea Pedis Ulcerative Type
Invasive involvement of interdigital into the dermis
Maceration
Secondary infection
Tinea Pedis Dermatophytid
Hand Involvement
Tinea Pedis Treatment First Line
Topical therapy: If maceration or wet lesion are present –> aluminum acetate foot soaks (Burrows solution)
Oral: Griseofulvin (not used), Fluconazole, Terbinafine
Oral treatments
Reevaluate at end of each treatment phase
Baseline CBC and LFT; recheck after 1 month of treatment
Tinea Capitis
Ring worm of the scalp
Involves the scalp hair follicles and skin
Mainly school age kids and rare in adults
- Scalp alopecia (circular), black dot (broken off hair shafts), dandruff
Tinea Capitis Symptoms
Hair loss
Pain and tenderness
Flaking or scaling
Tinea Capitis Treatment
Ketoconazole shampoo Topical antifungal solution and lotions Selenium sulfide Topical steroids ORAL: Griseofulvin, fluconazole
Athlete’s Foot - Tinea Pedis
Fluconazole: 150 mg once a week for 1 month
Terbinafine: 250 mg per day for 2 weeks
Ring Worm- Tinea Capitis
Griseofulvin: 15 mg/kg/day for 6-8 wks or 330 mg QD for 4-6 wks
Fluconazole: 50 mg or 6 mg/kg/day for 4-6 wks or 8 mg/kg/day for 4-16 wks
Intraconazole: 5 mg/kg/day or 100 mg QD for 4-6 wks
Terbinafine: 125 or 250 mg for 4-6 wks
Tinea Barbae
Lesions involving the hair follicles of the beard and mustache
- Animals = triggers
- Symptoms: pruitus, tenderness and pain
Tinea Barbae Treatment
ORAL therapy bc topical cannot penetrate hair follicles
- Grisefulvin, fluconazole, Itraconazole, terbinafine
Tinea Corporis
“Ring Worm”
- Circular lesions, demarcated borders
- Triggers: humid climate, daycare, animals
- Usually in trunk and limbs
- Symptoms: mild pruritus
Tinea Corporis Treatment
Localized infections: topical antifungal therapy (twice daily and continue for 1 wk after resolution) Aluminum acetate (wet lesions): apply dressing for 20-30 minutes 2-6 times per day Oral (extensive infections)
Tinea Corporis Oral
Fluconazole: 150 mg every week for 2-6 wks
Intraconazole: 100-200 mg QD for 2 wks
Terbinafine: 250 mg QD for 1-2 wks
Tinea Cruris
Jock Itch
Triggers: warm/humid environment, tight/occlusive clothing, obesity
- Men
- High rate of relapse
- Demarcated scaling plaques, erythematous, bilateral
- Thing and groin region, buttocks, penis and scrotum (rare)
Tinea Cruris Symptoms
Pruritus
Inflammation
Tinea Cruris Treatment
Topical (first line): 2x daily for 10 days and even after they disappear
Powder: absorbs moisture (will not kill the fungi, just help)
Aluminum acetate solution
Topical steroids/antifunal combo: Lotrisone and Mycolog II
Oral: extensive
Tinea Cruris Oral Treatment
Fluconazole: 150 mg every week for 2-4 wks
Terbinafine: 250 QD for 2-4 wks
Tinea Manuum
Fungal infections of the hands
Thickened scaling skin on palms
ORAL better than topical
Tinea Manuum Oral Treatment
Prevent onychomycosis or tinea pedis
Terbinafine: 250 mg QD for 14 days
Intraconazole: 200 mg QD for 7 days
Griseofulvin: 500 mg QD for 21 days
Tinea Versicolor
Caused by yeast P. orbiculare (normal flora, within sweat glands)
Trigger: heat and humidity, Cushing’s disease, pregnancy, malnutrition, etc
- Circular macular patches of carious colors
Tinea Versicolor Topical Treatment
Selenium sulfide (10 minutes daily for 7 days)
Ketoconazole, miconazole, clotriamizole, econazole (one to two times a day for 2-4 wks)
Keratolytic soaps
Tinea Versicolor Systemic agents
Ketoconazole: 400 mg single dose or 200 mg QD for 5 days
Intraconazole: 200 mg daily for five days
Fluconazole: 300-400 mg as a single dose
Topical agents indications and side effects
Tinea corporis, cruris, manuum, pedis (no follicule involvement)
Contact dermatitis
Topical agents duration
Up to 2 wks
Terbinafine or luliconazole for 1 wks
Topical agents disadvantages
Less effective for extensive infections or hyperkeratotic areas
Longer duration of therapy
Poor compliance
High relapse rate
Topical Ointment formulation
Hyperkeratotic lesions
- Greasy, best absorptions, keeps moisture in
Topical Lotions/Solutions formulation
Hairy areas of the body
Moist or weeping lesions
Prevent maceration
Topical Creams Formulation
Scaling, dry lesions
Topical powders formulation
Prevention- does not treat
Adjunctive therapy
Reduce maceration and moisture
Topical Agents: Toinaftate (Tinactine)
No prescription
Cream, spray, powder solution, and ointment
Twice daily
Topical Agents: Clotriamizole (Lotrimin)
No prescription
Cream, solution, lotion
Twice daily
Topical Agents: Ketoxonazole
Yes prescription
Shampoo, cream
Once daily
Topical Antifungals: Terbinafine (Lamisil)
No prescription
Cream, gel
QD or BID daily
Luzu-Luliconazole
Tinea corporis, cruris and pedis
QD for 1 wk: cruris/corporis
QD for 2 wk: pedis
Cream, 60 grams
