Tinea infections

Question 1

List the two main groups of fungi that infect humans:

Answer 1

Candida yeasts and the dermatophytes

Question 2

Dermatophyte skin infections are classed by?

Answer 2

Anatomical location

Question 3

ringworm of the body is called

Answer 3

tinea corporis

Question 4

Ringworm of the scalp is called

Answer 4

Tinea capitis

Question 5

Ringworm of the beard is called

Answer 5

Tinea barbae

Question 6

Ringworm of the nails is called

Answer 6

Tinea unguium

Question 7

Ringworm of the face is called?

Answer 7

Tinea faciei

Question 8

Ringworm of the groin is called

Answer 8

tinea cruris

Question 9

Ringworm of the hand

Answer 9

Tinea manus

Question 10

ringworm of the foot is called

Answer 10

Tinea pedis ( athlete foot)

Question 11

—- is the most common fungal infection

Answer 11

Tinea pedis

Question 12

State the epidemiology of Tinea infections

Answer 12

More prevalent in tropical and subtropical areas because fungal organisms prefer high temperature and high humidity

Question 13

State the aetiology of Tinea infection

Answer 13

Contagious and transmitted directly from one host to another
Invade the stratum corneum, hair and nail but do not generally infiltrate living tissue
Fungus then begins to grow and proliferate in the non-living cornified layer of keratinised tissue of the epidermis

Question 14

List the signs and symptoms of tinea pedis

Answer 14

Itching
Flaking and fissuring of the skin
Skin appears white and ‘soggy’ due to maceration of the skin
Feet often smell
Usual site is in the toe webs, especially the fourth web space
Infection can spread to the sole and instep of the foot
Nail involvement may be present

Question 15

State the specific questions to ask a patient suffering from a tinea infection

Answer 15

Age & Sex of patient

Presence of itch

Associated symptoms

Previous history
Most prevalent in young adults, especially men. Nail involvement usually occurs in older patient

Fungal infections usually have itch, irritation or burning sensation

Flaky, smelly, nail involvement

Usually have acute onset with no previous episodes, although athletes foot may be recurrent.

Question 16

what is the first line treatment for Tinea pedis

Answer 16

Imidiazoles for candidiasis;
e.g. Clotrimazole 1%, Miconazole, Ketoconazole, Bifonazole

New ONCE daily Canesten Bifonazole cream

In the case of Miconazole – this should be continued for 10 days to prevent re-lapse

Consider co-products with Hydrocortisone. – Only licensed for over 10 years old.

Canesten HC applied BD. Only licensed for 7 days use and for 10yrs and over. Limits the usefulness as the fungal infection takes longer to treat. So best to continue with non_HC product after

Question 17

List the side effects of Imidazoles

Answer 17

Side effects: occasional local irritation, burning sensation and itching

To prevent re-infection, imidazole should continued to be used after the lesions have healed.

Question 18

State the treatment used for dermatophyte

Answer 18

. Terbinafine for dermatophytes (LAMISIL range)
Recent POM to P switch
Better efficacy than imidiazoles, good for resistant cases
Reserve for treatment failure

All products (cream, gel & spray) licensed for 16 years and over except Lamisil ONCE >18 years old.

Question 19

State other products used to treat dermatophyte infections

Answer 19

Tolfinate
Undecenoic acid (mycota) 

Benzoic acid

Question 20

State the side effects of terbinafine

Answer 20

Redness and itching

Question 21

State the self advice to give to a patient suffering from tinea pedis

Answer 21

Dry the skin thoroughly after showering or bathing
Keep personal towel and do not share it
Wear cotton socks and change them at least once a day
Avoid use of occlusive non-breathable shoes
Dusts shoes and socks with antifungal powder
Avoid scratching infected skin
Use flip-flops when using communal changing rooms

Question 22

When to refer a patient suffering from Tinea pedis

Answer 22

OTC treatment failure

Nail involvement (if more than 2 nails refer. If diabetic refer)

Suspected facial or scalp involvement

Question 23

Onychomycosis means?

Answer 23

Infection develops slowly and causes the nail to become discolored (may turn white, black, yellow or green) , thickened and distorted. (becomes unusual shape and difficult to trim)
Can cause pain and discomfort particularly when pressure is applied
Can become brittle or crumbly where piece break off.

Toenails are more frequently affected than fingernails

Question 24

State the product used in treating onchomycosis

Answer 24

Curanil(amorolfine)

Curanail can be used for up to 2 nails. Otherwise tablets need to be taken .

Question 25

Affects major skin surfaces that do not involve ———

Answer 25

A face, hands, feet, groin or scalp.

Question 26

Signs and symptoms of Tinea corporis(Ringworm)

Answer 26

Itchy pink or red scaly slightly raised patches with WELL DEFINED INFLAMED BORDER
Over time the lesions show ‘central clearing’

Question 27

List the conditions to eliminate when suffering from Ringworm

Answer 27

Psoriasis and Dermatitis/eczema

Question 28

State how to differentiate ringworm from eczema and psoriasis

Answer 28

Central area is resistant to colonization

Lesions can occur singly, be numerous or overlap to produce a large lesion

Psoriasis – take family history. Lesions tend not to itch, and exhibit more scaling and do not show central clearing

Eczema/dermatitis- take family history. Very itchy, particularly affects arms and legs- can be difficult to differentially diagnose.

Same treatment

Question 29

When to refer to Ringworm infection?

Answer 29

Refer if large areas become involved, otc failure, facial/scalp involvement, signs of secondary bacterial infection (puss, redness or inflammation)