Fungal skin infections
Presentation of jock itch
A pruritic, red rash and is most common during warm weather; however, it can occur at any time of the year if the skin in the groin area stays warm and moist for long periods
Clotrimazole 1% and miconazole nitrate 2%
Imidazole derivatives that demonstrate fungistatic/fungicidal activity
vesicular type tinea pedis
-usually caused by T. Mentagrophytes var. indigitable -small vesicles or vesiculopustles are observed near the instep and on the mid-anterior plantar surface -skin scaling seen on those areas as well as on the toe web -symptomatic in summer but clinically quiescent in the winter
Chronic papulosquamous pattern of tinea pedis
-usually found on both feet -characterized by mild mild inflammation and diffuse, moccasin-like scaling on the soles of the feet
Four accepted variants of tinea pedis
1. Chronic intertriginous type 2. Chronic papulosquamous pattern 3. Vesicular type 4. Acute ulcerative type
Safe and effective non prescription drugs for fungal skin infections
1. Clotrimazole 2. Miconazole nitrate 3. Terbinafine hydrochlorate 4. Butenafine hydrochloride 5. Tolnaftate 6. Clioquinol 7. Undecylenic acid 8. Imidazoles
Cause of tinea pedis and tinea cruris
1. Epidermophyton 2. Trichophyton
Cause of tinea corporis
1. Epidermophyton 2. Trichophyton 3. Microsporum
Nonpharm therapy for fungal skin infections
1. Keeping the skin clean and dry 2. Avoiding the sharing of personal articles 3. Avoiding contact with infected fomites or persons who have a fungal infection
Three genera of fungi causing fungal skin infections
1. Microsporangia 2. Trichophyton 3. Epidermophyton
Four variants of tinea capitis
1. Noninflammatory 2. Inflammatory 3. Black dot 4. Favus
Types of fungal infections that require PCP referral
1. Tinea unguium 2. Tinea capitis
Treatment goals of fungal skin infections
1. To provide symptomatic relief 2. Eradicate existing infection 3. Prevent future infections
Cause of ringworm of the scalp
1. Trichophyton 2. Microsporum
Signs of fungal skin infections
Presents either as soggy malodorous, thickened skin; acute vesicular rash; or fine scaling of affected area with varying degrees of inflammation cracks and fissures may also be present
Tinea pedis
athlete's foot
Chronic intertriginous tinea pedis
-Characterized by fissuring, scaling, or maceration in the interdigital spaces; malodor; pruritus; and/or stinging sensation -typically involves lateral toe webs, usually between either fourth and fifth or third and fourth toes -warmth and humifidty aggravate the condition
ADR of terbinafine hydrochloride
-irritation -burning -itching/dryness
Acute ulcerative type of tinea pedis
-least common -often associated with macerated, denuded, weeping ulcerations on the sole of the foot -typically, white hyper keratosis and a pungent odor are present
Lesions of tinea corporis
-most often, they involve glaborous skin and begin as small, circular, erythrematous, scaly areas -lesions spread peripherally and the borders may contain vesicles or pustules -infected individuals may also complain of pruritus -can occur on any part of the body
Lesions in tinea cruris
-occur on medial and upper parts of the thighs and pubic area -well-demarcated margins that are elevated slightly and more erythemtous than the central area -small vesicles may be seen, especially at the margins -acute lesions are bright red and chronic lesions have a hyperpigmentated appearance -fine scaling usually present -generally bilateral with significant pruritus -lesions usually spare the penis and scrotum
Predisposing factors of fungal skin infections
-trauma to skin -diabetes -use of immunosuppressive drugs -impaired circulation -poor nutrition -hygeine -occlusion of the skin -warm and humid climate
Topical terbinafine hydrochloride 1%
An antifungal agent that inhibits squalene epoxidase; should be applied sparingly to the affected area
Topical butenafine hydrochloride 1%
Antifungal squalene epoxidase inhibitor indicated as a cure for tine pedis between the toes, tinea cruris, and tinea corporis; relieves itching, cracking, scaling
Nails affected by tinea unguium
Gradually lose their normal shiny luster and become opaque; if left untreated, nails become thick, rough, yellow, opaque, and friable
Risk for developing tinea pedis
Greater in individuals who use public pools or bathing facilities
Symptoms of fungal skin infections
Itching and pain
Noninflammatory tinea capitis
Lesions begins as small papules surrounding individual hair shafts; subsequently, the lesions spread centrifugaly to involve all hairs in their path; some scaling of the scal but little inflammation present; hairs in lesions are a dull gray color
black dot tinea capitis
Location of anthropores on the hair shaft causes hairs to break off at the level of the scalp, leaving black dots on the scalp surface; hair loss, inflammation, and scaling range from minimal to extensive
Cause of most tinea infections
Person-to-person contact with affected individuals
Resolution of fungal skin infections
May take between 2-4 weeks or up to 6 weeks
Tinea cruris occurrence
More often in men than in women and rarely affects children
Tinea capitis occurrence
Most often in children
Location of fungal skin infections
On areas of the body where excess moisture accumulates, such as the feet, groin area, scalp, and under the arms
Application of butenafine hydrochloride for tinea cruris or tinea corporis
Patient should apply a thin film to the affected area once daily for 2 weeks or as directed by a PCP
Application of butenafine hydrochloride for athlete's foot between toes
Patient should apply a thin film to the affected skin between and around toes twice daily for 1 week, once a day for 4 weeks, or as directed by a PCP
Application of terbinafine hydrochloride for jock itch or ring worm
Patients should apply once a day for one week, or as directed by PCP
Application of terbinafine hydrochloride for athlete's foot between the toes
Patients should apply twice a day for 1 week
Application for terbinafine hydrochloride for athlete's foot on the bottom or sides of the foot
Patients should apply twice a day for 2 weeks
Inflammatory tinea capitis
Produces a spectrum of inflammation ranging from pustules to kerion formation; fever and pain; high degree of pruritus; regional lymph nodes may be enlarged
Clinical spectrum of tinea infections
Ranges from mild itching and scaling to a severe, exudative inflammtory process characterized by denudation, fissuring, crusting, and or discoloration of the affected skin
tinea
Refers exclusively to dermatophyte infections
Application of clotrimazole or miconazole for jock itch
Should be applied twice daily for 2 weeks
Application of clotrimazole or miconazole nitrate for athlete's foot and ring worm
Should be applied twice daily for 4 weeks
Cause of fungal skin infections
Superficial fungal infection
Modifying factors of fungal skin infections
Treated with nonprescription astringents, antifungals, and nondrug measures to keep the area clean and dry
Favus tinea capitis
Typically presents as patchy areas of hair loss and scutula lesions can coalesce to involve a major portion of the scalp
Quantity/severity in fungal skin infections
Usually localized to a single region of the body but can spread
Timing of fungal skin infections
Variable onset
Drug-drug integration with miconazole
Warfarin; coadministration could increase the effects of warfarin
Kerion
Weeping lesions whose exudate forms thick crust on the scalp
Scutula
Yellowish crusts and scales
Tinea cruris
jock itch
Tinea corporis
ringworm of the body; most common in prepubescent individuals
tinea unguium
ringworm of the nails
tinea capitis
ringworm of the scalp