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