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Fungal on skin
Lecture 19,20,21
24
Pharmacology
Professional
04/04/2013

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Cards

Term
What are the primary reservoirs for tineas?
Definition
Most infections of tinea/trichophytons, are from human contact
**risk: poor hygiene, diabetes, inactivity, obesity
Term
What are signs of a tinea infection?
Definition
- Signs - soggy, smelly skin w/ cracks or fissures
- Itchy/painful
**KOH test is highly sensitive/inexpensive
Term
What are the different types of tineas?
Definition
- Feet - tinea pedis = athlete's foot. The most common
- Body - tinea corporis - children and stressed patients
- Groin - Tinea cruris = jock itch, more common in males. Acute = red, chronic = hyperpigmented
- Scalp - Tinea capitis - "ringworm of the scalp", affects black girls
Term
What are the types of tinea pedis?
Definition
- Chronic intertriginous - Most common. Scaling between toes. Malodor and stinging/itching
- chronic papulosquamous - inflammation and scaling on soles
- Vesicular - pustules at instep
- Acute ulcerative - weeping ulcers on soles, can impede ability to walk
Term
What are the types of tinea capitis?
Definition
- Noninflammatory - small papules, hair is gray and breaks
- inflammatory - pustules and weeping lesions. Fever and pain common
- Black dot - hair loss, inflammation, scaling
- Favus - patchy hair loss, yellow crust
Term
What tineas can be self-treated?
Definition
Tinea pedis, corporis, and cruris for 2-4 weeks
**Cannot self treat tinea capitis, or nails, scalp, genitals, face, immunocompromised, fever
Term
What OTC creams can treat tineas?
Definition
- Butenafine - Lotrimin Ultra - daily
- Clotrimazole - Lotrimin AF
- Miconazole - Micatin/Lotrimin AF
- Terbinafine - Lamisil
- Tolnaftate - Tinactin
**Creams most efficient, sprays are adjuncts
Term
What RXs can be used for tineas?
Definition
- Fluconazole 150 po weekly for 1-4 weeks
- Ketoconazole 200 QD x4 weeks
- Itraconazole 200-400 QD x1w
- Terbinafine 250 QD x2w
Term
What is used to treat Tinea Capitis?
Definition
- Griseofulvin - drug of choice for 4-6 weeks
- Terbinafine/Lamisil - 4-8 weeks
Term
What are risk factors for oral candidiasis?
Definition
- Local: mucosal disruption, smoking, dry mouth, dentures, steroid use
- Systemic: Malignancy, diabetes, HIV, Neonates/Elderly, drugs
Term
What are the different types of oral candidiasis?
Definition
- Pseudomembranous/thrush - white, wipeable plaques
- Hyperplastic/Candidal leukoplakia - in smokers. White firmly attached plques
- Erythematous - Sensitive red patches on tongue
- Angular cheilitis - cracking in corners of the mouth
- Denture stomatitis - Red, flat lesions under dentures
Term
What are the first line treatments for mild candidiasis?
Definition
- Nystatin or clotrimazole - Troches or suspension. Let troches dissolve, do not chew.
- Move to Fluconazole 100-200 QD for first episode if a moderate infection
**Use systemic for severe, high risk, unresponsive. Xerostomia not a good candidate for troches
Term
What treatments should be used for fluconazole refractory patients?
Definition
- Itraconazole solution 200mg
- Voriconazole - 200 mg BID on an empty stomach. Many AEs
- Posaconazole susp
- Amphotericin B
Term
What is vulvovaginal candidiasis?
Definition
Caused by albicans - on vagina and vulva
Increased risk w/ sexual activity, birth control, douching, diet, tight fitting clothes, Abx
Term
How is VVC diagnosed?
Definition
- Signs and symptoms
- KOH microscopy
- Candida cultures
Term
What are topical treatments for VVC?
Definition
- Butoconazole - Mycelex-3
- Clotrimazole 1-10% - Mycelex-7 or Gyne-Lotrimin
- Miconazole 2or4% - Monistat
- Tioconazole 6.5% - Vagistat 1
- Teraconazole - Terazol 3 or 7
**First line! Equivalent oral: Fluconazole 150 x1
Term
What is complicated vs uncomplicated VVC?
Definition
- Complicated - Immunocompromised, uncontrolled diabetes, pregnancy (avoid oral): Therapy should be 10-14 days
- Uncomplicated - none of the above, therapy duration does not matter
Term
What is recurrent VVC?
Definition
>4 episodes of VVC within 12 months
- Induction 10-14 days with a topical or oral azole
- Prolonged: Fluconazole 150 once weekly for 6 MONTHS
Term
What are exclusions for VVC self treatment?
Definition
- Recurrence
- Diabetes/HIV
- Pregnancy
- Girls < 12
- Fever, lower back pain
Term
What is onchomycosis?
Definition
= Tinea unguium, caused by trichophyton - the most common cause of nail dystrophy. Toes > fingers
Term
What are risk factors for onchomycosis?
Definition
- Age > 40, FH
- Immunocompromised, diabetes
- Psoriasis
- Smoking
- Tinea pedis
- Sports, nail trauma, occlusive footware
Term
What are the types of onchomycosis?
Definition
- Lateral distal subungual - penetration into stratum corneum. Tinea pedis usually involved
- Superficial white - nail plate, looks white
- Proximal subungual - AIDs patients, uncommon
- Candidal - entire nail plate
Term
What are first line treatments for onchomycosis?
Definition
- Terbinafine - inhibits squalene epoxidase, works on dermatophytes. 250 mg QD for 6 weeks in fingers, 12 weeks in toes. Watch LFTs
- Itraconazole - Do not use in liver or CHF. Pulse dose
**2nd: Fluconazole, Griseofulvin, Ketoconazole
Term
When is ciclopirox/penlac used for onchomycosis?
Definition
- Superificial infection involving <50% of nail, in early stages, limited to 3-4 nails. When someone can't use systemic therapy
- Apply daily, remove every 7 days. Must treat for 12 months
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