Fungal Infections- Self Care

Front 1

superficial fungal infections effect how much of the population

Back 1

10 to 20%

Front 2

what are the most common superficial fungal infections?

Back 2

Foot- tinea pedis
Body- tinea corporis
Groin- tinea cruris
Scalp- tinea capitis
Trunk- tinea versicolor
Nails- tinea unguium

Front 3

In superficial fungal infections, what are common dermatophytes

Back 3

Trichophyton
Microsporum
Epidermophyton
Candida*

Front 4

what is the source of infection for common dermatophytes

Back 4

People
Animals
Soil
Objects

Front 5

what are predisposing conditions for superficial fungal infections

Back 5

?climate (warm…)
? diabetes
? Poor hygeine
?

Front 6

Signs/Symptoms of Tinea Pedis
Types:

Back 6

Acute self-limiting, intermittant, itchy and red, localized, lesions, (hot, sweaty…)
Chronic - larger area, won’t resolve without treatment, could be some fissuring

Front 7

Signs/Symptoms of Tinea Corporis
Where does it occur?

Back 7

anywhere

Front 8

Signs/Symptoms of Tinea Corporis
Appearance?

Back 8

Round and spreads outward

Front 9

Signs/Symptoms of Tinea Corporis
Spreading?

Back 9

sometimes

Front 10

Signs/Symptoms of Tinea Capitis
2 distinct patterns

Back 10

Black dot
Gray Patch

Gray patch will cause hair to break off (can happen with black dot but not as often as gray patch)

Front 11

Signs/Symptoms of Tinea Unguium

Back 11

Yellow colored nails, thickened, brittle.
Will start out a light yellow color then progress to a darker yellow
Usually starts with the big toe
Could be white, brown or yellow

Front 12

Less Common Forms of Onychomyocosis

Back 12

Can’t be treated OTC

Front 13

Approach to Treating Superficial Fungal Infections
goals of treatment:

Back 13

Provide relief and clear infection and prevent future infections

Front 14

when should you refer to PCP (superficial fungal infections)

Back 14

When it can’t be treated with OTC b/c it’s very severe.
If you don’t really know what it is
In children
If they have a fever
If they have had it for an extened time
If it involves the face, mucous membrane or genitalia, nails, scalp
If there is a secondary infection
If they have HIV
If they are diabetic
If it covers a large area of the body
If they are in severe pain

Front 15

Untreated Tinea Infections

Back 15

Spreads, gets worse, secondary infection, lose their nail-hair, get scaring

Front 16

Nonpharmacologic Options

Back 16

Prevent spread on infection to other body parts and other individuals

Keep yourself clean. Any area that is going to be warm/moist should be kept clean and dry as possible.
Where protective footwear in gym area and/or shower area.

Front 17

Treatment Options for superficial fungal infections

Back 17

Topical Antifungals
Classes
Azoles
Benzylamine
Allylamine
Hydroxypyridone
Other
Other agents
Clioquinol
Undecylenic Acid

Front 18

Azole Antifungals
Available Agents
Imidazoles:

Back 18

Lotramin®, Lotramin® AF, clotrimazole
Spectazole®, econazole
Nizoral®, ketoconazole
Desenex®, miconazole

Front 19

Azole Antifungals
Available Agents
triazoles:

Back 19

Diflucan®, fluconazole

Front 20

Azole Antifungals
Available Agents
MOA:

Back 20

Reduce ergosterol production by inhibiting fungal P450 enzymes
Broad-spectrum including some gram + bacteria

Front 21

Azole Antifungals
Available Agents
uses:

Back 21

Treats tinea infections of the body, foot, groin, scalp, and nails.

Front 22

Azole Antifungals
side effects topical:

Back 22

Irritation and burning
Itching

Front 23

Azole Antifungals
side effects oral:

Back 23

N/V
Fatigue
Edema
Elevated LFTs
HA (more common for fluconazole)
Gynecomastia (ketoconazole only)
Impotence
Decreased libido
Photophobia

(LFT’s liver function test
Gynecomastia- breast growth in men)

Front 24

Azole Antifungals
Drug interactions:

Back 24

None when applied topically
Oral Ketoconazole- Inhibits P450 enzyme 3A4
Oral Intraconazole- Inhibits P450 enzyme 3A4
Oral Fluconazole- InhibitsP450 enzyme 2C19, 3A4

Front 25

Azole Antifungals
contraindications

Back 25

None when applied topically
Oral Ketoconazole
Achlorhydria/Hypochlorhydria
Pregnancy Category C
Lactation
(Pregnancy cat A- safe
Pregnancy cat B- kind of safe
Pregnancy cat C- benefits outweigh risks)

Front 26

Allylamine Antifungals
Available Agents

Back 26

Naftin®, naftifine
Lamisil AT, Desenex Max, terbinafine

Front 27

Allylamine Antifungals
MOA:

Back 27

Causes fungal cell death by inhibiting squalene epoxidase
Naftifine may have some anti-inflammatory effects

Front 28

Allyamine Antifungals
Use:

Back 28

For the treatment of tinea capitis, cruris, corporis, interdigitale pedis, unguium, and versicolor

Front 29

Hydroxypyridone Antifungals
available agent:

Back 29

Loprox®, Loprox® TS, PenlacTM, ciclopirox

Front 30

Hydroxypyridone Antifungals
MOA:

Back 30

Causes fungal death by blocking the uptake of essential intracellular substrates such as potassium ions.
Broad spectrum including yeast and some bacteria

Front 31

Hydroxypyridone Antifungals
Uses:

Back 31

For the treatment of tinea cruris, corporis, pedis, and versicolor

Front 32

Hydroxypyridone Antifungals
side effects (low incidence)

Back 32

Pruritis, burning, and worsening of sx
Rash and erythermia
Nail discoloration (Nail lacquer only)

Front 33

Hydroxypyridone Antifungals
drug interactions/ contraindications

Back 33

Drug Interactions
None
Contraindications
Do not use in children <10yrs of age

Front 34

Other Antifungals
available agents:

Back 34

Asorbine®, Aftate®, Tinactin®, tolnaftate

Front 35

Gout

Back 35

Furosemide, thiazides, Niacin (according to world)

Front 36

other antifungals
use:

Back 36

For the treatment of tinea capitis, cruris, corporis, pedis

Front 37

Other Antifungals- Tolnaftate
side effects, interactions....

Back 37

Side Effects
Irritation and burning
Drug Interactions
None
Contraindications
Do not use in children <2yrs of age

Front 38

Adjunctive Therapy

Back 38

Available Agents
Aluminum salts
MOA
Astringent agents that may decrease inflammation

Aluminum salts can be used with others to clean up infection

Front 39

Adjunctive Therapy- Aluminum Salts
side effects....

Back 39

Side Effects
Burning, irritation
Drug Interactions
NONE
Contraindications
Deep fissures of the skin
External use only

Front 40

Adjunctive Therapy
topical steroids

Back 40

Use not recommended as it may modify the appearance of infection (referred to as tinea incognito)

Treats the symptoms but not the infection.
Only time you will use it is when in combination with an RX product.
** do not use HC for fungal infections **

Front 41

Therapeutic Guidelines for Tinea Corporis, Cruris, Pedis
Topical vs Systemic:

Back 41

Topical preferred but systemic can be considered if large surface areas are involved, extensive dermatophytosis infxn, or if topical treatment fails

Front 42

which topical should you recommend?

Back 42

May need to use systemic if there is a large area, severe, other diseases involved…

Which one? All treatments are equally effective if used properly!

Front 43

Therapeutic Approach to Tinea Capitis, Corporis, Cruris, Pedis

Back 43

Consideration of Dosage Form
Cream/Solution
Use on non-oozing, moderately scaling lesions
Gel/Ointment
Use on hyperkeratotic lesions
Lotion
Use on interdiginous or hairy areas, and on oozing lesions
Power/Spray
May be helpful in preventing reinfection
Also may contain talc
Shampoo
Use on scalp only

Front 44

Therapeutic Approach to Tinea Unguium

Back 44

Drugs of Choice
Terbinafine
250mg po qd for 6wks (fingernail), 12wks (toenail)
Itraconazole, continuous tx
200mg po qd for 12 wks (toenail with or without fingernails)
Itraconazole, pulse
200mg po bid x 1 wk on, 3 weeks off

Front 45

Penlac info

Back 45

Penlac is applied for 7 nights, each time over the last application, don’t remove until after the 7th day and use alcohol.
Patients should keep their nails trimmed. Use an emery board to get rid of the “dead” parts.
Safety and efficacy for > 48 weeks has not been established