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7006PHM Prof Pharm II > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

List types of dermatophyte infections

A

Tinea pedis

Tinea corporis

tinea unguium

Tinea capitis

Tinea cruris

Tinea manuum

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2
Q

What are the signs and symptoms of tinea pedis? (sx, location)

A

Location = feet, between toes (can spread)

Characterised = itching, redness, flaking, moistness

May have unpleasant odour

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3
Q

What are the signs and symptoms of tinea corporis? (sx, location)

A

Location = trunk, legs, arms, neck

Characterised = pink/red scaly lesions, slightly elevated and well defined border w/ active outer edge, itch (mild- moderate)

May be singular or numerous

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4
Q

What are the signs and symptoms of tinea unguium? (sx, location)

A

Location = nails

Early characteristic = distal/lateral yellow/white discolouration of nail

Late characteristics = nail thickens, nail plate lifts off nail bed

Nail becomes brittle –> crumbles and falls off

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5
Q

What are the signs and symptoms of tinea capitis? (sx, location)

A

Location = head

Characteristics = may be asymptomatic or slight itch, redness/scales, hair breaking off

May be inflamed and/or pus-filled

Severe case = fungal abscess can occur

Systematic treated required due to hair follicle involvement

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6
Q

What are the signs and symptoms of tinea cruris? (sx, location)

A

Location = groin

Characteristics =scaly red margin from groin down to inner thigh, well defined raised patches

Margin can have small pustules, usually mildly itchy

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7
Q

What are the signs and symptoms of tinea manuum? (sx, location)

A

Location = hands

Characteristics = scaly, annular (circular or round) rash with active border

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8
Q

List the different kind of yeast infections

A

Pityriasis versicolour

Oral candidiasis

Vaginal candidiasis

Napkin candidiasis

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9
Q

How does pityriasis versicolour appear on different skin tones?

A

Fair skin = lesions are light-brown

Pigmented skin = patchy hypopigmentation

Caused by a yeast

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10
Q

How does pityriasis versicolour appearance differ in areas of high/low sun exposure?

A

Area unexposed to light = red-brownish circular lesion often joining up together

Areas exposed to light = infected lesions do not tan

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11
Q

What are the signs and symptoms of pityriasis versicolour (sx, location)

A

Location = upper trunk

Characteristics = discoloured skin patches, light scaling if skin is scratched, asymptomatic may itch

Not infectious but may itch

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12
Q

What are the signs and symptoms of oral candidiasis? (sx, location)

A

Location = mouth, tongue, cheeks

Characteristics = white, creamy patches in mouth (easily wipes off), may be red and painful, red sore splits in corner of mouth

Infants = may not feed well, uncomfortable sucking

Adults = taste disturbances

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13
Q

What are the signs and symptoms of vaginal candidiasis? (sx, location)

A

Location = vagina or vulva

Characteristics = thick, white discharge w/ non offensive odour, may itch/be sore, external dysuria

Sex may be painful

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14
Q

What are the signs and symptoms of napkin candidiasis? (sx, location)

A

Location = usually skin folds

Characteristics = clusters of red papules and plaques, well demarcated, painful red rash

Small satellite lesions may be present

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15
Q

How does Pityrosporum orbiculara/versicolour change skin colour?

A

Multiplies in superficial layers or stratum corneum on trunk and upper limbs –> mild inflammation –> carboxylic acid production –? inhibits melanin production

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16
Q

What are some differential diagnoses to tinea corporis?

A

Dermatitis = will go away with corticosteroid treatment whilst fungal will not

Discoid eczema = arms and legs, whole lesion is red and not just border

Psoriasis = patient will have fam hx, lesions are red and fully scaly

17
Q

What are some differential diagnoses to tinea unguium?

A

Trauma = identifiable event that affected nails

Eczema = ridges in nail, skin near/around feet affected

Psoriasis = will see nail pitting, less yellow discolouration seen

18
Q

What are some differential diagnoses to tinea capitis?

A

Alopecia = not associated with scales, not common

Seborrhoeic dermatitis = should not have hair loss

Psoriasis = has thicker scales

19
Q

What are some differential diagnoses to tinea manuum?

A

Pompholyx = often bilateral or symmetrical

Psoriasis = often bilateral or symmetrical

20
Q

List the topical drugs used to treat fungal infections

A

Imidazoles = clotrimazole, miconazole, ketoconazole, bifonazole, econazole

Terbinafine (lamisil)

Tolnaftate = not super effective

21
Q

What is the efficacy, duration, and considerations for topical imidazoles?

(Fungal infections)

A

Req freq application

Apply for 14 days after sx resolve

22
Q

What is the efficacy, duration, and considerations for topical terbinafine?

A

Rapid response, once daily application

short duration of use ~ 1 week

Continue use for 2-3 days after sx resolve

23
Q

Summarise the specific treatments for tinea unguium

A

Amorolfine nail lacquer = 1-2/week for 6 months (fingernails)/ 9-12 months (toenails)

- use until nail is completely cured/regrown

Bifonazole and Urea (mild-moderate infections) = used in phases

- Phase 1 (wk 1-3) = Urea ketatinolytic agent that softens infected nail only --> apply 1/day for 2-3 wks, soak in warm water + scrape to remove infected nail 

- Phase 2 (wk 4-7) = bifonazole Treats the infection, 1/day for 28 days
24
Q

List the systemic treatments for tinea

A

Oral terbinafine

Fluconazole

Itraconazole

Griseofulvin

25
Q

How long is systemic terbinafine used for tinea infections?

A

2-6 wks

Can be up to 12 weeks depending on severity

26
Q

How long is systemic fluconazole used for tinea infections?

A

150mg for 4 weeks OR 50mg/day for 2-6 wks = body

Nails = 52 weeks

27
Q

How long is systemic itraconazole used for tinea infections? (Toes and fingers)

A

200mg, 2/day for 1 week every:

- 3 to 4 months = toenails 
- 2 months for fingernails
  • take with food
28
Q

How long is systemic griseofulvin used for tinea infections?

A

Skin, hair, groin = 8-12 wks

Feet nails = 1g/day until nail grows out

29
Q

What are the treatments for pityriasis versicolour?

A

Topical antifungals = econazole 1% (short course 3 nights), ketoconazole 2% (5/7 course), miconazole 2% (10/7 course)

Anti-infective = selenium sulfide (7-10 days)

Fluconazole

Itraconazole = 1 day/month for 6 months

30
Q

What are the treatments for oral candidiasis?

A

Miconazole gel - s3 = 4x/day for 7-14 days after food

Nystatin oral suspension - S3 = 4x/day after food for 7-14 days

Amphotericin - S4 =4x/day after food for 7-14 days

*cont. treatment a few days after sx resolve

31
Q

Discuss the intravaginal antifungals used in vulvo vaginal candidiasis

A

nystatin = less effective than imidazoles but better tolerated, 14 night of tx

imidazoles = At night for 6, 3 or 1 night (clotrimazole, miconazole)

32
Q

Discuss the oral treatments for vaginal candidiasis

A

Fluconazole = 150mg single dose

Those that prefer oral therapy or are intolerant to topical

if not preg

33
Q

How is genital candidiasis treated in men?

A

imidazole cream = clotrimazole or miconazole w/ 1% hydrocortisone

34
Q

List the treatments for napkin candidiasis

A

Topical corticosteroids:

- hydrocortisone 
- Severe = methylprednisolone aceponate or triamcinolone acetonide

Topical antifungals +/- zinc oxide:

- miconazole, clotrimazole
- nystatin
35
Q

Outline some important information for topical corticosteroid use in napkin candidiasis

A

Can cause skin irritation

Can be used for 3-5 days for inflammation and discomfort

36
Q

Outline some important information for the use of topical antifungals (esp nystatin) +/- zinc in napkin candidiasis

A

Nystatin is less irritating than the imidazoles

Treatment continued for 14 days after sx resolve

37
Q

What are some lifestyle recommendations for tinea infections

A

Keep skin clean and dry

Use separate towel for infected areas to prevent spread

Wear clothes made of natural fibres (cotton, wool) or breathable fabrics that keep skin dry

Avoid wearing tight clothing and non-breathable synthetic fabrics

Do not share towels, shoes, socks, underwear, hats, hairbrushes, or combs

7006PHM Prof Pharm II (24 decks)

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