Ch 3.2 - Athlete's Foot & Warts/Verruca

Question 1

Describe the appearance of athlete’s foot (mild fungal infection)

Answer 1

Usually itchy, flaky skin in the web spaces between the toes
Flakes or scales of skin become white and peel off. Underneath skin is usually reddened and may be itchy and sore. Skin may be dry and scaly OR moist and weeping

Question 2

When should you refer a patient with athletes foot?

Answer 2

1. Severe, affecting other parts of the foot
2. Diabetic patients
3. Signs of bacterial infection
4. Unresponsive to appropriate treatment within 2 weeks
5. Involvement of toenails

Question 3

What are some of the treatment options for athlete’s foot?

Answer 3

Creams, powders, sprays, solutions

Topical Allylamines e.g. Terbinafine

Azoles e.g. Miconazole, clotrimazole, ketoconazole

Undecenoic acid

Tolnaftate

Question 4

What activity do Azoles have and how long should ketoconazole be used?

Answer 4

Azoles have anti fungal and antibacterial activity (useful as secondary infections can occur)

1 week treatment

Question 5

What formulations does Terbinafine come in and how to use it?

Answer 5

Come in a cream and spray

Cream applied once or twice daily for 1 week for athelets foot and 2 weeks for jock itch.
Spray used for 1 week.

evidence - terbinafine better to prevent recurrence compared to azoles.

Question 6

Who can’t use terbinafine?

Answer 6

Children

Spray can’t be used in those under 16

Question 7

What formulation does Tolnaftate come in and how long should it be used?

Answer 7

Available in powder, cream, aerosol and solution formulations

should be applied twice daily and treatment
should be continued for up to 6 weeks

Question 8

Why would a pharmacist not recommend hydrocortisone for the treatment of athletes foot?

Answer 8

although it would reduce inflammation, it would not deal
with the fungal infection, which might then worsen.

Combination products maybe - limited to 7 days use

Question 9

Non-pharmacological advice on athletes foot

Answer 9

Allow feet to breathe - leather shoes
Avoid shoes that are too tight or made from synthetic material
- Cotton socks
- Feet should be washed and carefully & thoroughly dried
- Wear footwear in public baths, swimming, changing rooms to avoid transmission

Question 10

What virus causes warts and verrucaes?

Answer 10

Human Papilloma Virus

Question 11

What are the differences in appearances between warts and verrucaes?

Answer 11

Warts - raised lesions and roughened surface that are flesh coloured

Verrucae - occur on weight-bearing areas of sole and heel. so flat inward looking lesions.

Question 12

How long do warts last without treatment?

Answer 12

6 months - 2 years

Any changes in the appearance of wart- treated with suspicion and referral

Question 13

Why should Diabetic patients not use OTC wart/verrucae products?

Answer 13

Impaired circulation can lead to delayed healing, ulceration or even gangrene.

Peripheral neuropathy may mean that even extensive damage to the skin many not provoke sensation of pain

Question 14

When to refer someone with wart/verrucae?

Answer 14

1. Changed appearance of lesions, size, colour
2. Bleeding
3. Itching
4. Genital warts
5. Facial warts
6. Immunocompromised patients

Question 15

What is the treatment scale for warts/verrucae?

Answer 15

3 months - if not then referral

Question 16

Salicyclic acid is the treatment of choice for warts. How does it work?

Answer 16

Acts by softening & destroying the skin, thus mechanically removing infected tissue.

It is keratolytic and has an antimicrobial effect

Question 17

Why is Formaldehyde used for verrucae but not warts?

Answer 17

Irritant effect on skin - thicker skin on feet protects from irritation

Gel applied twice daily.

Question 18

What strengths is Glutaraldehyde used in? what should patients be warned of?

Answer 18

5% or 10% gel or solution used to treat warts but more generally verrucae

It may stain skin brown, although this will fade once treatment has stopped

Question 19

What are the practical points - application of salicylic acid?

Answer 19

Affected hand/foot soaked inwater water for 5-10min, to help soften & hydrate skin = increasing action of S.A

Removal of dead skin from surface of wart using a pumice stone will help S.A reach surface of lesion

Use petroleum jelly to protect surrounding healthy skin.

Use an orange stick to help confine substance on lesion