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446- ID and transplant > Superficial Fungal Infections > Flashcards

Superficial Fungal Infections Flashcards

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1
Q

dermatophytosis is a

A

superficial mycotic infection of the skin

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2
Q

tinea is the latin word for

A

fungus

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3
Q

dermatophytes are

A

a group of filamentous fungi that require keratin for growth- survive on dead keratin

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4
Q

most superficial fungal infections are caused by which 3 genera of dermatophytes

A

(trichophyton, Epidermophyton, microspore)

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5
Q

how are superficial fungal infections generally transmitted

A

direct contact, fomites, environment (soil), animals

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6
Q

what are some predisposing host factors that may increase the chance of a superficial fungal infection

A

moisture (occlusive clothing/ shoes, warm humid climates), genetic susceptibility, impaired immunity (ex- diabetes, HIV, chemo)

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7
Q

tinea pedis is most commonly caused by ___________ and _________

A

dermatopytes
gram - bacteria that are ulcerative

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8
Q

which of the following is false about athletes foot
1. females are more likely to get it than males
2. prevalence increases with age
3. 70% will acquire it in their lifetime
4. marathon runners have a 30% prev rate
5. all of the above are true

A

1- males 4x more likely

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9
Q

what are the 4 variations of athlete’s foot

A

chronic interdigital infection
mocassin type infection
vesicular
ulcerative

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10
Q

what is the most common variant of athlete’s foot

A

chronic interdigital infection

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11
Q

describe the sx of chronic interdigital infxn

A

often between 4th and 5th toe
scaling, fissuring, whitened, thickened
burning, itching, malodorous

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12
Q

describe the sx of moccasin type infection

A

typically both feet
mild inflammation + diffuse scaling
toenails may be affected

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13
Q

describe the sx of vesicular type tinea pedis

A

Small vesicles near instep + mid anterior plantar surface
Typically with skin scaling

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14
Q

describe the sx of ulcerative type tinea pedis

A

Weeping and inflamed
Often malodorous due to secondary bacterial infxn

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15
Q

in tinea pedis fungus invades the __________, there is __________ initially or the patient may be ____________

A

outermost layer of the skin
drying and scaling initially
pt may be asymptomatic

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16
Q

what promotes fungal growth

A

moisture + increase temp by hot sweaty feet

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17
Q

list 2 differential dx for tinea pedis

A

Contact dermatitis, eczema, psoriasis, or bacterial infxns

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18
Q

list 2 nonpharm measures for tinea pedis

A

Mainly focused on prevention of recurrence + avoiding transmission
Avoid standing barefoot in public spaces, manage hyperhidrosis (antiperspirants or absorbent powders - talc/ aluminum Cl), allow shoes to dry thoroughly, avoid tight fitting shoes, breathable shoes- leather/ canvas allow feet to breathe
Personal hygiene: wash feet and dry thoroughly, change socks daily (avoid nylon materials), launder items used by infected person often + don’t share towels

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19
Q

what are the 4 classes of pharm tx for tinea pedis

A

allylamines
imidazoles
misc
hydroxypyridone

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20
Q

list the drug that is an allylamide that treats tinea pedis

A

terbinafine

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21
Q

what 3 topical imidazoles may be used to tx tinea pedis

A

miconazole, clotrimazole, ketoconazole

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22
Q

what 2 topical hydroxypyridones may be used to tx tinea pedis

A

ciclopirox
undecylenic acid

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23
Q

what is the 1 drug that is topical in misc for tx of tinea pedis

A

tolnaftate

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24
Q

how should terbinafine topical be used?

A

app 1-2x/d F4wks, 1-2wks if mild

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25
rank the following topical TP tx from most to least pref: clotrimazole, tolnaftate, terbinafine, miconazole
terbinafine > clotrimazole/ miconazole > tolnaftate
26
what class of topical agents is pref in TP
allylamines
27
T or F: tea tree oil is effective for TP tx
F- but no harms
28
T or F: recurrence of TP is common
T- tx failure in 30% cases often d/t poor adherence- need to assess cause
29
product selection in TP should be based on
individual preference
30
what is a major downside of topical ointments for TP
remain on skin longer = can occlude + cause maceration = slowed skin healing
31
how should you apply topical TP products
Apply to clean dry area Affected area including 2-3cm beyond border Most products (Ex- creams, lotions, etc) = apply/ massage into area BID F4wks (should be used for ~1wk after infxn cleared to prevent recurrent infxn) Sprays/ powders - apply to dry footwear and skin (check directions)
32
you should refer for TP if there is no improvement in _____________ or sx are not completely resolved by __________
no improvement after 2wks not completely resolved after 6wks of tx
33
systemic tx for TP should be considered in pts with
immunocomp, DM, tx failure, mocassin type presentaion
34
prior to using systemic tx for TP, a _________________ should be done
microscopy/ culture growth (to confirm presence of dermatophyte)
35
what allylamide may be used for systemic tx of TP
terbinafine
36
what azoles may be used for systemic tx of TP
itraconazole fluconazole
37
T or F: topical antifungal/ CS combinations may be more efficacious than single entity antifungal agents for TP
F- rec to aviod due to reduced eff + incr cost + SEs
38
jock itch involves the ___________ area and occasionally the _________
groin, medial and upper pts of thight, pubic area, occasionally anal cleft (may also include buttocks)
39
T or F: tinea cruris often spares the penis and scrotum
T
40
3 principle dermatophytes for jock itch
T. rubrum (most common), T. mentagrophytes, E. floccosum
41
how is tinea cruris transmitted
Contagious- transmitted by contaminated towels, hotel bed sheets, or autoinoculation from reservoir on hands or feet (caution- pts with tinea pedis- can spread from infected feet to groin when putting on underwear)
42
list 2 RFs for tinea cruris
Moist conditions including tight fitting/ wet clothing/ undergarments Humid climates Genetic predisposition Immunocompromised (DM, HIV, chemo) Males- esp in summer months
43
tinea cruris is often _____________ due to inner thigh contact. it leaves __, __________ lesions with ___________ margin
bilateral/ symmetrical round, well defined bordered lesions with raised erythematous margin
44
which of the following applies to tinea cruris 1. dry scaling is common 2. may be asymptomatic 3. can become macerated + infected 4. all of the above
4
45
list 2 differential dx for tinea cruris
Candidiasis (v red with poorly defined borders), seborrheic dermatitis (usually also involves scalp, face, etc) psoriasis (symmetrical erythematous plaques) bacterial infections
46
list 2 nonpharm tx for tinea cruris
Avoid tight fitting clothes to reduce moisture at affected area Wear clothes made out of breathable fibers (cotton) Dry all areas completely (use separate towel to dry groin area) Laundering of contaminated clothing separately Drying powders- no evidence + concern that cornstarch could encourage fungal growth by acting as food source for yeast (may help reduce moisture + rubbing)
47
T or F: you should recommend a drying powder for tinea cruris to keep the area less moist
F- no evidence + concern that cornstarch could encourage fungal growth by acting as food source for yeast (may help reduce moisture + rubbing)
48
what are the 3 imidazole, 1 hydroxypyridone, and 1 allylamine topical tx for tinea cruris
clotrimazole, miconazole, ketoconazole ciclopirox olamine terbinafine
49
what are the 3 systemic tx for TCruris
oral terbinafine, fluconazole, itraconazole
50
what 2 drying powders are there for TC
Tolnaftate 1% cr/spray (Tinactin)- BID F2-4wks Undecylenic acid (Fungicure) BID F2wks
51
tinea corporis infects the _____________, less commonly can affect the ______
hairless skin of trunk and arms (excludes face, hands, feet, groin) less commonly face
52
what are teh 3 possible organisms for TCorporis
T. rubrum (most common), M. canis, T. mentagrophytes
53
describe TCorprois presntation
starts as flat, circular, scaly spots with central clear portion raised vesicular red border - may have pustules within active border occurs on upper body and extremities usually asymptomatic, occasionally pruritic
54
how is TCorporis transmitted
Direct skin to skin contact (ex- wrestlers), animal contact, fomite, environment
55
RFs for TCorporis
Humid climates, impaired immune states, occlusive clothing, genetic predisposition
56
how is TCorporis tx
Similar to Tinea cruris Usually used for longer tx period (~4wks)- exception = topical terbinafine F1wk
57
the prev of tinea unguium increases in
elderly, DM, immunocomp
58
what organisms may cause tinea unguium
T. rubrum (50-70%), T. mentagrophytes (5-17%), E. floccosum, many other dermatophytes Rarely caused by candida or molds (ex- aspergillosis)
59
how is tinea Unguium transmitted
1/3 causes associ wtih TP
60
describe the presentation of tinea unguium
Usually toenails but can affect fingernails Nail plate may separate from nail bed (onycholysis) Subungual area thickens (subungual hyperkeratosis) Nail plate turns yellowish/ brown or white Needs physician to diagnose via nail clipping: culture, direct microscopy (KOH exam), biopsy Hallmark sx: thickening, discoloration, separation
61
what are the 3 hallmark sx of tinea unguium
thickening, discoloration, separation
62
what are the 3 types of tinea unguium
Distal lateral subungual onychomycosis (DLSO) - most common type Superficial white onychomycosis (SWO)- 10% Proximal subungual onychomysosis (PSO)- least common - may be a sx of immunocomp = refer
63
list 2 times when you should refer the pt for tinea unguium
Pt has not been previously dx >3 nails affected or involvement of >50% nail- PO tx rec Suspected drug or disease induced Pt immunosuppressed Poorly controlled diabetes or pts with peripheral vascular disease <18yrs Nail presentation: trauma to nail, pitting, lifting
64
what is preferred in tx of tinea unguium? topical, oral, or surgical tx?
oral- 1st line esp for more extensive nail involvement surgery = last resort + not always successful topical = less eff than systemic tx due to poor penetration, recurrence after stopping, poor adherence
65
what are 5 pharm tx for tinea unguium
topical efinaconazole topical propylene glycol, urea, lactic acid oral terbinafine itraconazole fluconazole
66
efinaconazole MOA
blocks production of ergosterol (important pt of fungal membrane) = loss of fxn, death, reduction in infxn
67
efinaconazole is mostly used for __________ TU cases
mild-mod
68
what are the directions on using topical efinazonazole
Apply 1 application to the dry toenail, preferably at bedtime for up to 48 weeks. (Big toenail 2 applications (see next slide). Afterwards, ensure to use the brush to spread around the entire toenail (cuticle, folds of nail and sides/underside of toenail and on the end of toenail and surrounding skin). Allow to dry for 30 seconds No need to remove the medication weekly due to lack of medication build up No need to debride or remove diseased nail Monitor for application site vesicles and dermatitis (redness, itching, burning, stinging in surrounding areas)
69
T or F: jublia is only for toenails
T- not indicated for fingernail onychomycosis
70
tropical propylene glycol, urea, lactic acid is used in _________ cases of TU and has ______ systemic absorption
mild minimal
71
what are the directions for emtrix use
applied daily to infected nail + under free edge, cover nail with thin layer + allow to dry for few min Used up to 24wks
72
which can be used on fingernails- jublia or emtrix
emtrix
73
AEs of emtrix include
transient irritation of skin next to affected nail, whitening of nail, nail may become loose and detach
74
what is the drug of choice in TU
oral terbinafine (lamasil)
75
why is oral terbinafine the drug of choice in TU
best efficacy, tol, lower risk of DDI comp other PO options
76
oral terbinafine remains in nails ____ mths after stopping
8mths
77
what labs must be monitored with use of oral terbinafine
baseline LFTs + wks 4-6
78
oral terbinafine inhibits _________
CYP2A6
79
itraconazole is detectable in nails within _______ of tx
1-2wks
80
intraconazole is a strong ______ inhibitor
CYp3A4
81
what are the 2 types of itraconazole dosing for TU
pulse dosing: 200mg BID F1wk/mth, repeat 2-3 cycles continuous dosing: 200mg daily F6-8wks 9fingernails), 12wks (toenails)
82
what type of itraconazole dosing is most commonly prescribed
continuous
83
what labs must be ordered for itraconazole
liver enzymes qmth
84
what is a 3rd line tx for PO tx of TU + useful in peds or DDI
fluconazole
85
describe the efficacy of the following for tinea infections - bitter orange - garlic - tea tree oil - vick's vaporub
Bitter orange- T. corporis, T. cruris, T. pedis- insuff reliable evidence Garlic - T. pedis - possibly effective (garlic gel cont 0.6% ajoene) but insuff reliable evidence Tea tree oil: possibly ineffective Vick’s vaporub- T. unguium- no proven benefit
86
growth of diseased area of nail should stop in _______ for toenails, nails should appear normal in _____
12wks 12-18mths
87
when should u FU with tinea pts
12wks

446- ID and transplant (18 decks)

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