Term
| What are the primary reservoirs for tineas? |
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Definition
Most infections of tinea/trichophytons, are from human contact
**risk: poor hygiene, diabetes, inactivity, obesity |
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Term
| What are signs of a tinea infection? |
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Definition
- Signs - soggy, smelly skin w/ cracks or fissures
- Itchy/painful
**KOH test is highly sensitive/inexpensive |
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Term
| What are the different types of tineas? |
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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 |
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Term
| What are the types of tinea pedis? |
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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 |
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Term
| What are the types of tinea capitis? |
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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 |
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Term
| What tineas can be self-treated? |
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Definition
Tinea pedis, corporis, and cruris for 2-4 weeks
**Cannot self treat tinea capitis, or nails, scalp, genitals, face, immunocompromised, fever |
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Term
| What OTC creams can treat tineas? |
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Definition
- Butenafine - Lotrimin Ultra - daily
- Clotrimazole - Lotrimin AF
- Miconazole - Micatin/Lotrimin AF
- Terbinafine - Lamisil
- Tolnaftate - Tinactin
**Creams most efficient, sprays are adjuncts |
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Term
| What RXs can be used for tineas? |
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Definition
- Fluconazole 150 po weekly for 1-4 weeks
- Ketoconazole 200 QD x4 weeks
- Itraconazole 200-400 QD x1w
- Terbinafine 250 QD x2w |
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Term
| What is used to treat Tinea Capitis? |
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Definition
- Griseofulvin - drug of choice for 4-6 weeks
- Terbinafine/Lamisil - 4-8 weeks |
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Term
| What are risk factors for oral candidiasis? |
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Definition
- Local: mucosal disruption, smoking, dry mouth, dentures, steroid use
- Systemic: Malignancy, diabetes, HIV, Neonates/Elderly, drugs |
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Term
| What are the different types of oral candidiasis? |
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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 |
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Term
| What are the first line treatments for mild candidiasis? |
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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 |
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Term
| What treatments should be used for fluconazole refractory patients? |
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Definition
- Itraconazole solution 200mg
- Voriconazole - 200 mg BID on an empty stomach. Many AEs
- Posaconazole susp
- Amphotericin B |
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Term
| What is vulvovaginal candidiasis? |
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Definition
Caused by albicans - on vagina and vulva
Increased risk w/ sexual activity, birth control, douching, diet, tight fitting clothes, Abx |
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Term
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Definition
- Signs and symptoms
- KOH microscopy
- Candida cultures |
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Term
| What are topical treatments for VVC? |
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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 |
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Term
| What is complicated vs uncomplicated VVC? |
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Definition
- Complicated - Immunocompromised, uncontrolled diabetes, pregnancy (avoid oral): Therapy should be 10-14 days
- Uncomplicated - none of the above, therapy duration does not matter |
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Term
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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 |
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Term
| What are exclusions for VVC self treatment? |
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Definition
- Recurrence
- Diabetes/HIV
- Pregnancy
- Girls < 12
- Fever, lower back pain |
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Term
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Definition
| = Tinea unguium, caused by trichophyton - the most common cause of nail dystrophy. Toes > fingers |
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Term
| What are risk factors for onchomycosis? |
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Definition
- Age > 40, FH
- Immunocompromised, diabetes
- Psoriasis
- Smoking
- Tinea pedis
- Sports, nail trauma, occlusive footware |
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Term
| What are the types of onchomycosis? |
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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 |
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Term
| What are first line treatments for onchomycosis? |
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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 |
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Term
| When is ciclopirox/penlac used for onchomycosis? |
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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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