Skin fungal infection

Fungal Skin Infections

-       Fungus are saprophytes that love to grow at warm, moist environment

-       Common causing agents are dermatophytes eg Trichophyton, Microsporum, Epidermophyton and yeast eg Candida

Fungal skin infection
Types	Sign and symptoms	OTC recommendations /Advice
Athlete’s foot “tinea pedis”	Peeling, cracking and scaling of feet; splitting; redness; blisters; softening and breaking down of skin; itching’, burning or both; smelly feet	Topical antifungal eg miconazole, terbinafine         Wear sandals in public showering areas         Wear shoes that allow the feet to breathe         Dry the feet thoroughly (use a foot powder eg Gran’s Remedy)
Jock Itch “tinea cruris”	Affect genitals inner thighs and buttocks – appear red or reddish-brown, itchy rash; defined edge	Topical antifungal eg miconazole, terbinafine         Wash and dry affected area with clean towel         Change clothes especially underwear everyday         Do not share personal items such as towel
Ring worm “tinea corporis”	Circular, inflamed, red, flat patches; white healing middle; itchy; pustular; scaly skin; can be single or more than one patch of ringworm on the skin	Topical antifungal eg miconazole, terbinafine Do not use topical corticosteroid eg hydrocortisone cream only, may cause tinea incognito.
Onchomycosis “tinea unguium” or nail infection	thick, yellow nail, brittle, crack easily	Topical application of ciclopirox or amorolfine or biconazole + urea  (only up to 2 nails)         May take months to clear up the infection         (2-3 months for fingernail; up to 6-months for toe nail)         File the nail using emery board or pumice stone before applying topical medicine
Yeast infection (Candidiasis)	At skin folds: red, patches that ooze clear fluid, pimple-like bumps, itching or burning At nail beds,; Swelling, pain, pus , white or yellow nail that separates from the nail bed	Topical antifungal eg miconazole, terbinafine
Pityriasis versicolor - superficial infection caused by yeast – Malassezia species	Only affect trunk and proximal limbs - lesions are usually non-itchy , hyper or hypopigmented macules that coalesces to form scaling plaques.	Topical econazole foaming solution Apply to wet body on 3 consecutive evenings and rinse off the following morning; repeat after 1 and 3 months

Topical antifungal are widely available on the market with a range of different formulations, including cream, gel, lotion, lacquers, spray, powder etc.

Two main classes: imidazole antifungals (eg miconazole, clotrimazole) and allylamine eg terbinafine

**For topical imidazole antifungal:-

Apply to affected area ONCE or TWICE daily. Continue to use for 10-14 days once the symptoms has cleared.

**For topical allylamine antifungal:-

Apply to affected area ONCE or TWICE daily up to 1-2 weeks. Review after 2-weeks.

If affected area are red and inflamed, pharmacist only medicine:-

Combination of antifungal and topical corticosteroid (eg. Miconazole 2% + hydrocortisone 1%) can be used.

Apply to affected area 1-2 times daily until symptoms resolved. Maximum use of 14-days.

Once the symptom has resolved, continue to use antifungal medicine (miconazole) for 2-weeks.

•    Are there any patient factors that you'd need to consider when recommending your chosen products?

Age – it is rare for children under 12 has athlete’s foot

Referral or red flags - 

-       For those with fungal infection on the scalp (also known as tinea capitis) - inflammation on head and patches of hair loss – need to refer to doctor for oral antifungal

-       sign of secondary bacterial infection in broken skin

-       if topical treatment fails

-       if fungal infection is widespread

-       for nail infection, if more than 3 nails (finger or toe nail) and affect the lower half of nail

Overall,

1.     Keep the affected skin clean and dry

2.     Use own towels and pat dry whole body especially between the toes and in the skin folds

3.     Use topical antifungal and corticosteroid products appropriately.

References

1.     WebMD http://www.webmd.com/skin-problems-and-treatments/guide/fungal-infections-skin#4

2.     New Zealand Formulary

3.     DermNet New Zealand http://www.dermnetnz.org/topics/fungal-skin-infections/

4.     Pharmacy Today Healthcare Guidebook


NOTE - all picture or photos obtained from Google search machine.