1. Management of Common Fungal & Bacterial Skin Infections Dr. Sandra McLeod Consultant Dermatologist Skin Clinic KPH/NCH Downloded from www.pharmacy123.blogfa.com

2. Superficial Fungal Infections DERMATOPHYTES. aka Tinea YEASTS - Pityrosporum. -Candida sp. Downloded from www.pharmacy123.blogfa.com

3. TINEA Infections T.Corporis- ringworm of body T.Cruris- groin T.Pedis- foot T.Unguium- nail T.Capitis scalp Downloded from www.pharmacy123.blogfa.com

4. T.Corporis Itchy Annular patch Well defined edge Scaling more obvious at edges(central clearing) Downloded from www.pharmacy123.blogfa.com

5. T.Pedis Downloded from www.pharmacy123.blogfa.com

9. Often assoc with T.pedis “Jock itch” Tight hot sweaty groin eg athletes, obese,in lycra TINEA CRURIS Downloded from www.pharmacy123.blogfa.com

11. Onycholysis Subungual hyperkeratosis Dystrophy/ pigmentary changes Downloded from www.pharmacy123.blogfa.com

12. TINEA CAPITIS - KERION Downloded from www.pharmacy123.blogfa.com

13. TINEA CAPITIS – Black dot Downloded from www.pharmacy123.blogfa.com

14. Management General Measures Non-specific- –Keratolytics-eg Whitfield’s ointment -Irritant Downloded from www.pharmacy123.blogfa.com

15. Specific Antifungal Rx Griseofulvin Azoles- -Imidazole eg ketoconazole (^ liver toxicity, oral prep ) topical preps -Triazole eg itraconazole,fluconazole Allylamines eg terbinafine, naftifine Ciclopiroxolamine Downloded from www.pharmacy123.blogfa.com

16. TOPICAL Rx Localized disease of skin –extend rx for 3-5/7 after apparent cure –1% clotrimazole less effective Sprays & solutions –tinea pedis /hairy areas Limited nail disease –Batrafen nail lacquer Downloded from www.pharmacy123.blogfa.com

17. ORAL Rx Extensive disease Nail disease Tinea Capitis Downloded from www.pharmacy123.blogfa.com

18. Regimes-Tinea Unguium TERBINAFINE –Terbinafine250mg od ITRACONAZOLE –Pulse rx Itraconazole - 1wk/mth 200mg bid –Itraconazole 200mg od FLUCANAZOLE –Fluconazole 150mg once weekly Downloded from www.pharmacy123.blogfa.com

19. Rx-Tinea Capitis MUST use oral Rx- prolonged course –Griseofulvin-20mg/kg/od x 6-8/52 Terbinafine-62.5mg-250mg od x 4/52 –Flucanazole-50mg-150mg/wk x 4-6/52 Downloded from www.pharmacy123.blogfa.com

20. Rx-Tinea Capitis Adjunctive Measures Shampoo- antifungal/ antiseptic/antidandruff Antibiotics NO STEROIDS Downloded from www.pharmacy123.blogfa.com

21. Yeasts Pityrosporum. Candida. Ordinarily commensals. Can become pathogens under favourable conditions. Downloded from www.pharmacy123.blogfa.com

22. Pityriasis Versicolor Ppted by heat, sweat, steroids Asymptomatic scaly macules Chest, back, face hypopigmented Downloded from www.pharmacy123.blogfa.com

23. P.Versicolor Hyperpigmented Downloded from www.pharmacy123.blogfa.com

24. Management Many Rx No Rx eradicates yeast permanently NONSPECIFIC Keratolytics –whitfield ung, sulphur Antiseptics –selenium sulphide, Na thiosulphate CHEAP, smelly, messy, irritant, slower Downloded from www.pharmacy123.blogfa.com

25. Antifungal Rx Azoles-oral/topical Ketoconazole 200mg od x7 Itraconazole 200mg od x 7 Fluconazole 300mg-400mg stat FORGET terbinafine tabs for P.V Downloded from www.pharmacy123.blogfa.com

26. P.V-tougher than you think! High recurrence Hypopigmentation post-rx –UVB helpful Prophylaxis Downloded from www.pharmacy123.blogfa.com

27. Candidiasis oCandida sp- commensal of GIT oPrecipitating Factors  Endocrinopathy  Immunosuppression  Fe/Zn deficiency  Oral antibiotic Rx oOropharyngeal candidiasis is marker for AIDS Downloded from www.pharmacy123.blogfa.com

28. Candidiasis Oropharnygeal Candidal intertrigo-breasts, groin, web spaces Chronic Paronychia - nail fold infection Vaginitis/balanitis Downloded from www.pharmacy123.blogfa.com

29. Candidal Intertrigo Moist folds Erythematous patch with satellite lesions Downloded from www.pharmacy123.blogfa.com

30. Management Rx underlying disorder Reduce moisture- –Wt loss, cotton underwear –Absorbent/antifungal powder eg Zeasorb AF Rx partner in recurrent genital candidiasis Rx-Nystatin Azoles Downloded from www.pharmacy123.blogfa.com

31. Chronic Paronychia Infection of nail fold Wet alkaline work Excess manicuring Damage to cuticle Swelling of nail fold (bolstering) Nail dystrophy Downloded from www.pharmacy123.blogfa.com

32. Chronic Paronychia Keep hands dry /Wear gloves Long term Rx Oral Azoles Antifungal solution-(high alcohol content) +/-Broad spectrum antibiotics-cover staph/GNB Downloded from www.pharmacy123.blogfa.com

33. Bacterial Infections Impetigo Folliculitis- furuncles,carbuncles Cellulitis Erythrasma- Secondarily infected skin disorders Downloded from www.pharmacy123.blogfa.com

34. Folliculitis Downloded from www.pharmacy123.blogfa.com

35. Erythrasma Obese Diabetic Erythromycin 250 mg qid x 2 weeks Azoles less effective Downloded from www.pharmacy123.blogfa.com