fungal infections

fungal infection locations

scalp- tinea capitis

groin- tinea cruris

body- tinea corporis

foot/ feet- tinea pedis

nails- tinea ungium

three genera of fungi

Trichophyton: pedis, cruris, capitis, corporis, ungium

Microsporum: capitis, corporis

Epidermophyton: pedis, cruris, corporis

tinea pedis (athletes foot)

(presentation, predisposing factors, treatment)

itching, scaling- caucasians and adult males. episodic

public pools and baths, hyperhidrosis, tight socks/ shoes

miconazole 2% BID

clotrimazole 1% BID

tolnaftate 1% BID (soln better than cream)

terbinafine 1% BID - 12+

butenafine 1% BID- 12+

undecylenic acid QD

tinea corporis (ringworm)

(presentation, predisposing factors, treatment)

itching, lesions in zoophilic or anthropophilic areas

(exposed) (occluded)

contact sports, warm climates, stress, obesity

miconazole 2% BID

clotrimazole 1% BID

Terbinafine 1%- 12+

undecylenic acid QD

tinea cruris (jock itch)

(presentation, predisposing factors, treatment)

itching, lesions, vesicles in groin area

wet clothes, friction, obesity

miconazole 2% BID

clotrimazole 1% BID

terbinafine 1% BID - 12+

butenafine 1% BID - 12+

undecylenic acid QD

tinea capitis

(presentation, predisposing factors, treatment)

noninflammatory, inflammatory, black dot variety, favus varient

NA

referral

tinea ungium

(presentation, predisposing factors, treatment)

thick, rough, yellow nails

NA

butenafine 1% QD- 12+

(although fda has not approved self treatment)

tinea versicolor

(presentation, predisposing factors, treatment)

hypo/hyper pigmentation trunk/shoulders/back

warm climates

selenium sulfide 1% QD x14 days then taper AND

clo, mico, or tol QD 14 days

vulvovaginitis

white vaginal discharge, itching

diabetes, pregnancy, tight clothes, broad spectrum AB

butoconazole 2%

clotrimazole 1%

miconazole 2-4%

ticonazole 6.5%

(1, 3, 7 day courses)

which meds for vulvovaginitis are safe to use in pregnancy

butoconazole 2%

clotrimazole 1%

miconazole 2-4%

for 2nd and 3rd trimester

miconazole and clotrimazole

2+

BID up to 4 weeks

tolnaftate

prevents and treats

BID 2-4 weeks

2+

terbinafine and butenafine

fungal death

12+

terbinafine: BID 1-4 weeks

butenafine: pedis: BID x 1 week or QD x 4 weeks

cruris and unguium: QD x 2 weeks

exclusions for treatment

unsuccessful initial treatment

nails or scalp

face, mucous membranes

secondary bacterial infection

oozy

diabetes, fever, immunocompromised

no clearing of inf after 4 weeks

odor

exclusions for vulvovaginitis

first episode

more than 3-4 infections/year

abdominal pain

odor discharge

younger than 12

returning symptoms within 2 months

if no improvement/ worsening within 3 days

non pharm treatment

non pharm for vulvo.

wash clothes and items in hot water and dry in hot dryer

eat less carbs and sugars, increase yogurt consumption