Treatment of Fungal
diseases: Skin-
Skin :-
INTERTRIGO
Obese people are at greatest risk.
Itching burning and stinging
are the most common symptoms
apposing skin folds retain
moisture and become warm
macerated and inflamed Candida is the most common secondary infection but
bacteria fungi or viruses may be
a factor . Erosions are possible Sweat
feces urine and vaginal
discharge may aggravate intertrigo . The
course can be recurrent and chronic.
CLINICAL FEATURES
There are two
presentations In the first type
pustules form but become macerated under apposing skin surfaces and develop into red papules
with a fringe of moist scale at the
border. Intact pustules may be found
outside the opposing skin surfaces.
The second
type consists of a red moist glistening plaque that extends to or
just beyond the limits of the opposing skin folds. The advancing border is long and sharply defined and has an ocean wave shaped
fringe of macerated scale. The characteristic pustule of
candiadiasis is not observed in intertriginous areas because it is
macerated as soon as it forms .Pinpoint
pustules do appear outside the advancing border and are an important diagnostic
feature. There is a tendency for painful fissuring in the skin creases.
TREATMENT
General Measures
Education
about the role of moisture and maceration is important . The
following techniques may be recommended drying
affected areas after bathing using a hand held hair dryer
on low heat at least once a day . Supportive clothing and weight reduction air conditioning in
warm environments and regular
application of a plain or medicated
powder to the areas.
For
very inflammatory lesions open
compresses three to four times a day
with water or normal saline will expedite relief
of symptoms. Cool water
compresses applied for ½ hour
two or three times a day for just a few days are rapidly effective in controlling moisture and suppressing
inflammation.
Topical Agents
A 1 or 2
week course of group VI to VII topical
steroids may be all that is necessary
. long term continuous use
of topical steroids in skin fold areas may result in atrophy and
striae 0.1% tacrolimus
may be used as an anti inflammatory agent instead of topical steroids
for initial treatment or for
cases requiring long term intermittent treatment
Ciclopirox cream or lotion
twice daily for 1-2 weeks or until
resolved is another option .
It is a good practice to add a
topical anti yeast medication,
such as miconazole creams with topical
steroids. To separate and expose
skin effectively in order to
promote dryness administer
while the patient is in the
supine position. After clinical resolution topical antifungal
treatments may be continued twice
weekly to prevent recurrence and
topical steroids should be stopped.
Gentian
violet 0.25to 2.0 5 and Castellani paint are older
remedies which are effective but may sting and will stain
clothing bed linen and skin
Systemic
Agents
Outside the setting
of chronic mucocutenous candiadiasis chronic
systemic suppressive therapy
in immune suppressed
individuals is discouraged due
to the risk of colonization with resistant organisms.
Fulconazole
50 to 100
mg daily for 14 days
150 mg weekly for 2- 4 weeks
Itraconazole
200 mg twice daily for 14 days .
Tinea
corporis – Griseofulvin -500-1000
mg / day ( micro size ) or 375
- 500 mg /d ( ultramicrosize
) x 2-4 weeks , Fluconazole – 150mg /
week 2-4 weeks , terbinafine – 250 mg
daily x 1-2 weeks , Itraconazole – 200mg / day x 1 week or 100 mg / day x2 weeks ,
Ketoconazole – 200-400 mg /day for 2 weeks
Tinea corporis (children ) Griseofulvin 15-20 mg
/kg / day ( micro size suspension )x2-4
weeks , Fluconazole -6 mg / kg/week 2-4
weeks , Terbinafine – 125 mg daily x 1weeks , Itraconazole – 3-5 mg / kg / day
( maximum 200 mg ) x 1 week
,Ketoconazole – not recommended
Tinea
Pedis/manuum – Griseofulvin – 750-1000 mg
/ day ( micro size ) or
500- 750 mg / d ( ultramicrosize )
x 6-12 weeks , Fluconazole –
150-200 mg / week x 4-6 weeks ,
Terbinafine – 250 mg daily x 2 weeks , Itraconazole - 200-400 mg / day x 1 week , Ketoconazole –
not recommended
Tinea Pedis / manuum ( children ) Griseofulvin - 15-20
mg / kg / day ( microsize suspension ) x 4 weeks , Fluconazole 6 mg / kg / week x 4-6 weeks , Terbinafine
-125 mg ( < 20-40 kg ) or 250 mg ( > 40 kg ) x 2 week ,
Itraconazole - 3-5 mg / kg /day (
maximum 200 mg ) x 1 week , Katoconazole – not
recommended
Tinea Versicolor - Griseofulvin – Not recommended , Fluconazole
– 400 mg single dose repeat in 2 weeks
in needed , Teribinafine – oral therapy not effective ,Itraconazole - 200 mg / day x 1 week Prophylaxis 200 mg BD 1
day / month for 6 months in
recurrent disease , Ketoconazole – 400
mg single dose 400 mg single 200 mg OD
for 5 days , 400 mg once a month for recurrent
disease
Vaginal
candidiasis –Grisofulvin- Not effective , Fluconazole - 200-400
mg daily for 5 days , Tribinfine – Not effective , Itraconazole –
200 mg 3-5 days , Katoconazole - 150 mg
single dose
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