Please enable JavaScript.
Coggle requires JavaScript to display documents.
FUNGAL INFECTIONS: SKIN AND NAIL. Superficial infections caused by…
FUNGAL INFECTIONS: SKIN AND NAIL. Superficial infections caused by dermatophytes. Can be transmitted through direct contact of infected person, infected clothing/materials, infected animal or cntact with soil.
BODY AND GROIN
RISK FACTORS: obesity; hot humid clomates or environments; wearing tight fitting clothing; hyperhidrosis or immunocompromised states.
COMPLICATIONS; secondary bacterial infection; transferrance of fungal infection to hand from scratching; tinea incognito-inappropriate use of topicl corticosteroids leads to extensive spread of fungal infection.
EXAMINATION
History of dry, scaly, itchy skin to affected area.
Examination to body: single or multiple red or pink annular (ring shaped) patches of varying size which enlarge outwards.Typically have active red advancing edge and clear central area. Asymmetrical in distribution.
Examination to groin: usually affects the inguinal folds and proximal medial thighs. Can also affect the perianal skin, buttocks and above the waistline.
ASSESSMENT
Ask about nature, duration and site of symptoms.
Any previous treatments including OTC.
Ask about family hisotry, any family or household with symptoms or any comorbidities that can cause underlying immunsupression.
Examine pattern, extent and severity of infection and any associated inflammtion.
Assess for any signs of complications. Assess for other areas with possible infection which may be spread through contact transmission.
Diagnostic tests not usually required but can be considered in those with severe, extensive disease or if diagnosis inclear.
Differentials if infection to body or groin: discoid eczema, pityriasis rosea, pityriasis versicolor, psoriasis, granuloma annulare, erythema multiforme or subacute cutaneous lupus.
MANAGEMENT
Advise self management, wear loose fitting clothing, preferrably cotton fabrics, maintain good hygiene and washing and ensure skin thoroughly dried including skin folds. Do not share towels, wash frequently and separately.
Avoid scratching to reduce risk of spread and further irritation.
TREATMENT: Offer antigungal topicl treatment such as terbinafine, clotrimazole or miconazole cream - see BNF/NICE cks for duration and prescribing guidance.
If infection is severe can consider oral antifungal treatments such as oral terbinafine - see BNF/NICE CKS prior to prescribing to check guidance, side effects and monitoring. Patients require LFT monitoring prior to commencing and at 4-6 weeks due to risk of hepatoxicity.
TREATMENT: offer topical corticosteroid for inflammation to affected areas, such as hydrocortisone as well as frequent emollients.
If severe infection identified in children refer to dermatology specialist for assessment and management.
IN NAILS
Keep nails trimmed short, avoid sharing clippers or scissors.
Advise to wear well fitting, flat shoes, avoid high heels. Advise wear of cotton absorbent socks. Wear protective footwear in communal bathing/swimming pools.
Avoid trauma to nails and encourage good foot hygiene.
If no infection or asymptomatic treatment may not be required. Advise ongoing monitoring.
If oral treatment required, treat as per confrmed diagnosis on clippings obtained. Give consideration to PMH and risk of complications.
Topical treatment option available, nail lacquer amorolfine, OTC treatment to be applied for 6 months for finger nails and 9-12 months for toenails. Avoid use of nail varnish.
NAILS- Onychomycosis. Can affect any part of the nail, entire nail including nail bed and root of the nail.
Nail can discolour, nail plate distort and nail bed and adjacent tissue may thicken. Toenails more likley than finger nails to be infected.
COMPLICATIONS associated with nail infections: psychological distress, reduced self esteem, impared tactile function, difficulties walking or shoes ill-fitting, secondary fungal or bacterial infection or spread of infection.
Diagnosis: nail appears abnormal or discoloured, may affect one or several nails. Nails may present as superificial white with small white flaky patches, nail becomes roughened and friable as infection spreads, may be associated with paronychia.
ASSESSMENT in NAILS
Ask about pain, discomfort, impact on qulaity of life, associated with the infection. Ask about comorbidities, or family members/household with similar symptoms.
Examine infection, try to identify type of onychomycosis and any other associated infection.
Obtain sample by obtaining nail clippings for microscopy and culture to confimr diagnosis and underlying cause.
DIFFERENTIALS: psoriasis, lichen planus, eczema, alopecia areata, bacterial infection, viral warts, onychogryphosis, trauma, yellow nail syndrome or malignancy. See NICE CKS for guidance on alternate diagnosis.