Tinea Corporis, Cruris & Pedis

Tinea Corporis, Cruris & Pedis (1 of 7)

1 Patient presents w/ lesions on the body suggestive of a tinea infection

2 DIAGNOSIS Do clinical presentation, microscopy, & culture conﬁrm tinea Yes corporis, cruris No or pedis? Tinea corporis, Tinea cruris, Tinea pedis ALTERNATIVE DIAGNOSIS

A Non-pharmacological therapy • Patient education B Pharmacological therapy Topical Antifungal Any one of the following: • Allylamines • Azoles • Benzylamine • Ciclopirox • Others (Amorolﬁ ne, Amphotericin B, Haloprogin, Tolnaftate) Oral Antifungal (consider in refractory or widespread infection or immunocompromised patients) Any one of the following: • Fluconazole • Griseofulvin • Itraconazole ©• Terbinaﬁ ne MIMS

Not all products are available or approved for above use in all countries. Speciﬁ c prescribing information may be found in the latest MIMS.

B376 © MIMS 2019 T. CORPORIS, CRURIS & PEDIS • Diagnosis Alternative • • • • Culture • Microscopy Positive • • Microscopy • • • Tinea (Athlete’s Pedis Foot) • • • • • Itch) Tinea (Jock Cruris • • • • • (Ringworm) Tinea Corporis • - Tinea pedis: Eczema, psoriasis, dyshidrosis, contact juvenile plantar oratopic dermatosis dermatitis, dyshidrosis, psoriasis, Tinea Eczema, pedis: - intertrigo, erythrasma candidal contact dermatitis, psoriasis, Tinea Seborrhea, cruris: - multiforme erythema syphilis, secondary psoriasis, eczema, Tinea eruptions, Drug corporis: - Other conditions may have &thus similarpresentations infections excluded: totinea have tobe oraltherapy orwhen considering long-term treatment, diagnosis, unclear topical toregular unresponsive infections infections, forhair&nailfungal Culture are studies necessary accurateAllows identification oforganism when isnegative microscopy even positive may be Results or cruris corporis pedis, of tinea rarely fordiagnosis indicated weeks; may take upto 4 results Slow & expensive, fi rod-shaped (branching, Hyphae visible be will &arthrospores ofseparation) w/lines width laments ofequal under hairsordebris light are in10-20%Potassium mounted microscope Scale, hydroxide (KOH) &viewed soln inaff butmay positive the show rapid ofdiagnosis notalways most means Provides patients ected Tmentagrophytes by Usually caused - May mimicacutecontact dermatitis butthe latter notaff does areas intertriginous ect - onthe ofthe sides feet common primarily form; Least - Vesicular type orvesiculobullous Tmentagrophytes &sometimes Trubrum by Usually caused - achronic takes course &isresistant totreatment Disease - tender &pruritic Skin ispink, - covered w/afi istypically offoot Sole scale ne silvery - Plantar type hyperkeratotic ormoccasin Patient are usuallycomplains removed that ofitching &socks orburning intense ismost when shoes - Maceration, fi ofthe interdigital &scaling spacesssuring ofthe 4th &5th toes - pedis common Most oftinea form - Interdigital - causative agents Feet aff may be also have the cruris same &tinea pedis the tinea source &become as ofthe infection ected Patients usuallycomplain &itching ofburning Maceration isusuallypresent - area have borders at pustules &vesicles the ofinfected activeedge w/raised lesions scaling Red More common &immunodefi inmen including than obesity factors women w/risk ciency unaff tend Scrotum tobe &penis ected - foundonthe may groin; Lesions aff the thighs proximal &abdomen &extendect medial tothe buttocks Trichophyton Microsporum common &TrichophytonMost canis, organisms: mentagrophytes rubrum mayPruritus present ormay notbe Papules present orpustules may onthe be border - annular, pattern w/apolycyclic borders have serpiginous, irregular sharp, Lesions &very edges reddened that singleormultiple,&scaly have round as central oroval, are characterized &elevated Lesions clearing extremities orface excluding inmen area the beard the trunk, of infl degree size, Patient of varying w/ lesions usually presents ammation & depth of involvement found on - Usually involvement w/epidermal - are superfiDermatophytoses that infections have diffcial fungal erent onlocation presentations based &are named

© MIMStophyte infections treating by the &other concomitant prevented may infection derma- be cruris Recurrent tinea pedis tinea problem Aff healthy butunusualect individuals orextensive presentations may indicate anunderlying immunologic Tinea Corporis,Cruris&Pedis (2of7) 1 CLINICAL PRESENTATION 2 DIAGNOSIS B377 © MIMS 2019 • • Others • • • Benzylamines • • • • • • Azoles • • • • Allylamines • • • Topical Antifungals • • • • Patient Education • • • - Amphotericin B - Alternative treatment optionfor patients pedis w/tinea - Amorolfi ne Eff ects: FungicidalActions: in vitro Butenafine issimilarinstructure tothe allylamines Efinaconazole isa treatment optionforpatients infection w/co-existing unguium tinea combinations potent anti-infl &LuliconazoleSertaconazole possess effammatory comparableects toantifungal-corticosteroid Eff ects: in vitro fungistatic elements, Actions: activity are available agents &these & triazoles haveMany imidazoles broad-spectrum Luliconazole, Miconazole, Sulconazole Sertaconazole, Oxiconazole, Eberconazole,Eg Clotrimazole, Econazole, Efinaconazole, Fluconazole, Itraconazole, Ketoconazole, : s Naftifi anti-inflne has t properties ammatory c ffe E Fungicidal inActions: vitro Eg Naftifine, Terbinafi ne Topical therapy isthe route preferred oftreatment - treatment control towards ofthe istargeted tootherbody For &spread ofsymptoms parts pedis, tinea - Choice physician ofagent &patient oncost, depend will preference topically treated be can infections &pedis cruris corporis, tinea Most occlusive footwear &wearing Avoid garments sharing barefoot, walking completely are dried that covering before w/clothes sure areas Make are infected likely tobecome ofproperties shouldhave the sametype Socks - awaymade towick moisture the from skinsurface Encourage patient loose-fi towear preferablytting garments madeofcotton materials that orsynthetic are insideshoes applied may be powder Antifungal - toavoid maceration powders Use foot - environments moist inwarm Educate thrive patient conditions fungi about &practices growth; that promote fungal - Tolnaftate - Haloprogin - Ciclopirox -

adverse events seen seen events adverse Treatment w/minimal including dermatophytosis, infections fungal mucocutaneous optionforvarious Eff ects: one agent another over agents ofdiff comparison direct studies between ere are few itisdiffierent groups; choice of cult tojustify no antibacterial oranti-candidal activity Eff ects: Eff ects: Eff ects: Eff ects: Has high cure rates & long disease-free intervals in treating interdigital tinea pedis intreating interdigital pedis tinea intervals highcure rates &longdisease-free Has Allylamines may produce a faster response &slightly more may response eff Allylamines produce afaster than azoles ective Typically incure result when treating infections tinea Bind to phospholipids in the fungal cell ofessential intracellular membrane inthe inloss resulting tophospholipids fungal wall Bind Eff activity; antifungal versicolor narrow-spectrum &tinea buthas dermatophytoses inmost ective Active against dermatophytes, dimorphic fungi, yeasts, other fi yeasts, fungi, dimorphic Active dermatophytes, against lamentous &dematiaceous fungi Has equivalent effi equivalent Has w/Tolnaftatecacy including yeasts spectrum a broader fungal buthas © bacteria &some yeasts coverage dermatophytes, against broad-spectrum Has pathogenic most against activity antifungal fungi broad-spectrum Has MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing A NON-PHARMACOLOGICAL THERAPY Tinea Corporis,Cruris&Pedis (3of7) B PHARMACOLOGICAL THERAPY B378 © MIMS 2019

T. CORPORIS, CRURIS & PEDIS T. CORPORIS, CRURIS & PEDIS 1 Topical information for specifi combined w/ corticosteroids prescribing antifungals see are available. Please c formulations in the latest MIMS. • Powders &Sprays • Ointments • • Lotions • Creams VehiclesOptimal ofTopical Treatment • • • Antifungals Oral • • • • Topical Corticosteroids Typically eff notvery intreating activeinfection ective - rather tothe applied feet than shouldbe tothe toprevent reinfection; shoes used May be forhyperkeratoticUseful lesions lesions oroozing areas forintertriginous Recommended areas onhairy spread Easily lesions &moderately fornon-oozing scaling Recommended - Use ofFluconazole inimmunocompromised patients donesparingly shouldbe - ofFluconazole, Itraconazole doses Pulse &Terbinafi eff shown ne have been - ective tocontrol pedis used tinea have acutevesicular Oral antifungals been ina27-35%cure rate resulted use Griseofulvin - oforalTerbinafi dose Recommended cure rates toproduce of71-94% sustained shown been ne has - ofthe tinea plantar surface moccasin-type severe immunocompromised, or totreatments, unresponsive consideredMay inpatients be w/extensive disease, Itraconazole, TerbinafiEg Fluconazole, Griseofulvin, ne inchildren corticosteroids administered Combination topical ofage shouldnotbe <12years w/antifungal face) Use w/cautionwhentreatingareasofthinskin&naturallyoccludedbody(eggroin,axillae,breast Eff ects: onlyinthe fi used Should be days oftreatmentrst few - suff symptomatic infl from ering sensation &burning erythema ammation, itching, incombination onlytoconfi &limited used w/antifungal Should onlybe inpatients infections fungal rmed

anticoagulants & inhibitors, reductase HMG-CoA substrates, w/CYP3A4 caution inpatients treated being Observe © MIMS ere isusuallyrapid symptomatic relief 1 Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not B Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing PHARMACOLOGICAL THERAPY (CONT’D) Tinea Corporis,Cruris&Pedis (4of7) B379 © MIMS 2019 Fluconazole Griseofulvin Itraconazole Terbinafi ne Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed 24 hrly x up to6wk wkly x3wkor50mgPO once 150mgPO Tinea pedis: 24hrly x2-4wk 50 mgPO once wklyor 150 mgPO Tinea corporis/cruris: 4-8 wk x doses 24 hrly or individed 500-1000mgPO Tinea pedis: x2-6wk doses divided 24hrly orin 500-1000 mgPO Tinea corporis/cruris: PO 12hrly x1wk PO 24 hrly x 30 days or200mg 100mgPO Tinea pedis: 24hrly x1wk or 200mgPO 24hrly x15days 100 mg PO Tinea corporis/cruris: 24 hrly x2-6wk 250mgPO Tinea pedis: 24hrly x2-4wk 250 mg PO Tinea corporis/cruris: & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Tinea Corporis,Cruris&Pedis (5of7) Dosage Guidelines ANTIFUNGALS (ORAL) • • Instructions Special • Reactions Adverse • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse • • • • Instructions Special • Reactions Adverse B380 benzodiazepines, HMG-CoA reductase inhibitors, etc) inhibitors, reductase HMG-CoA benzodiazepines, short-acting anticoagulants, macrolides, Rifampicin, interactions ofdrug (egMonitor forsymptoms Use w/cautioninpatientsrenal&hepaticimpairment levels) disturbance, liver enzyme taste elevated GI eff fl pain,diarrhea, (abdominal ects atulence, N/V, used longterm used if renal function &hematopoietic Monitor hepatic, GIeffurticaria); (N/V, distress) ects epigastric diarrhea, effCNS eff Dermatological (headache); ect (rash, ects benzodiazepines, calcium-channel blockers, etc) calcium-channel blockers, benzodiazepines, short-acting(eg oralanticoagulants, Rifampicin, interactions ofdrug Monitor forsymptoms (eg cola) w/anacidicdrink, the administering drug by improved may be absorption In patients w/hypochlorhydria, hepatic impairment &renal insufficiency Use w/caution failure, inpatients at forheart risk treatment) w/prolonged hypokalemia Other effangioedema); edema, (alopecia, ects urticaria, rash, Allergic (pruritus, reactions dizziness); cholestatic eff jaundice);hepatitis, CNS (headache, ects levels, inliver enzyme increase constipation, diarrhea, GI eff pain,nausea, abdominal (dyspepsia, ects Reduce doses inpatients w/renalReduce doses impairment Use w/ caution inpatients w/psoriasis oraltherapystarting inallpatients before tests Perform liver function inpatients notuse w/hepatic impairmentDo eff Dermatological (headache); urticaria) (rash, ects effdisturbance CNS liver dysfunction); oftaste, ect GI eff (N/V,ects or pain,loss abdominal diarrhea, Remarks © MIMS 2019

T. CORPORIS, CRURIS & PEDIS T. CORPORIS, CRURIS & PEDIS S raoaoe2 ra Apply 12-24hrly 2%cream Tioconazole Sertaconazole Oxiconazole 2%cream, Miconazole Ketoconazole Isoconazole 1%powd, Econazole Clotrimazole Bifonazole Imidazoles Butenafi ne Benzylamine Terbinafi ne Naftifi ne Allylamines Drug Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, women, &non-breastfeeding non-pregnant for are recommendations dosage All © MIMS cream 1% soln, cream 1% lotion, soap liqd cream, tinct, soln, 2% powd, Apply 12-24hrly gel, spray Apply 8-12hrly 1% cream 1% cream spraycream, lotion, soln, cream 1% soln, Apply 24hrly 1% cream gel spray,soln, 1% cream, cream 1% lotion, Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Tinea Corporis,Cruris&Pedis (6of7) ANTIFUNGALS (TOPICAL) Dosage Guidelines Apply 12-24hrly Apply 12-24hrly Apply 12hrly Apply 12-24hrly Apply 8-12hrly Apply 24hrly Apply 12-24hrly hrly Apply 24 Dosage B381 • • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse • • • Instructions Special • Reactions Adverse lesions clear lesions Continue wkafter treatment days-1 forfew usually 1-2wk oftherapy Length Tinea is &cruris: corporis 3-4 wk Tinea oftherapy Length isusually pedis: pruritus) sensation, erythema, burning mild reactions, &hypersensitivity irritation effDermatological (occasional local ects lesions clear after wk Continue treatmentforfewdays-1 usually 1-2wk oftherapy Length Tinea is &cruris: corporis 3-4 wk Tinea oftherapy Length isusually pedis: sensation, itching) effDermatological stinging (redness, ects lesions clear lesions Continue wkafter treatment days-1 forfew usually 1-2wk oftherapy Length Tinea is &cruris: corporis 3-4 wk Tinea oftherapy Length isusually pedis: itching) irritation, sensation, erythema, burning/stinging effDermatological (contact ects dermatitis, Remarks

© MIMS 2019 Terbina ne B380 T Tioconazole B381 Tolnaate B382 Tolnaftate Ciclopirox olamine) ( Ciclopiroxolamine, Ciclopirox Amorolfi ne Others Drug Products listed above may not be mentioned in the disease management chart but have been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed & non-elderly adults w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal adults & non-elderly All dosage recommendations are for non-pregnant & non-breastfeeding women, are for & non-breastfeeding non-pregnant All recommendations dosage © MIMS spray powd spray liqd, oint, cream, lotion, soln, 1% powd, Apply 12hrly 1% cream Apply 24hrly x 0.25% cream Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please Tinea Corporis,Cruris&Pedis (7of7) ANTIFUNGALS (TOPICAL)(CONT’D) Dosage Guidelines Apply 8-12hrly 2-3 wk Dosage B382 • • • Instructions Special • • • Reactions Adverse lesions clear lesions Continue wkafter treatment days-1 forfew usually 1-2wk oftherapy Length Tinea is &cruris: corporis 3-4 wk Tinea oftherapy Length isusually pedis: dermatitis) contact sensation, pruritus, stinging Tolnaftate: eff Dermatological (irritation, ects sensation, pain) burning redness, eff Dermatological Ciclopirox: (pruritus, ects sensation) burning pruritus, (erythema, Amorolfi effne: Dermatological ects Remarks © MIMS 2019

T. CORPORIS, CRURIS & PEDIS