DOCSLIB.ORG

Fungal Skin Infections

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fungal Skin Infections Fungal Skin Infections Aditya K. Gupta, MD, PhD, FRCP(C), FAAD,*† Melissa A. MacLeod, MSc,† Kelly A. Foley, PhD,† Gita Gupta, MD,‡ Sheila Fallon Friedlander, MDx *Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada †Mediprobe Research, Inc, London, Ontario, Canada ‡Wayne State University, Detroit, MI xDermatology and Pediatrics, Pediatric Dermatology Training Program, University of California at San Diego School of Medicine, Rady Children’s Hospital, San Diego, CA Education Gap Most pediatricians appear to be familiar with candidal diaper dermatitis, but there is a lack of knowledge about other, less common fungal infections in children. Objectives After completing this article, readers should be able to: 1. Recognize the clinical presentations of different fungal infections in children. 2. Know the differential diagnosis of various fungal skin infections. 3. Know what diagnostic tests can be used to confirm infection. 4. Be aware of available treatment options and how to manage the infections appropriately. AUTHOR DISCLOSURE Dr A. Gupta has disclosed that he is on the Speakers’ Bureaus of Valeant, Janssen, Novartis, and Bayer; he is a consultant for Anacor, Sandoz, and Moberg INTRODUCTION Pharma; and he is a clinical trials investigator for Valeant Canada, Nuvolase, Bristol Meyers Candidal diaper dermatitis is the most common fungal infection of childhood. Squibb, Eli Lilly, Merck, Novartis, Janssen, and This yeast infection almost always secondarily invades diaper-area skin that has Allergan. Ms MacLeod and Dr Foley have disclosed that they are employees of been damaged by an irritant contact dermatitis from maceration, urine, and/or Mediprobe Research, Inc, which conducts stool. Children in the preschool-age group who no longer wear diapers are clinical trials under the supervision of Dr. A. more likely to develop tinea infections, particularly tinea capitis. Tinea refers to Gupta. Drs G. Gupta and Fallon Friedlander have disclosed no financial relationships dermatophyte infections in the epidermis and areas high in keratin, such as the relevant to this article. This commentary does hair and nails. In prepubertal children, tinea capitis and tinea corporis are most contain a discussion of an unapproved/ common; in adolescence, tinea pedis (TP), tinea cruris, and tinea unguium investigative use of a commercial product/ (onychomycosis) are more common. (1) Yeast infections other than candidal device. diaper dermatitis, including pityriasis versicolor (PV) (formerly known as tinea ABBREVIATIONS versicolor) and mucocutaneous candidiasis (MC), may also occur. Chronic MC CMC Chronic mucocutaneous candidiasis (CMC) is a rare, usually inherited disorder. PVis a common infection in adolescents HIV Human immunodeficiency virus and adults that usually affects the sebum-prone areas (face, chest, back). Fungal id Dermatophytid KOH Potassium hydroxide infections can be a substantial source of morbidity in the pediatric population, MC Mucocutaneous candidiasis accounting for about 15% of pediatric outpatient visits in the United States. (2) PCR Polymerase chain reaction This article reviews the epidemiology and clinical presentations of tinea in- PV Pityriasis versicolor fections (capitis, corporis, pedis, cruris, unguium), PV, and MC in children. The TP Tinea pedis 8 Pediatrics in Review Downloaded from http://pedsinreview.aappublications.org/ by guest on February 27, 2017 differential diagnosis and methods for confirming diagnosis audouinii was the major source of tinea capitis in North based on clinical presentation are discussed. Recommended America. (6) Subsequently, epidemiology shifted and cur- treatment options for each typeofinfectionarespecified rently about 95% of tinea capitis in North America is caused (Table 1). Of note, many recommendations are off-label, as the by Trichophyton species (predominantly T tonsurans). Micro- safety of many agents has not been established for children. sporum species, (7) usually transmitted by pets, causes the remainder of the cases. However, in central and southern Europe as well as in developing countries, M canis is the TINEA CAPITIS most common causal species. (7) It is important for clini- Epidemiology cians to be aware of the predominant pathogen in their Tinea capitis, a communicable fungal infection of the scalp communities because this has implications for optimal and hair shaft, is the most common fungal infection in treatment choice. children. (3) The prevalence ranges from less than 1% in western Europe to as much as 50% in Ethiopia where the Clinical Presentation infection is endemic. (4) In North America, the prevalence is Tinea capitis may be difficult to diagnose because clinical estimated to range from 3% to 8% in children. It is unclear signs may be subtle and can vary substantially from child to whether it is increasing, but immigrant populations, par- child. Symptoms may include scaling, alopecia, broken hair ticularly those from Africa, are at higher risk. (5) Tinea shafts at the scalp, erythema, pustules, and/or large boggy capitis most often affects children between ages 3 and 9 scalp masses. Patients may complain of pruritus or tender- years, those of African heritage, those of low socioeconomic ness, and occipital and posterior cervical adenopathy are often status, and those residing in urban settings and/or crowded present (Fig 1). A nonspecific, eczematous, pruritic eruption living conditions. (1)(4) Prior to the 1950s, Microsporum may be noted on the trunk and extremities either before or TABLE 1. Summary of Treatment Recommendations for Tinea Infections in Children* INFECTION FIRST-LINE TREATMENT ALTERNATIVES TERTIARY OPTIONS Tinea capitis Oral antifungals: terbinafine, griseofulvin Adjunctive agents: selenium sulfide Itraconazole, fluconazole (Microsporum canis) shampoo, ketoconazole shampoo Tinea corporis/ Topical antifungals: butenafine, ciclopirox, Oral antifungals (resistant or severe Tinea cruris clotrimazole, miconazole, terbinafine, infection): terbinafine, griseofulvin, tolnaftate itraconazole, fluconazole Tinea pedis Topical antifungals: butenafine, clotrimazole, Topical antifungals: ciclopirox Urea cream miconazole, terbinafine Oral antifungals (resistant or recurrent infection): terbinafine, itraconazole, fluconazole Pityriasis versicolor Zinc pyrithione, selenium sulfide, or Oral antifungals (resistant, recurring, serious ketoconazole shampoos infection): itraconazole, fluconazole Other topical antifungals: clotrimazole, ketoconazole, miconazole, terbinafine Tinea unguium Topical antifungals: ciclopirox, efinaconazole, Oral antifungals (severe infection): Itraconazole, fluconazole (onychomycosis) tavaborole terbinafine MC – Oropharyngeal Mild: Clotrimazole troches, miconazole, Fluconazole-resistant infections: Amphotericin B candidiasis nystatin suspension itraconazole, posaconazole suspension Moderate-severe: fluconazole MC – Esophageal Fluconazole Intravenous fluconazole, echinocandin Amphotericin B candidiasis/CMC (anidulafungin, caspofungin, micafungin) Fluconazole-resistant infections: itraconazole, voriconazole, amphotericin B, or an echinocandin *Some agents may be used off-label usage in children or be approved for particular ages. See Table 3 for details. CMC¼chronic mucocutaneous candidiasis, MC¼mucocutaneous candidiasis. Vol. 38 No. 1 JANUARY 2017 9 Downloaded from http://pedsinreview.aappublications.org/ by guest on February 27, 2017 during treatment; this is known as an autoeczematization or Diagnostic Tests dermatophytid (id) eruption. Tinea capitis typically presents Clinical diagnosis should be confirmed via either potassium as 1 of 6 clinical patterns: gray type, black dot, diffuse scale, hydroxide (KOH) microscopy or culture. Culture is prefer- pustular type, favus, and kerion. Gray type is characterized able because speciation is provided, allowing determination by circular patches of alopecia and marked scaling with or of the most appropriate treatment option. Polymerase chain without erythema. (4)(8) Black dot presents with patches of reaction (PCR) evaluation of dermatophyte infections has alopecia and is dotted with broken hair stubs (“black dots”). become much more cost effective and “kits” are now avail- Diffuse scale is characterized by widespread scaling and is able, which is likely to lead to wider availability of this dandruff-like, with or without erythema. Pustular type pre- exceedingly rapid and sensitive test in the next few years. sents as alopecia with scattered pustules, scaling, and lymph- At this time, PCR appears more sensitive for nail and skin adenopathy. Favus has distinctive yellow cup-shaped crusting infections than for hair samples. (12) Wood’s light exami- around the hair called scutula, along with patchy alopecia nation causes Microsporum species to fluoresce, but most and generalized scale; this variant is extremely rare and not infections in North America are caused by Ttonsurans,which usually seen in the United States. Kerion is a boggy tumor does not fluoresce. (13) Pathogens that do fluoresce include with pustules, lymphadenopathy, erythema, and tenderness. Microsporum species and Trichophyton schoenleinii. (7) Under (4)(8) It is the most severe inflammatory response and can microscopic analysis, an infected hair can present with be caused by either Ttonsuransor Mcanis. (9) When chil- mycelium (mass of fungal hyphae) on the external surface dren present without distinguishing characteristics of tinea of the hair shaft (ectothrix) or with mycelium within the hair capitis such as black
Load more

Recommended publications
  • Estimated Burden of Serious Fungal Infections in Ghana
    Journal of Fungi Article Estimated Burden of Serious Fungal Infections in Ghana Bright K. Ocansey 1, George A. Pesewu 2,*, Francis S. Codjoe 2, Samuel Osei-Djarbeng 3, Patrick K. Feglo 4 and David W. Denning 5 1 Laboratory Unit, New Hope Specialist Hospital, Aflao 00233, Ghana; [email protected] 2 Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB-143, Korle-Bu, Accra 00233, Ghana; [email protected] 3 Department of Pharmaceutical Sciences, Faculty of Health Sciences, Kumasi Technical University, P.O. Box 854, Kumasi 00233, Ghana; [email protected] 4 Department of Clinical Microbiology, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi 00233, Ghana; [email protected] 5 National Aspergillosis Centre, Wythenshawe Hospital and the University of Manchester, Manchester M23 9LT, UK; [email protected] * Correspondence: [email protected] or [email protected] or [email protected]; Tel.: +233-277-301-300; Fax: +233-240-190-737 Received: 5 March 2019; Accepted: 14 April 2019; Published: 11 May 2019 Abstract: Fungal infections are increasingly becoming common and yet often neglected in developing countries. Information on the burden of these infections is important for improved patient outcomes. The burden of serious fungal infections in Ghana is unknown. We aimed to estimate this burden. Using local, regional, or global data and estimates of population and at-risk groups, deterministic modelling was employed to estimate national incidence or prevalence. Our study revealed that about 4% of Ghanaians suffer from serious fungal infections yearly, with over 35,000 affected by life-threatening invasive fungal infections.
    [Show full text]
  • Smelly Foot Rash
    CLINICAL Smelly foot rash Paulo Morais Ligia Peralta Keywords: skin diseases, infectious Case study A previously healthy Caucasian girl, 6 years of age, presented with pruritic rash on both heels of 6 months duration. The lesions appeared as multiple depressions 1–2 mm in diameter that progressively increased in size. There was no history of trauma or insect bite. She reported local pain when walking, worse with moisture and wearing sneakers. On examination, multiple small crater- like depressions were present, some Figure 1. Heel of patient coalescing into a larger lesion on both heels (Figure 1). There was an unpleasant ‘cheesy’ protective/occluded footwear for prolonged odour and a moist appearance. Wood lamp periods.1–4 examination and potassium hydroxide testing for fungal hyphae were negative. Answer 2 Question 1 Pitted keratolysis is frequently seen during What is the diagnosis? summer and rainy seasons, particularly in tropical regions, although it occurs Question 2 worldwide.1,3,4 It is caused by Kytococcus What causes this condition? sedentarius, Dermatophilus congolensis, or species of Corynebacterium, Actinomyces or Question 3 Streptomyces.1–4 Under favourable conditions How would you confirm the diagnosis? (ie. hyperhidrosis, prolonged occlusion and increased skin surface pH), these bacteria Question 4 proliferate and produce proteinases that destroy What are the differential diagnoses? the stratum corneum, creating pits. Sulphur containing compounds produced by the bacteria Question 5 cause the characteristic malodor. What is your management strategy? Answer 3 Answer 1 Pitted keratolysis is usually a clinical Based on the typical clinical picture and the negative diagnosis with typical hyperhidrosis, malodor ancillary tests, the diagnosis of pitted keratolysis (PK) (bromhidrosis) and occasionally, tenderness, is likely.
    [Show full text]
  • Introduction
    Notes Introduction 1. In the book, we use the terms ‘fungal infections’ and ‘mycoses’ (or singular fungal infection and mycosis) interchangeably, mostly following the usage of our historical actors in time and place. 2. The term ‘ringworm’ is very old and came from the circular patches of peeled, inflamed skin that characterised the infection. In medicine at least, no one understood it to be associated with worms of any description. 3. Porter, R., ‘The patient’s view: Doing medical history from below’, Theory and Society, 1985, 14: 175–198; Condrau, F., ‘The patient’s view meets the clinical gaze’, Social History of Medicine, 2007, 20: 525–540. 4. Burnham, J. C., ‘American medicine’s golden age: What happened to it?’, Sci- ence, 1982, 215: 1474–1479; Brandt, A. M. and Gardner, M., ‘The golden age of medicine’, in Cooter, R. and Pickstone, J. V., eds, Medicine in the Twentieth Century, Amsterdam, Harwood, 2000, 21–38. 5. The Oxford English Dictionary states that the first use of ‘side-effect’ was in 1939, in H. N. G. Wright and M. L. Montag’s textbook: Materia Med Pharma- col & Therapeutics, 112, when it referred to ‘The effects which are not desired in any particular case are referred to as “side effects” or “side actions” and, in some instances, these may be so powerful as to limit seriously the therapeutic usefulness of the drug.’ 6. Illich, I., Medical Nemesis: The Expropriation of Health, London, Calder & Boyars, 1975. 7. Beck, U., Risk Society: Towards a New Society, New Delhi, Sage, 1992, 56 and 63; Greene, J., Prescribing by Numbers: Drugs and the Definition of Dis- ease, Baltimore, Johns Hopkins University Press, 2007; Timmermann, C., ‘To treat or not to treat: Drug research and the changing nature of essential hypertension’, Schlich, T.
    [Show full text]
  • New Insights Into the Effect of Amorolfine Nail Lacquer
    Review article New insights into the effect of amorolfine nail lacquer C. Flagothier, C. Pie´ rard-Franchimont and G. E. Pie´ rard Department of Dermatopathology, University Hospital of Lie`ge, Lie`ge, Belgium Summary Despite improvements in antifungal strategies, the outcome of treating onychomycoses often remains uncertain. Several factors account for treatment failure, of which the pharmacokinetics and pharmacodynamics of the antifungal are of importance. The taxonomic nature and ungual location of the fungus cannot be neglected, besides the type of nail and its growth rate. In addition, the biological cycle of the fungus and the metabolic activity of the pathogen likely play a marked influence in drug response. The presence of natural antimicrobial peptides in the nail is also probably a key feature controlling the cure rates. There are many outstanding publications that cover the full spectrum of the field. The purpose of this review is to put in perspective some facets of activity of the topical treatment using amorolfine nail laquer. The antifungal activity of the drug is likely less pronounced in onychomycosis than that expected from conventional in vitro studies. However, the nail laquer formulation should reduce the propensity to form antifungal-resistant spores and limit the risk of reinfection. Key words: amorolfine, antifungal, fungus, onychomycosis, spore. Topical treatments are often considered to be less Introduction efficacious than current oral treatments. However, some During the last 2 decades, the efficacy of treating topical formulations may provide effects that cannot be onychomycoses has been considerably improved by achieved by other treatments. In discussing the treat- the introduction of new generations of potent antifun- ment of onychomycosis, it should not be forgotten that gals.
    [Show full text]
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [Show full text]
  • Candida Auris
    microorganisms Review Candida auris: Epidemiology, Diagnosis, Pathogenesis, Antifungal Susceptibility, and Infection Control Measures to Combat the Spread of Infections in Healthcare Facilities Suhail Ahmad * and Wadha Alfouzan Department of Microbiology, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait; [email protected] * Correspondence: [email protected]; Tel.: +965-2463-6503 Abstract: Candida auris, a recently recognized, often multidrug-resistant yeast, has become a sig- nificant fungal pathogen due to its ability to cause invasive infections and outbreaks in healthcare facilities which have been difficult to control and treat. The extraordinary abilities of C. auris to easily contaminate the environment around colonized patients and persist for long periods have recently re- sulted in major outbreaks in many countries. C. auris resists elimination by robust cleaning and other decontamination procedures, likely due to the formation of ‘dry’ biofilms. Susceptible hospitalized patients, particularly those with multiple comorbidities in intensive care settings, acquire C. auris rather easily from close contact with C. auris-infected patients, their environment, or the equipment used on colonized patients, often with fatal consequences. This review highlights the lessons learned from recent studies on the epidemiology, diagnosis, pathogenesis, susceptibility, and molecular basis of resistance to antifungal drugs and infection control measures to combat the spread of C. auris Citation: Ahmad, S.; Alfouzan, W. Candida auris: Epidemiology, infections in healthcare facilities. Particular emphasis is given to interventions aiming to prevent new Diagnosis, Pathogenesis, Antifungal infections in healthcare facilities, including the screening of susceptible patients for colonization; the Susceptibility, and Infection Control cleaning and decontamination of the environment, equipment, and colonized patients; and successful Measures to Combat the Spread of approaches to identify and treat infected patients, particularly during outbreaks.
    [Show full text]
  • Skin Diseases in Wrestling
    Skin conditions in wrestling – how to prevent Krisztián Gáspár, MD, PhD Assistant professor University of Debrecen Faculty of Medicine Department of Dermatology Debrecen, Hungary Disclosure • Presenter: Krisztián Gáspár • I have the Relationships with commercial interests: – Advisory Board/Speakers Bureau: none – Funding (Grants/Honoraria): none – Research/Clinical Trials: Eli Lilly, Novartis, Pfizer, Janssen, Sanofi, Abbvie – Speaker/Consulting Fees: Eli Lilly, Novartis, Janssen, Sanofi, Abbvie • None to disclose regarding this presentation Objectives • Normal and impaired skin barrier • Atopic dermatitis – model for understanding barrier • Skin diseases in wrestling • Treatments • Prevention techniques in skin infections Skin barrier Danger model: ”The basic function of immune system is not to distinct between self and non-self, but to recognize danger” Polly Matzinger, PhD, Immunologist, NIH In order to avoid or prevent a loss on the mat you need a good defense – The same is true for skin (an active defense) Skin barrier functions Physicochemical barrier and immunological barrier – in close morphological and functional connection Physicochemical barrier Immunological barrier (SIS) Stratum corneum: corneocytes • Epidermis, dermis Stratum granulosum: keratinocytes • Keratinocytes, dendritic cells, T cells Cornified envelop , structural proteins • Defensins, cytokines, chemokines (filaggrin) Lipid layer, proteases, protease inhibitors, defensins Tight junctions, corneodesmosomes Physicochemical barrier Genetics Environmental factors
    [Show full text]
  • The Management of Common Skin Conditions in General Practice
    Management of Common Skin Conditions In General Practice including the “red rash made easy” © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care University of Auckland, Tamaki Campus Reviewed by Hon A/Prof Amanda Oakley - 2019 http://www.dermnetnz.org Management of Common Skin Conditions In General Practice Contents Page Derm Map 3 Classic location: infants & children 4 Classic location: adults 5 Dermatology terminology 6 Common red rashes 7 Other common skin conditions 12 Common viral infections 14 Common bacterial infections 16 Common fungal infections 17 Arthropods 19 Eczema/dermatitis 20 Benign skin lesions 23 Skin cancers 26 Emergency dermatology 28 Clinical diagnosis of melanoma 31 Principles of diagnosis and treatment 32 Principles of treatment of eczema 33 Treatment sequence for psoriasis 34 Topical corticosteroids 35 Combination topical steroid + antimicrobial 36 Safety with topical corticosteroids 36 Emollients 37 Antipruritics 38 For further information, refer to: http://www.dermnetnz.org And http://www.derm-master.com 2 © Arroll, Fishman & Oakley, Department of General Practice and Primary Health Care, University of Auckland, Tamaki Campus. Management of Common Skin Conditions In General Practice DERM MAP Start Is the patient sick ? Yes Rash could be an infection or a drug eruption? No Insect Bites – Crop of grouped papules with a central blister or scab. Is the patient in pain or the rash Yes Infection: cellulitis / erysipelas, impetigo, boil is swelling, oozing or crusting? / folliculitis, herpes simplex / zoster. Urticaria – Smooth skin surface with weals that evolve in minutes to hours. No Is the rash in a classic location? Yes See our classic location chart .
    [Show full text]
  • Voriconazole
    Drug and Biologic Coverage Policy Effective Date ............................................ 6/1/2020 Next Review Date… ..................................... 6/1/2021 Coverage Policy Number .................................. 4004 Voriconazole Table of Contents Related Coverage Resources Coverage Policy ................................................... 1 FDA Approved Indications ................................... 2 Recommended Dosing ........................................ 2 General Background ............................................ 2 Coding/Billing Information .................................... 4 References .......................................................... 4 INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these Coverage Policies are based. For example, a customer’s benefit plan document may contain a specific exclusion
    [Show full text]
  • 2U11/13U195 Al
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date Χ n n 20 October 2011 (20.10.2011) 2U11/13U195 Al (51) International Patent Classification: ka Pharmaceutical Co., Ltd., 1-7-1, Dosho-machi, Chuo- C12P 19/34 (2006.01) C07H 21/04 (2006.01) ku, Osaka-shi, Osaka 541-0045 (JP). (21) International Application Number: (74) Agents: KELLOGG, Rosemary et al; Swanson & PCT/US201 1/032017 Bratschun, L.L.C., 8210 SouthPark Terrace, Littleton, Colorado 80120 (US). (22) International Filing Date: 12 April 201 1 (12.04.201 1) (81) Designated States (unless otherwise indicated, for every kind of national protection available): AE, AG, AL, AM, English (25) Filing Language: AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, (26) Publication Language: English CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (30) Priority Data: HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, 61/323,145 12 April 2010 (12.04.2010) US KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, (71) Applicants (for all designated States except US): SOMA- ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, LOGIC, INC. [US/US]; 2945 Wilderness Place, Boulder, NO, NZ, OM, PE, PG, PH, PL, PT, RO, RS, RU, SC, SD, Colorado 80301 (US). OTSUKA PHARMACEUTI¬ SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, CAL CO., LTD.
    [Show full text]
  • Diagnosis and Treatment of Tinea Versicolor Ronald Savin, MD New Haven, Connecticut
    ■ CLINICAL REVIEW Diagnosis and Treatment of Tinea Versicolor Ronald Savin, MD New Haven, Connecticut Tinea versicolor (pityriasis versicolor) is a common imidazole, has been used for years both orally and top­ superficial fungal infection of the stratum corneum. ically with great success, although it has not been Caused by the fungus Malassezia furfur, this chronical­ approved by the Food and Drug Administration for the ly recurring disease is most prevalent in the tropics but indication of tinea versicolor. Newer derivatives, such is also common in temperate climates. Treatments are as fluconazole and itraconazole, have recently been available and cure rates are high, although recurrences introduced. Side effects associated with these triazoles are common. Traditional topical agents such as seleni­ tend to be minor and low in incidence. Except for keto­ um sulfide are effective, but recurrence following treat­ conazole, oral antifungals carry a low risk of hepato- ment with these agents is likely and often rapid. toxicity. Currently, therapeutic interest is focused on synthetic Key Words: Tinea versicolor; pityriasis versicolor; anti­ “-azole” antifungal drugs, which interfere with the sterol fungal agents. metabolism of the infectious agent. Ketoconazole, an (J Fam Pract 1996; 43:127-132) ormal skin flora includes two morpho­ than formerly thought. In one study, children under logically discrete lipophilic yeasts: a age 14 represented nearly 5% of confirmed cases spherical form, Pityrosporum orbicu- of the disease.3 In many of these cases, the face lare, and an ovoid form, Pityrosporum was involved, a rare manifestation of the disease in ovale. Whether these are separate enti­ adults.1 The condition is most prevalent in tropical tiesN or different morphologic forms in the cell and semitropical areas, where up to 40% of some cycle of the same organism remains unclear.: In the populations are affected.
    [Show full text]
  • Common Derm Conditions and Treatments
    4/10/17 Classes of Dermatologic Medications What is that?! Common Dermatologic Conditions and ● Topical Immune Suppressants ● Immune Suppressants How to Treat Them ● Vitamin D Derivatives ● Antibiotics, Antivirals, Antiparasitic Matthew Fox, MD ● Retinoids ● Antimalarials Assistant Professor, Division of Dermatology ● Biologic Agents Dell Medical School, University of Texas at Austin Director of Dermatologic Surgery, Seton Healthcare Family ● Chemotherapeutic agents Learning Objectives Approach to Dermatologic Conditions • Know the clinical subtypes of acne *Know the mechanism and recommended dosing of topical retinoids, oral antibiotics and oral retinoids in the management of acne Acne • Understand the clinical presentation cutaneous dermatophyte infection Infectious diseases of the Skin *Know the classes and recommended dosing of antifungal treatments • Recognize the clinical manifestations of dermatitis Eczema *Know the relative potencies, side effects and indications of topical steroids Psoriasis • Describe the classic clinical findings for psoriasis *Know the mechanism of action and side effects of systemic antipsoriatic medications Sun Damage / Actinic Keratoses • Know the pertinent history and physical exam findings associated with a diagnosis of skin cancer, including the ABCDEs of melanoma Fundamentals Words to the wise… • All medications have side effects If you advise the patients of side effects ahead of time, you are informing the • Always consider drug interactions, patient. including with food and supplements If you did not tell the patient about a known • Always consider pregnancy and lactation side effect until after they experience status that side effect, it is an excuse 1 4/10/17 Reference: Approach to Dermatologic Conditions • Wolverton SE, ed. Acne Comprehensive Infectious diseases of the Skin Dermatologic Drug Eczema nd Therapy, 2 Ed.
    [Show full text]