Fungal infections superficial

Fungal infections superficial dermatophyte or Candida infections purely involving the skin can be treated with a topical imidazole (e.g. clotrimazole, miconazole). Pityriasis versicolor, a yeast infection, primarily involves the trunk m young adults it responds poorly to imidazoles but topical terbinafine or selenium sulphide preparations are effective severe infection may require systemic itraconazole. Invasion of hair or nails by a dermatophyte or a deep mycosis requires systemic therapy terbinafine is the most effective drug. Terbinafine and griseo-fulvin are ineffective against yeasts, for which itraconazole is an alternative. Itraconazole can be used in weekly pulses each month for 3-4 months it is less effective against dermatophytes than terbinafine. 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Distinguish between superficial and systemic fungal infections... 

Fungal infections range from superficial skin infections to fife-threatening systemic infections. Systemic fungal infections are serious infections that occur when fungi gain entrance into the interior of the body. 

Antifungal drugs are used to treat superficial and deep fungal infections. The antifungal drugs specifically discussed in this chapter are amphotericin B (Fungizone), flucona-... 

Promoting an Optimal Response to Therapy Superficial and deep fungal infections respond slowly to antifungal therapy. Many patients experience anxiety and depression over the fact that therapy must continue for a prolonged time Depending on the method of treatment, patients may be faced with many problems during therapy and therefore need time to talk about problems as they arise Examples of problems are the cost of treatment, hospitalization (when required), the failure of treatment to adequately control the infection, and loss of income. The nurse must help the patient and the family to understand that therapy must be continued until tlie infection is under control. In some cases, therapy may take weeks or months. 

Tinea infections are superficial fungal infections in which the pathogen remains within the keratinous layers of the skin or nails. Typically these infections are named for the affected body part, such as tinea pedis (feet), tinea cruris (groin), and tinea corporis (body). Tinea infections are commonly referred to as ringworm due to the characteristic circular lesions. In actuality, tinea lesions can vary from rings to scales and single or multiple lesions. 

TABLE 80-5. Signs and Symptoms of Superficial Fungal Infections... 

Chap. 80 - Superficial Fungal Infections Universal Program Number 014-999-07-095-H04... 

Miconazole is an imidazole antifungal agent used as miconazole base or miconazole nitrate for the treatment of superficial candidiasis and of skin infections dermato-phytosis and pityriasis versicolor. The drug has also been given intravenously by infusion for the treatment of disseminated fungal infections. Miconazole can be given by mouth in a dose of 120-240 mg, as oral gel four times daily after food, for... 

The spectrum of its activity is somewhat narrower than that of amphotericin and nystatin, but at the same time, it is less toxic. It exhibits especially pronounced activity against a few strains of Fusarium and Cefalosporium. Natamycin is a drug for treating superficial fungal infections, and it is used only for ophthalmologic purposes. Synonyms of this drug are pimafucin, pimaricin, tennecetin, and others. 

Over the last fifty years, as chemotherapeutics for the treatment of cancer, bacterial infections, and to prevent transplant rejections have improved, there has been a concomitant increase in the number of patients suffering from fungal infections. In the past, most fungal infections were superficial, affecting only the skin, hair, or nails. However, as medical science has progressed in other disease areas, many more patients are immunocompromised, which has resulted in a greater incidence of systemic fungal infections. 

Superficial fungal infections involve cutaneous surfaces, such as the skin, nails, and hair, and mucous membrane surfaces, such as the oropharynx and vagina. A growing number of topical and systemic agents are available for the treatment of these infections. Deep-... 

A significant decrease in mortality from deep-seated mycoses was noted among bone marrow transplant recipients treated prophylactically with fluconazole, but similar benefits have not been seen in leukemia patients receiving prophylactic fluconazole. Fluconazole taken prophylactically by end-stage AIDS patients can reduce the incidence of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections. 

Contraindications Acute superficial herpes simplex keratitis, systemic fungal infections, varicella... 

The treatment of superficial fungal infections caused by dermatophytic fungi may be accomplished (1) with topical... 

The antifungal agents that can be administered sys-temically by oral or intravenous routes are listed here. These agents are often used to treat invasive (deep) fungal infections in the body, or they can be administered systemically to treat more superficial infections that have disseminated over a large area of the skin or subcutaneous tissues. The clinical use, mechanism of action, and potential adverse effects of these drugs are addressed here. 

Note Drugs listed here are only available in topical or local preparations. Certain systemic agents listed in Table 35-1 can also be applied locally to treat various superficial fungal infections. 

Clinical Use. Ketoconazole (Nizoral) is used to treat a variety of superficial and deep fungal infections.9,35,72 This drug can be administered orally to treat pulmonary and systemic infections in candidiasis, coccidioidomycosis, histoplasmosis, and several other types of deep fungal infections. Oral administration is... 

Eluang DB, Ostrosky-Zeichner L, Wu JJ, et al. Therapy of common superficial fungal infections. Dermatol Ther. 2004 17 517-522. 

Ketoconazole (Nizoral) has a broad therapeutic potential for a number of superficial and systemic fungal infections. Ketoconazole dissolves in an acidic media therefore, antacids or histamine2-receptor-blocking agents reduce its effectiveness (Figure 45.3). Ketoconazole can cause gastrointestinal disturbances. 

Fungal infections can range from superficial, noninvasive diseases of normal children and adults to life-threatening systemic diseases of immunocompromised individuals. The incidence of disseminated infections has grown in the past decade, at least in part as a consequence of changing clinical practices. With the use of effective broad-... 

Amphotericin B is obtained from Streptomyces nodosus. It is fungistatic and administered intravenously as an infusion in the treatment of severe systemic fungal infections. It also is used for the local treatment of superficial candidiasis. Test-dose administration is advised to confirm adverse reactions. The amphotericin infusion should be slow to prevent the risk of irritation and infusion-related adverse effects. The drug is used in pregnancy without any adverse side effects.66... 

Calzavara-Pinton PG, Venturini M, Sala R. A comprehensive overview of photodynamic therapy in the treatment of superficial fungal infections of the skin. J Photochem Photo-biol B 2005 78 1-6. 

The 1,3-dioxolane ring is found in a major antifungal drug, ketoconazole (123). Ketoconazole is a broad spectrum, orally active antifungal agent and is used to treat a wide variety of superficial or deep fungal infections. Various workers, especially in Russia, have explored the use of simple oxathiolanes as radioprotectants. For example, the survival rate of mice irradiated with lethal doses of X- or -y-rays was 40% when they were pretreated with 2,2-dimethyl-l,3-oxathiolane. Other oxathiolanes were less active. 1,3-Oxathiolane, administered intravenously to dogs 2 or 3 times daily for 2-4 days before chronic irradiation with polonium-210, increased their life expectancy from 9 months to 3-7 years and alleviated radiation sickness. Some blood indicators were also restored to normal. 

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