Fungal skin infections

• Terminology:
Most often, tinea infections are named based on the area
affected:
Athlete’s foot
When to refer
Antifungals
3-Amorolfine is available as a 5% nail lacquer. It is used weekly
and treatment lasts until the affected nail(s) have regrown and
are clear of infection. This takes approximately 6 months for
fingernails and 9 to 12 months for toenails.
 Cold sore

Clinical Pharmacy
Fourth year undergraduates
University of Kufa – Faculty of Pharmacy
 Management
B-Aciclovir (5% cream)(zovirax®):
1-The cream is applied five times daily, at 4-hourly
intervals, starting, if possible, as soon as prodromal
symptoms occur (it may shorten attacks by a day or
two if use is begun early enough.
Treatment should be continued for 5 days. If
healing is not complete, treatment can be
continued for up to 5 more days, after which
medical advice should be sought if the cold sore
has not resolved.
 Acne
inflammatory and non inflammatory
• Management
• The general aims of therapy are to remove
follicular plugs so that sebum is able to flow
freely and to reduce the number of bacteria on
the skin.
• Treatment should reduce comedone formation.
• The most useful formulations are lotions, creams
and gels.
• Gels with an alcoholic base dry quickly but can
be irritating.
• Those with an aqueous base dry slower but are
less likely to irritate the skin.
1-Benzoyl peroxide
2-Other keratolytics
3-Nicotinamide
4-Antibacterials
• Diet
• Sunlight
• Skin hygiene
• The two major types of hair loss are diffuse hair loss
and alopecia areata.
• Alopecia androgenetica (male pattern baldness,
sometimes known as common baldness because it can
affect women) is the most common cause of diffuse hair
loss.
• Other causes of diffuse hair loss include
• 1-Telogen effluvium
• 2-Hypothyroidism,
• 3-Severe iron deficiency and protein deficiency.
• 4- Diffuse hair loss is seen after pregnancy, in chronic
renal failure and with certain drugs and chemical agents.
 Case 1
Jalal khalid, the local plumber, is in his early twenties and captains the local
football team on Sunday mornings. Today he wants to buy something for his
athlete’s foot(mixture preparation from fugdin+HC2.5%cream), which he says he
just can’t get rid of. His wife told him about it. The skin between the third and
fourth toes and between the second and third toes is affected. jalal tells you the
skin is itchy and that it looks flaky. He tells you that he has had athlete’s foot
before and that it keeps coming back again. He wears trainers most of the time
(he has them on now) and he want to use cream.
A-asses the patient symptom
B-what is the most appropriate non pharmacological treatment to prevent
reinfection
C-what is your opinion regarding this mixture
D- What is best option to control his symptom and treatment of fungal infection?
E-if the patients have other symptom like fungal infection of the toenails asses the
case now and what is the treatment recommendation
G-if the symptom persist more than 2 weeks what is your action now (improper
use can led to treatment failure)
 Case 2
Lamis ali asks if you can recommend anything for
athlete’s foot. She tells you that it affects her toes
and the soles and top of her feet, and is extremely
itchy. When asked about the skin between her
toes, she tells you she does not think the rash is
between the toes and the skin like weepy and
yellow crust. She says the skin is dry and red and
has been like this for several days. She has not tried
any medication to treat it.
A- asses the case severity
B- what is the best option
 Case 3
A 29-Year-Old Female Teacher suffer from painful fluid-filled blisters
nearly the lips ,she describe these symptom before at the same site
and in similar situation which developed after common cold that
she describe as ulcer after fever. She stressed from past exam and
want kenalog paste as she know from her neighbour useful for her
ulcer .
A-asses the patient symptom
B- at which stage
C-what are the trigger factors
D-what are the appropriate pharmacological and non
pharmacological treatments
E- What is your opinion regarding her choice kenalog
F-if symptom not cured after 6 days what is your recommendation
sara., a 16-year-old high school student, presented to the pharmacy for a requisite treatment
of her facial acne and asked if it was bothersome. Relieved at the question, saea stated that
she had been bothered by facial acne for the past 3 months with modest improvement . She
described facial breakouts that began gradually, varied in severity, worsened during menses,
and never completely cleared. She was disappointed with her recent yearbook pictures and
admitted the breakouts contributed to feelings of low self-esteem. She tried over-the-counter
5% benzoyl peroxide (BP) gels and washes, as well as multiple facial cleansing products
noacne soap, without improvement. sara followed her mother's advice to eliminate chocolate
and fried foods from her diet, but also without improvement. She was prescribed
norgestimate/ethinyl estradiol at a time for her menstrual irregularity but didn’t used . In
addition to normal physical examination results, her menstrual cycle was irregular, She was
not taking any medications and denied any allergies. A physical examination revealed a
healthy young woman with 5 open and closed comedones, (see Figure 1). No nodules or cysts
were present. Additional history and physical examination findings were noncontributory.
A-asses symptom severity
B-what are the trigger or exacerbated factors
C- is referral indicated and what is your advice regarding method of administration and
treatment time scale
D-what is non-pharmacological advice
E-after 1 weeks of application he return suffer from redness and sore effect what is your
action
F-is antibiotic indicated or not and what type if needed
 Case 5
Nadir is a 28-year-old man who was seen in my office with
acne primarily located on his cheeks, chin, and forehead. he
had more than 10 pustules on each of these areas,. She had
open comedones on his nose and chin and closed
comedones primarily on his cheeks, chin, and forehead. In
addition, he experienced painful red cysts on her cheeks and
chin. he had pale skin with red undertones like in fig
above .he is on chronic phenytoin treatment bec of epilepsy
and want treatment for his symptom
A-asses the symptom severity
B- what is your action and why
 Case 6
A 25 year old male presented to the pharmacy consultation with grave
concerns he was suffering with hair loss, as there was history on both
sides of his family. He also was showing visible signs of thinning which
was extremely distressing to him.
Upon the initial consult it was discovered the client had already been
diagnosed with male pattern hair loss and was undergoing treatment
with prescribed medications from his own doctor minoxdil shampoo,
although only for a the 1 month and had not noticed any change at this
time.The visible decreased density on the crown and frontal areas of
the scalp in gradual manner affecting less than 10 cm . The client had
no past or present medical concerns and presented in good health.
A- asses the type of alopecia
B- what is your opinion regarding the treatment is referral needed.
C- if the symptom associated with itching and red angle area what is
best choice now
 Case 7
A 25 year old female presented to the pharmacy consultation
with grave concerns he was suffering with continuous hair
loss, she describe that she had menstrual cycle disturbances
with diagnosed history of PCOS her hair began to loss
gradually ,generalised and there is an increase in the parting
width her father and mother have history of androgenic
alopecia she ask for treatment recommendation form her case
A-asses the type of alopecia
B- Best treatment recommendation
C- if this case associated with no increase in the parting width
and negative history of androgenic alopecia what is the most
likely the type and best option with sever menorrhagia
 Case 8
years old man suffering from sudden hair loss at his 25
symptom ,Hair usually falls out in small patches on the scalp.
These patches are often several centimeters or less. Hair loss
also occur on other parts of the face, like the eyebrows Some
people lose hair in a few places. he first notice clumps of hair
on his pillow or in the shower ,he didn’t suffer from other
symptom he had history of asthma and negative family
history of alopecia ,he ask you for minoxdil shampoo that
help his friend from male pattern alopecia
A-asses the type of alopecia
B- what is your recommendation
 Case 9
years old man presented with itchy acne as 7 papules 18
and developed at his face and sholder he compliant that
he shame from it and required an powerful antibiotic for
this case ,he is not taking any medication he tried
benzoyl oxide 5% cream but not improve enough and
want to eliminate these acne as soon, he describe his
. skin as greasy one he want zyneryte lotion
A-asses the patient severity
B-what is best non pharmacological treatment
C-what is your opinion regarding this item
Thank you