msyamp
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c
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| drpkaur
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C
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| robin082006
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C
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| yasmeen
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yes its c i checked
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| gpsbrar
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PLease provide reasoning. Why not D instead of C? Topical azole (Clotrimazole) is all time fave though.
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| msyamp
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topcal that too 3 day course would not be sufficient yaar
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| gpsbrar
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Yep you are right 3 days is too little. I forgot to read 3 days in front of our azole friend. And for that reason I would prefer oral Griseofulvin.
But if it was 2 wks of topical ketoconazole or 2 weeks of griseofulvin then what would you prefer. I know I am just getting nosy now.
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| leen
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hey guys I saw this q on some forum and acc to the ppl there the ans was A .....no greseofulvin ...no azoles
can anyone advice?
thanks
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| tolito
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the infection will not clear without treatment! yes it is good sense to wipe groin before feet but i cannot think how that would help clear his infection.
topical stuff would also work but would need to be continued for weeks to months (same as for oral drugs) for new tissue to grow and replace old
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| yasmeen
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its atheletes foot requires treatment
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| gpsbrar
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Acute tinea pedis Clinical features — Attacks of acute tinea pedis are self-limited, intermittent, and recurrent. They often follow activities that cause the feet to sweat. Acute tinea pedis begins with the appearance of intensely pruritic, sometimes painful, erythematous vesicular or bullous lesions between the toes and on the soles, frequently extending up the instep (show picture 5). The disease may be unilateral or bilateral. Secondary staphylococcal infections with lymphangitis often complicate the picture. Secondary eruptions at distant sites may occur simultaneously due to an immunologic reaction to the fungus. This is a sterile vesicular eruption that often occurs on the palms and fingers, referred to as an "id" reaction. This improves as the primary infection is treated. Diagnosis — The history and clinical picture combination is characteristic, but the diagnosis should be confirmed by KOH examination of scrapings from the lesions (show picture 6). The roof of a vesicle is a good place to look. Culture on Sabouraud's medium is also helpful in difficult cases. Chronic tinea pedis Clinical features — Chronic tinea pedis is the most common form of tinea pedis encountered in practice. Untreated it usually persists indefinitely. The disease begins with slowly progressive pruritic, erythematous lesions between the toes, especially in the fourth digital interspace. Interdigital fissures are often present (show picture 7). Extension onto the sole follows and later onto the sides or even the top of the foot ("moccasin ringworm"). The border between involved and uninvolved skin is usually quite sharp, and the normal creases and markings of the skin (dermatogliphs) tend to accumulate scale. In many cases the palms and flexor aspects of the fingers may be similarly involved (tinea manuum). Mycotic nail dystrophy (onychomycosis) is also often present. The appearance of tinea pedis, cruris, and corporis can be modified in patients who have inappropriately been treated with topical steroids. This is referred to as tinea incognito. Patients can have diminished erythema without the typical scaling erythematous border, or can develop a folliculitis (Majocchi granuloma) that may require oral antifungal therapy. Treatment — Tinea pedis can usually be treated with a topical antifungal cream for four weeks; interdigital tinea pedis may only require one week of therapy. A review of the available evidence found strong evidence that topical treatments increase cure rates for tinea pedis compared with placebo [17]. A number of topical antifungal creams are available over the counter (show table 1); some prescription agents have a broader spectrum of action and may be administered once instead of twice daily, but generally all of the creams are equally effective [17]. Patients with chronic disease or extensive disease may require oral antifungal therapy with griseofulvin (250 to 500 mg of microsize twice daily), terbinafine (250 mg daily), or itraconazole (200 mg daily). In a systematic review, terbinafine was found to be more effective than griseofulvin, while the efficacy of terbinafine and itraconazole were similar [18]. Nail involvement is another indication for oral therapy. Secondary infection should be treated with oral antibiotics. Pediatric dosing options include: - Griseofulvin 10 to 15 mg/kg daily or in divided doses
— 10 to 20 kg: 62.5 mg daily
— 20 to 40 kg: 125 mg daily
— Above 40 kg: 250 mg daily - Itraconazole 5 mg/kg daily
- Fluconazole 6 mg/kg daily
In addition to antifungal therapy, Burow's wet dressings, applied for 20 minutes two to three times per day, may be helpful if vesiculation or maceration is present. Other adjunctive therapies include use of foot powder to prevent maceration, treatment of shoes with antifungal powders, and avoidance of occlusive footwear.
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| tolito
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thanks gpsbrar that was good info
hey guys, let us look at this closely.
pt is healthy, no symptom in past
symptom only 4days
altho confirmed by scrapings.
it might not be a bad option to advise him on good foot care and ask him to come back. what is the hurry in giving a drug that affects the liver adversely?? the 3 day course of topical is ridiculous. the 6-8 wk course of griseofulvin is killing a fly with a hammer as oral drugs are given for chronic conditions. the bath towel thing looks funny to me. most people dry from up down anyway. that is only sensible other wise water drips back over your dry legs. so i change my mind
answer is E.
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| gpsbrar
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Tolito When confirmed fungal infection dx is there, you have to treat it though. If this is a case of mild infection then topical cream or a powder is prescribed or you get ' em over the counter. It you think it is something serious then it should be treated with oral antibiotics. I talked to one of the doctors over here. They said it is an acute infection case, then a mild infection, for some reason he said he had never used topical ketoconazole (he actually told that no one in their practice has used topical ketoconazole, so you can rule out that. Topical Clotrimazole would be of some use if it was 1-2 weeks) Griseofulvins should be secondary Tx. You should wipe from top tyo bottom to eliminate the option of spreading the infection.
He actually looked at the question and said answer is A. But I still think answer should be C.
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