Tinea Infections Overview
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Questions and Answers

Which of the following genera of fungi is NOT involved in causing tinea infections?

  • Trichophyton
  • Microsporum
  • Candida (correct)
  • Epidermophyton

Tinea pedis is the most prevalent cutaneous fungal infection.

True (A)

Name one environmental factor that contributes to the risk of developing tinea infections.

Moist environments

The clinical presentation of tinea capitis includes ______ around hair shafts.

<p>papules</p> Signup and view all the answers

Match the tinea infection to its specific signs and symptoms:

<p>Tinea pedis = Fissuring, maceration, and itching between toes Tinea unguium = Thickened, discolored nails Tinea corporis = Circular, erythematous scaly lesions Tinea cruris = Red, well-demarcated lesions on thighs/groin</p> Signup and view all the answers

Which of the following conditions is NOT a risk factor for tinea infections?

<p>High blood pressure (C)</p> Signup and view all the answers

Tinea infections can spread through indirect contact with contaminated surfaces.

<p>True (A)</p> Signup and view all the answers

What is the main goal of treatment for fungal infections?

<p>Eradication of infection</p> Signup and view all the answers

Azoles function by inhibiting ______ synthesis, which is crucial for fungal cell membranes.

<p>ergosterol</p> Signup and view all the answers

Which antifungal medication is known to inhibit squalene epoxidase?

<p>Terbinafine (D)</p> Signup and view all the answers

What is the approved treatment for athlete's foot prevention?

<p>Tolnaftate powder or spray (B)</p> Signup and view all the answers

Topical antifungals can cause severe hypersensitivity reactions.

<p>False (B)</p> Signup and view all the answers

List two dosage forms of antifungals.

<p>Creams, sprays, powders, solutions, gels</p> Signup and view all the answers

The role of aluminum salts is to reduce __________ and maceration.

<p>wetness</p> Signup and view all the answers

Match the following tinea infections with their treatments:

<p>Tinea corporis = Terbinafine, once daily for 2 weeks Tinea cruris = Clotrimazole, twice daily for 2 weeks Tinea pedis (interdigital) = Terbinafine, twice daily for 1 week Tinea pedis (moccasin-type) = Terbinafine, twice daily for 2 weeks</p> Signup and view all the answers

Which antifungal interacts with warfarin, increasing the risk of bleeding?

<p>Miconazole (B)</p> Signup and view all the answers

Tea tree oil is an alternative therapy for fungal infections with strong evidence supporting its efficacy.

<p>False (B)</p> Signup and view all the answers

What are two counseling points for antifungal use?

<p>Apply to clean, dry skin; use for full duration despite symptom improvement.</p> Signup and view all the answers

Refer for nail/scalp involvement, extensive infections, or signs of __________ infection.

<p>secondary</p> Signup and view all the answers

What is the fungicidal activity of clotrimazole and miconazole primarily effective against?

<p>Dermatophytes and yeasts (C)</p> Signup and view all the answers

What is a common reason for relapse of superficial fungal infections after tolnaftate therapy is discontinued?

<p>Inadequate duration of treatment (B)</p> Signup and view all the answers

Tolnaftate can cause severe hypersensitivity reactions.

<p>False (B)</p> Signup and view all the answers

Which vehicle is used in the aerosol formulation of tolnaftate?

<p>Talc, alcohol, and propellant</p> Signup and view all the answers

Tolnaftate is applied _____ daily to the affected area after thorough cleaning.

<p>twice</p> Signup and view all the answers

Match the following dosage forms of tolnaftate with their respective properties:

<p>1% solution = More effective than cream Topical powder = Effective water absorption Cream = Formulated in polyethylene glycol vehicle Topical aerosol = Includes talc and alcohol</p> Signup and view all the answers

What is an important counseling point for patients taking an antifungal medication?

<p>Wash hands with soap and water before applying. (A)</p> Signup and view all the answers

Patients should only be advised on pharmacologic treatments for fungal infections.

<p>False (B)</p> Signup and view all the answers

What should patients with diabetes be counseled on for managing fungal infections?

<p>Glucose control and foot hygiene.</p> Signup and view all the answers

To avoid spreading fungal infections, patients should use a __________ towel to dry affected areas.

<p>separate</p> Signup and view all the answers

Match the dosage form with its characteristic:

<p>Creams = Efficient for delivering medication to the skin Sprays = Best as adjunctive therapy Gels = Effective for epidermal delivery Powders = Less effective if not rubbed in</p> Signup and view all the answers

What should a patient do if there is no improvement in fungal infection after one week of treatment?

<p>Refer to primary care provider. (D)</p> Signup and view all the answers

Topical antifungal medications can cause severe systemic side effects.

<p>False (B)</p> Signup and view all the answers

What is the recommended duration for treatment with topical antifungals?

<p>2 to 4 weeks.</p> Signup and view all the answers

Which of the following dosage forms is commonly available for antifungal agents?

<p>Oral tablets (B)</p> Signup and view all the answers

Topical antifungal agents are generally considered safe with minimal side effects.

<p>True (A)</p> Signup and view all the answers

Name one key counseling point for patients using topical antifungals.

<p>Apply to clean and dry skin.</p> Signup and view all the answers

Nonprescription topical antifungal agents are often used for both _______ and treatment.

<p>prevention</p> Signup and view all the answers

Match the dosage form of antifungal medications with their descriptions:

<p>Cream = A semi-solid emulsion for topical application Spray = An aerosolized form for easy application to large areas Powder = A fine particulate used to absorb moisture and treat affected skin Gel = A topical form that provides a cooling sensation upon application</p> Signup and view all the answers

What is an essential factor to consider when recommending a topical antifungal?

<p>The extent of the infection (C)</p> Signup and view all the answers

Warfarin does not interact with miconazole cream.

<p>False (B)</p> Signup and view all the answers

List one chronic health problem that can increase the risk of tinea infections.

<p>Diabetes</p> Signup and view all the answers

The main goal of patient counseling for antifungal use is to ensure proper _______ of the medication.

<p>adherence</p> Signup and view all the answers

Which form of topical antifungal is best for large areas of infected skin?

<p>Spray (D)</p> Signup and view all the answers

What is the primary active ingredient in Lamasil AT Cream for athlete's foot?

<p>Terbinafine HCl 1% (C)</p> Signup and view all the answers

Which of the following topical antifungal agents is considered a fungicidal agent?

<p>Butenafine (B)</p> Signup and view all the answers

Tolnaftate is commonly used only for treating tinea infections and not for prevention.

<p>False (B)</p> Signup and view all the answers

How often should Clotrimazole be applied for athlete's foot?

<p>Twice daily for up to 4 weeks</p> Signup and view all the answers

Topical powders and sprays are generally more effective than creams for treating superficial fungal infections.

<p>False (B)</p> Signup and view all the answers

The active ingredient in Lamasil AT Spray for athlete's foot is ______.

<p>Terbinafine HCl 1%</p> Signup and view all the answers

Name one formulation type that is preferred in hairy areas for antifungal treatment.

<p>Solutions</p> Signup and view all the answers

Terbinafine and butenafine are considered __________ agents that kill fungi.

<p>fungicidal</p> Signup and view all the answers

Which of the following formulations of Lamasil is applied between the toes?

<p>Lamasil AT Spray (B), Lamasil AT Cream (D)</p> Signup and view all the answers

Clotrimazole and Miconazole can cause severe skin irritation in all patients.

<p>False (B)</p> Signup and view all the answers

What is the formulation type of Lamasil AT Defence Athletes' Foot Powder?

<p>Spray Powder</p> Signup and view all the answers

For patients with poorly controlled diabetes, what is the recommended treatment approach for superficial fungal infections?

<p>Refer for systemic therapy (D)</p> Signup and view all the answers

Topical antifungal products can be used interchangeably without checking active ingredients.

<p>False (B)</p> Signup and view all the answers

Miconazole is applied _____ a day for jock itch.

<p>twice</p> Signup and view all the answers

What is a common theme found throughout the OTC aisle for antifungal products?

<p>Variations in active ingredients</p> Signup and view all the answers

Match the following antifungal agents with their application frequency for athlete's foot:

<p>Clotrimazole = Twice daily for up to 4 weeks Miconazole = Twice daily for up to 4 weeks Lamasil AT Cream = Twice daily for 2 weeks Tolnaftate = Twice daily for 4 weeks</p> Signup and view all the answers

What is the action mechanism of Imidazoles like Clotrimazole and Miconazole?

<p>Inhibiting ergosterol biosynthesis (C)</p> Signup and view all the answers

The treatment for __________ infections may need to be systemic due to the extent of the condition.

<p>tinea capitis</p> Signup and view all the answers

When considering formulations for treating fungal infections, which should be prioritized?

<p>Efficacy and patient preference (A)</p> Signup and view all the answers

What is the recommended duration for using terbinafine for Tinea Pedis in the case of interdigital infections?

<p>Twice daily for 1 week (A)</p> Signup and view all the answers

Oral terbinafine is required for the treatment of Tinea Capitis.

<p>True (A)</p> Signup and view all the answers

How long should Clotrimazole be applied for Tinea Corporis?

<p>4 weeks</p> Signup and view all the answers

Oral terbinafine for toenail fungus should be taken for ______ weeks.

<p>12</p> Signup and view all the answers

Match the following treatments with their corresponding tinea infections:

<p>Terbinafine = Tinea Cruris Griseofulvin = Tinea Capitis Butenafine = Tinea Corporis Miconazole = Tinea Pedis</p> Signup and view all the answers

Flashcards

Tinea pedis

The most common fungal skin infection, also known as athlete's foot

Tinea infections

Fungal skin infections caused by Microsporum, Trichophyton, and Epidermophyton.

Risk factor for tinea

Conditions like trauma, immunosuppression, diabetes, and hygiene issues.

Tinea capitis

Fungal infection of the scalp with hair breakage and lesions.

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Tinea corporis

Circular, red, scaly skin lesions.

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Tinea cruris

Fungal infection of the groin, often with red, well-defined margins.

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Tinea unguium

Nail infection, marked by thickened, discolored nails.

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Antifungal Mechanisms

Azoles inhibit ergosterol synthesis; Terbinafine/Butenafine stops squalene epoxidase leading to fungal death.

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Tinea pedis variants

Common types include interdigital, moccasin-type, vesicular, and ulcerative.

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Environmental factors tinea

Warm, humid environments, tight clothing, and inappropriate shoes.

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Athlete's foot prevention

Tolnaftate (powder or spray) is used daily to prevent athlete's foot.

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Tinea corporis treatment

Terbinafine, once daily for two weeks, treats body ringworm.

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Tinea cruris treatment

Clotrimazole twice daily for two weeks treats groin ringworm.

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Tinea pedis treatment

Terbinafine twice daily for 1-2 weeks treats foot ringworm.

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Aluminum salts role

Aluminum salts reduce wetness to treat fungal infections.

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Topical antifungal side effects

Mild irritation, burning, stinging and rare hypersensitivity reactions can occur.

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Warfarin/Miconazole interaction

Miconazole cream with warfarin increases bleeding risk due to CYP2C9 inhibition.

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Fungistatic/fungicidal agents

Clotrimazole and miconazole target various dermatophytes and yeasts.

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Referral criteria

Refer to a doctor for nail involvement, extensive infection or secondary infections.

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Antifungal counseling

Apply to clean, dry skin, and treat until complete even if symptoms improve; practice hygiene.

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Diabetes & Fungal Infections

Patients with diabetes need to manage their blood sugar levels to prevent fungal infections. Increased glucose in sweat can promote fungal growth.

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Topical Antifungal Application

Apply the antifungal to a clean and dry affected area. Massage it in and wash your hands thoroughly after application.

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Antifungal Treatment Duration

Topical fungal infections can take 2 to 4 weeks to resolve. Patients should be advised to complete the full course of treatment even if symptoms improve.

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Non-Pharmacologic Measures

Maintaining clean and dry skin, using separate towels, avoiding shared personal items, and laundering contaminated items in hot water can help prevent fungal infections.

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Footwear & Tinea Pedis

For Tinea Pedis, wear protective footwear in shared showers, choose breathable shoes, and use foot powder to keep feet dry.

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Topical Antifungal Efficacy

Creams, gels, and solutions are generally most effective for topical antifungal treatment. Sprays and powders may be less effective.

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Monitoring Antifungal Treatment

Patients should start to experience improvement within a week. If the infection doesn't improve or worsens, consult a primary care provider.

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Lamisil AT Cream

A topical cream containing 1% terbinafine hydrochloride used to treat athlete's foot. It is applied twice daily for 1-2 weeks depending on the affected area.

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Lamisil AT Spray

A topical spray containing 1% terbinafine hydrochloride used to treat athlete's foot. It is applied twice daily for 1 week, primarily between the toes.

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Lamisil AT Defence Powder

A topical spray powder containing 1% tolnaftate used to prevent and treat athlete's foot. It is applied twice daily for 4 weeks, particularly between the toes.

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Clotrimazole and Miconazole

Topical antifungal medications that work by inhibiting ergosterol synthesis in fungal cells, leading to cell death. They are commonly used to treat skin infections like athlete's foot and jock itch.

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Tolnaftate

A topical antifungal medication that distorts fungal hyphae and inhibits their growth. It is the only nonprescription drug approved for both treating and preventing tinea infections.

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How do Clotrimazole and Miconazole work?

They inhibit the synthesis of ergosterol, a crucial component of fungal cell membranes, leading to cell death.

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How does Tolnaftate Work?

It is believed to damage fungal hyphae, the thread-like structures that make up fungi, and inhibit their growth.

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What is the unique benefit of Tolnaftate?

It is the only nonprescription drug approved for both preventing and treating tinea infections.

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How are Clotrimazole and Miconazole applied?

They are applied once in the morning and once in the evening for up to 4 weeks for athlete's foot, or twice daily for 2 weeks for jock itch.

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What are common side effects of Clotrimazole and Miconazole?

Mild skin irritation, burning, and stinging can occur, but these are rare.

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Systemic Therapy Needed?

Systemic antifungal treatment is often necessary for severe fungal infections like tinea capitis, tinea unguium, extensive moccasin-type tinea pedis, or extensive tinea corporis.

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OTC Antifungal Options

Over-the-counter topical antifungals include butenafine, clotrimazole, miconazole, terbinafine, and tolnaftate. They come in creams, solutions, lotions, sprays, shampoos, and powders.

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Creams vs. Sprays & Powders

Creams and solutions are generally more effective for treating fungal infections because they can be directly applied to the infected area.

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Fungicidal vs. Fungistatic

Terbinafine and butenafine are fungicidal (kill fungus), while other agents like clotrimazole and miconazole are fungistatic (inhibit growth).

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Active Ingredient Check

Be sure to look at the active ingredient when recommending an OTC product, as brand names can be misleading.

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Treatment Duration

Topical fungal infections can take 2 to 4 weeks to resolve. Patients should be advised to complete the full course of treatment even if symptoms improve.

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What are some common risk factors for tinea infections?

Conditions like trauma, immunosuppression, diabetes, and hygiene issues.

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Tinea Capitis Symptoms

Fungal infection of the scalp with hair breakage and lesions.

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Tinea Corporis Symptoms

Circular, red, scaly skin lesions.

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What is Tinea Cruris?

Fungal infection of the groin, often with red, well-defined margins.

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Tinea Unguium Symptoms

Nail infection, marked by thickened, discolored nails.

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Environmental Factors for Tinea

Warm, humid environments, tight clothing, and inappropriate shoes.

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Tolnaftate Vehicle Advantages

Tolnaftate's vehicles (creams, solutions, powders) are designed to be non-occlusive, nontoxic, nonsensitizing, water-miscible, anhydrous, easy to apply, and efficient in drug delivery.

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Tolnaftate Treatment Duration

Tolnaftate usually takes 2-4 weeks for effective therapy. Some individuals might need 4-6 weeks, especially for lesions between toes or on foot pressure points.

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Butenafine Action

Butenafine inhibits squalene epoxidase, causing a fungal cell death by disrupting ergosterol production.

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Butenafine Efficacy

Butenafine treatment for interdigital tinea pedis shows around 38% effectiveness with a 1-week application and 74% effectiveness with 4-week application.

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Tolnaftate Side Effects

Tolnaftate is usually well-tolerated, but may cause mild stinging. Delayed hypersensitivity reactions are rare. Discontinue use if irritation occurs.

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Tinea pedis treatment duration

Treatment duration for tinea pedis depends on the type and severity of infection. For example, Interdigital Tinea Pedis (between the toes) requires twice-daily application of terbinafine for one week, while Moccasin-type Tinea Pedis (soles/sides of feet) requires twice-daily application for two weeks.

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Tinea capitis treatment

Tinea capitis (scalp infection) requires prescription treatment as it involves the scalp and hair. Oral medications like terbinafine or griseofulvin are typically used for several weeks.

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Fungistatic vs. Fungicidal

Antifungal medications can be either fungistatic (inhibiting the growth of fungus) or fungicidal (killing the fungus). For example, clotrimazole and miconazole are fungistatic, while terbinafine and butenafine are fungicidal.

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Treatment duration for topical fungal infections

It usually takes 2-4 weeks for topical fungal infections to resolve. It's crucial to complete the full course of treatment even if symptoms improve, as stopping early can lead to the infection returning.

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Study Notes

Tinea Infections: Overview

  • Fungal Genera: Microsporum, Trichophyton, and Epidermophyton cause tinea infections.
  • Most Common: Tinea pedis (athlete's foot) is the most prevalent cutaneous fungal infection.
  • Risk Factors: Trauma, immunosuppression, public pools, diabetes, poor hygiene, hyperhidrosis, occluded skin, warm/humid climates, obesity, and tight clothing increase risk.
  • Infection Mechanisms: Direct contact, fomites, infected animals, and contaminated soil facilitate spread.
  • Environmental Factors: Moist, warm environments, tight clothing, and non-porous shoes contribute to infections.
  • Chronic Health Risks: Diabetes, immunosuppression, poor circulation, and malnutrition add to the risk.

Clinical Presentations

  • Tinea Capitis: Scalp lesions, hair breakage, and black dots.
  • Tinea Corporis: Circular, red, scaly patches with a clear center.
  • Tinea Cruris: Well-demarcated red patches in the groin.
  • Tinea Pedis: Scaling, maceration, fissuring, and itching, often between toes.
  • Tinea Unguium: Thickened, discolored, and often separated nails.

Diagnosis and Differentiation

  • Distinguishing Criteria: Tinea infections have often circular, red, scaly lesions, distinct borders, and fungal characteristics lacking in bacterial infections.
  • Tinea Pedis Variants: Interdigital, moccasin-type, vesicular, and ulcerative.

Treatment

  • Anti-fungal Goals: Eradicate infection, relieve symptoms, and prevent recurrence.
  • Mechanism of Antifungals: Azoles inhibit ergosterol synthesis; terbinafine/butenafine block squalene epoxidase.
  • Common OTC Antifungals: Clotrimazole, miconazole, terbinafine, butenafine, and tolnaftate.
  • Indications for OTC: Treatment and preventing recurrence of tinea infections.
  • Dosage Forms: Creams, solutions, sprays, powders, gels.
  • Athlete's Foot Prevention: Tolnaftate (powder/spray) daily.
  • Aluminum Salts: Adjunctive therapy to reduce wetness and maceration.

Potential Risks & Interactions

  • Side Effects (Topical): Mild irritation, burning, stinging, and sometimes hypersensitivity.
  • Drug Interactions: Warfarin and miconazole cream: increased bleeding risk due to CYP2C9 inhibition.

Specific Treatment Plans (Examples)

  • Tinea Corporis: Terbinafine (1x daily for 2 weeks).
  • Tinea Cruris: Clotrimazole (2x daily for 2 weeks).
  • Tinea Pedis: Terbinafine (2x daily for 1 week-interdigital; 2 weeks-moccasin type).

Critical Assessment and Referral

  • Referral Considerations: Nail/scalp involvement, extensive infections, or secondary infection warrants medical consultation.

Alternative/Unverified Therapies

  • Caution: Limited evidence for alternative therapies; avoid unverified products.

Counseling Points

  • Application Instructions: Apply to clean, dry skin and continue treatment duration (even with improvement) to prevent recurrence. Importance of practicing good hygiene.

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Description

This quiz covers the essential aspects of tinea infections, including the fungal genera responsible, common types, risk factors, and clinical presentations. Test your knowledge on how these infections spread and the environmental conditions contributing to their prevalence.

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