Introduction
Pathogens
1. Trichophyton |
a. T. rubrum |
b. T. mentagrophytes |
c. T. tonsurans |
2. Epidermophyton |
a. E. floccosum |
3. Microsporum |
a. M. canis |
Clinical syndromes
Interdigital-type tinea pedis
Moccasin-type tinea pedis
Vesiculobullous tinea pedis
Predisposing factors
A. Host Factors |
1. Immunosuppression |
a.) Chemotherapy |
b.) Immunosuppressive Drugs |
c.) Steroids |
d.) Organ Transplant |
e.) Acquired Immunodeficiency Syndrome (AIDS) |
2. Poorly controlled diabetes mellitus |
3. Obesity |
4. Age |
B. Local Factors |
1. Trauma |
2. Occlusive Clothing |
3. Public Showering |
4. Moist Conditions |
Complications
Lower extremity cellulitis
Tinea unguum (onychomycosis)
Dermatophytid and Majocchi's granuloma
Asthma and atopic disease
Molecular immunopathogenesis
Diagnosis
Treatment
Non-pharmacological
DRUG | DOSE | SIDE EFFECTS |
---|---|---|
1. Griseofulvin* | 375–500 mg qd 3–6 months | Nausea, Hepatotoxic, Photosensitivity, Headache, Leukopenia+, Neutropenia+ |
2. Azoles
| ||
A. Ketoconazole** | 200–400 mg qd 6–8 weeks | Hepatotoxic, Hepatitis Idiosyncratic rxn, Nausea, Vomiting, Diarrhea |
B. Itraconazole
| 100 mg qd 2–4 weeks | Abdominal pain, Increased transaminases |
400 mg qd 1 week | ||
C. Fluconazole
| 50 mg qd 6 weeks | Hepatotoxic+, Anaphylaxis |
100 mg qd 8 weeks | ||
150 mg q week 6 weeks | ||
3. Allylamines
| ||
A. Terbinafine
| 125 mg qd 8 weeks | Headache, Rash, Cholestatic hepatitis, Blood dyscrasia Steven-Johnson Syndrome |
250 mg qd 2–6 weeks |
1. Griseofulvin:
|
Aspirin, Oral contraceptives, Phenobarbital, Porfimer, Theophylline, Warfarin |
2. Ketoconazole:
|
Alcohol, Oral hypoglycemics, Phenytoin |
3. Itraconazole:
|
Alfentanil, Alprazolam, Amphotericin B, Agenerase, Antacids, Atorvastatin, Bexarotene, Buspirone, Bussulfan, Carbamazepine, Cilostazol, Cimetidine, Cisapride, Citalopram, Clarithromycin, Cyclosporine, Diazepam, Didanosine, Digotoxin, Docetaxel, Dofetilide, Erythromycin, Famatidine, Felodipine, Grapefruit juice, Haloperidol, Indinavir, Isoniazid, Lansoprazole, Lovastatin, Methylprednisone, Midazolam, Nevirapine, Nifedipine, Omeprazole, Oral hypoglycemics, Phenobarbital, Phenytoin, Pimazide, Quinidine, Ranitidine, Rifabutin, Rifampin, Retonavir, Saquinavir, Sildenafil, Simvastatin, Sirolimus, Sodium bicarbonate, Sucralfate, Tacrolimus, Triazolam, Trimetrexate, Verapamil, Vincristine, Warfarin |
4. Fluconazole:
|
Amphotericin B, Celecoxib, Cimetidine, Cisapride, Citalopram, Cyclosporine, Defetilide, Felodipine, Glipiside, Glyburide, Hydrochlorothiazide, Lovastatin, Midazolam, Oral hypoglycemics, Phenytoin, Pimozide, Prednisone, Quinidine, Rifabutin, Rifampin, Sildenafil, Simvastatin, Sirolimus, Tacrolimus, Theophylline, Trizolam, Warfarin, Zidovudine |
5. Terbinafine:
|
Cimetidine, Cyclosporine, Nortriptyline, Rifampin, Terfenadine, Theophylline, Warfarin |