Question

Tom is 50-year-old male who presents with distal lateral subungual onychomycosis of his left great toe. He has had symptoms for four months. On exam, he also appears to have interdigital tinea pedis.

Referring to clinical guidelines, what is the first-line treatment for both tinea pedis and onychomycosis in adults?

What medication precautions does the patient need to be educated on?

What kind of follow-up does the patient require?

Answer 1

So Mr Tom is suffering from Tinea pedis and onychomycosis on left foot.

This is basically fungal disase also called as Athlete's foot, caused by fungus called as Trichophyton rubrum and T. mentagrophytes

Let us understand this disease in detail, it is a common skin infection of the feet which is caused by fungus.

Signs and symptoms are itching, scaling, cracking and redness. MOST COMMON SITE OF Athlete's foot is INTERDIGITSL AREAS however fungus may grow in any part of the foot. The SECOND COMMON MOST area is the bottom of the foot. This same fungus can also affect the nails causing onychomycosis WHICH IS PRESENT INMR. TOM'S case.

NOW ANSWERING YOUR Q,

1) What is first-line treatment for both tinea pedis and onychomycosis in adults?
it consist of 3 things

A) MAINTAINING GOOD HYGIENE by washing feets and avoiding it to be wet.

B) TOPICAL ANTIFUNGAL OINTMENTS - Most commonly used is miconazole nitrate, however clotrimazole and terbinafine are also used.

C) ORAL MEDICATIONS - usually this infection is taken care by above two things but if it not or if the infection is very severe then there is need of oral medication, FIRST LINE DRUG IS terbinafine is more effective however Fluconazole or itraconazole can also be taken.

What medication precautions does the patient need to be educated on?

Ans - Usually patient is advised to maintain good foot hygiene and if patient is taking oral medication then he should bemade aware of its adverse effects like Terbinafine can cause headache ,GI upset and rash, also patient is to be explained about applying cream on fungal infection and wash that part twice daily before applying cream sothat the desd layer of skin comes out and our antifungalcream can act.

What kind of follow-up does the patient require?

usually 30-40% cases are taken care of bytopical creams so two follow up at an interval of 3days followed by sosfollow ups are required. follow up also depends on severity of infection.