Dermatology Case No 8.Tinea Pedis

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Dermatology Case No 8.Tinea Pedis

টিনিয়া_পেডিস,

পায়ের মধ্যে যদি ফাংগাল ইনফেকশন হয়, তাকে টিনিয়া পেডিস বলে, টিনিয়া পেডিস মূলত Trichophyton Rubrum নামক এক প্রকার ফাংগাস দিয়ে হয়ে থাকে,

ট্রাইকোপাইটন মূলত পরিবেশে মাটিতে থাকে, এবং আক্রান্ত হস্টে থাকে, মাটি থেকে এইটা পায়ে এসে পা কে আক্রান্ত করে, খালি পায়ে যারা হাঁটে, তাদের আক্রান্ত হবার সম্ভাবনা অনেক বেশি।

পায়ের_কোথায়_বেশি_হয়?

পায়ের আংগুলের চিপায় বেশি হয়, বৃদ্ধাঙ্গুলীর চিপায়, পায়ের তালুতে, এবং পায়ের অন্যান্য আঙ্গুলের উপরিভাগে,

চিপায় বেশি হয়,, আদ্র পরিবেশে ঝুকি বেড়ে যায়,

নখের মধ্যেও হয়।

উপসর্গঃ

আংগুলের চিপায় লাল হয়ে ক্ষত হয় যায়, প্রচুর চুলকাতে ইচ্ছা হয়, অনেক বেড়ে গেলে ব্যাথা হয়, আংগুলের উপরিভাগে হলে তা মোটা হয় যায়, scaly lesion দেখা যায়,

শরিরের অন্যান্য জায়গায় ring worm infection হলে যেমন

গোলাকার লেশন হয়, টিনিয়ে পেডিসের ক্ষেত্রে সেইরকম হয়না, চুলকাতে চুলকাতে লাল হয়ে পানি বের হয়ে যেতে পারে। এবং চিকিৎসা না করালে সেকেন্ডারি ইনফেকশন ডেভেলপ করে। একজিমার সাথে কনফিউজড হওয়া যাবেনা, একজিমা অধিকাংশ সময় দুই পায়েই হয়ে থাকে।

ফাংগাল ইনফেকশন একটু ব্যতিক্রম। আবার অনেকের ক্ষেত্রে জুতা দিয়ে কন্টাক্ট ডার্মাটাইটিস হবার পরে সেইখানে ফাংগাল ইনফেকশন হয়.

আংগুলের চিপায় হলে তাকে Inter digital tinea pedis বলে।

প্রতিরোধ ঃ

পরিষ্কার পরিচ্ছন্ন থাকতে হবে, খালি পায়ে না হাঁটা,

একবার টিনিয়া পেডিস হলে দ্রুত চিকিৎসা নেওয়া।

নিচে টিনিয়া পেডিসের কিছু ছবি দেওয়া হলো।

চিকিৎসা ঃ Topical antifungal cream :

Terbenafine cream commonly used

Cream 1:-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations.).

Indications of Cream :-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations).

Xfin tablet: This tablet is indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium).

Xfin granules: This is indicated in Tinea Capitis.

Xfin cream: Fungal infection of the skin caused by Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum. Yeast infections of the skin, principally those caused by the genus Candida (e.g. C. albicans). Pityriasis (tinea) versicolor due to Pityrosporum orbicular (also known as Malassezia furfur).

Xfin 1% Spray: This spray is indicated in the treatment of tinea infections of the skin. This spray is also indicated in the treatment of pityriasis (tinea) versicolor due to Malassezia furfur.

Pharmacology of Cream :-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations).

Terbinafine, an Allylamine antifungal, inhibits biosynthesis of Ergosterol (an essential component of fungai cell membrane) via inhibition of Squalene Epoxidase enzyme. This results in fungal cell death primarily due to the increased membrane permeability mediated by the accumulation of high concentrations of Squalene but not due to Ergosterol deficiency. Depending on the concentration of the drug and the fungal species test in vitro, Terbinafine hydrochloride may be fungicidal. However, the clinical significance of in vitro data is unknown. Terbinafine has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections: Tricophyton Mentagrophyte, Trichophyton Rubrum.

Dosage & Administration

Terbinafine tablet:

For the treatment of fingernail onychomycosis: Terbinafine 250 mg (one tablet), once daily for 6 weeks.
For the treatment of toenail onychomycosis: Terbinafine 250 mg (one tablet), once daily for 12 weeks.
The optimal clinical effect is seen some months after mycological cure and cessation of treatment. This is related to the period required for the outgrowth of healthy nail.

Terbinafine granules:

Body Weight: <25 kg: 125 mg/day up to 6 weeks
Body Weight: 25-35 kg: 187.5 mg/day up to 6 weeks
Body Weight: >35 kg: 250 mg/day up to 6 weeks

Terbinafine cream: Terbinafine cream can be applied once or twice daily. Cleanse and dry the affected areas thoroughly before application of the terbinafine cream. Apply the cream to the affected skin and the surrounding area in a thin layer and rub in lightly. In the case of intertriginous infections (submammary, interdigital, intergluteal, inguinal) the application may be covered with a gauze strip, especially at night. The likely durations of treatment are as follows:

Tinea corporis, cruris: 1 to 2 weeks
Tinea pedis: 1 week
Cutaneous candidiasis: 2 weeks
Pityriasis versicolor: 2 weeks

Relief of the clinical symptoms usually occurs within a few days. Irregular use or premature discontinuation of treatment carries the risk of recurrence. If there are no signs of improvement after two weeks, the diagnosis should be verified.

Terbinafine 1% Spray: This spray is applied once or twice daily, depending on the indication. The affected areas should be cleansed and dried thoroughly before application of this spray. A sufficient amount of solution should be applied to wet the treatment area(s) thoroughly.

Tinea pedis: once a day,1 week
Tinea corporis/cruris: once a day,1 week
Pityriasis versicolor: twice a day, 1 week

Relief of clinical symptoms usually occurs within a few days. If there are no signs of improvement after two weeks the diagnosis should be verified.

Side Effects of Cream :-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations).

The adverse events reported encompass gastrointestinal symptoms (including diarrhea, dyspepsia and abdominal pain), liver test abnormalities, rashes, urticaria, pruritus, and taste disturbances. In general, the adverse events were mild, transient, and did not lead to discontinuation. Adverse events, based on worldwide experience with terbinafine use, include: idiosyncratic and symptomatic hepatic injury and more rarely, cases of liver failure, some leading to death or liver transplant, serious skin reactions, severe neutropenia, thrombocytopenia, angioedema and allergic reactions (including anaphylaxis). Other adverse reactions that have been reported include malaise, fatigue, vomiting, arthralgia, myalgia, and hair loss.

Pregnancy & Lactation of Cream :-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations).

Terbinafine tablet: There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, and because treatment of onychomycosis can be postponed until after pregnancy is completed, it is recommended that terbinafine not be initiated during pregnancy. After oral administration, terbinafine is present in the breast milk of nursing mothers. Treatment with terbinafine is not recommended in nursing mothers.

Terbinafine cream: Foetal toxicity and fertility studies in animals suggest no adverse effects. There is no clinical experience with terbinafine in pregnant women; therefore, unless the potential benefits outweigh any potential risk, terbinafine should not be administered. Terbinafine is excreted in breast milk and therefore mothers should not receive terbinafine treatment whilst breast-feeding.

Therapeutic Class of Cream :-Xfin 1% 10gm tube (As a Terbinafine Hydrochloride AS A Other Antifungal preparations, Topical Antifungal preparations).

Other Antifungal preparations, Topical Antifungal preparations

OR Any one ointment can be used.

Luliconazole, new anti fungal but highly effective in Tinea pedis.

Cream 2.Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Indications of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Lucazol cream is indicated for the topical treatment of interdigital tinea pedis, tinea cruris and tinea corporis caused by the organisms Trichophyton rubrum and Epidermophyton floccosum.

Pharmacology of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Luliconazole is a topical antifungal agent. It is a broad-spectrum antifungal agent that belongs to the azole group. It acts against fungus by inhibiting the enzyme lanosterol demethylase and blocks ergosterol synthesis which is an important constituent of fungal cell membrane. Thus it exerts strong fungicidal activity both in-vitro and in-vivo against dermatophytes, Candida albicans, Malassezia spp, Trichophyton and Epidermophyton spp.

Dosage & Administration of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Adult & Geriatric:

Interdigital tinea pedis: Luliconazole cream should be applied to the affected area and approximately 1 inch of the immediate surrounding area(s) once daily for two weeks.
Tinea cruris and Tinea corporis: Luliconazole cream should be applied to the affected area and approximately 1 inch of the immediate surrounding area(s) once daily for one week.

Pediatric: Safety and effectiveness have not been established.

Side Effects of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Contact dermatitis and cellulitis may occur. Application site reactions were observed in iess than 1% of subjects in clinical trial.

Pregnancy & Lactation of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

There are no adequate and well-controlled studies of Luliconazole cream in pregnant women. Luliconazole cream should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Luliconazole is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Luliconazole cream is applied to women who are breastfeeding.

Therapeutic Class of Cream:-Lucazol 1% 20gm tube (AS A Luliconazole AS A Miscellaneous topical agents).

Miscellaneous topical agents

severe case: Oral antifungal Terbenafine for upto 6 week…

Tablet3:Elvina 250 mg (As a Terbinafine Hydrochloride As a Other Antifungal preparations, Topical Antifungal preparations)

General Quaries:-

1.Dyshydrotic eczema & tinea manuum এর মধ্যে পার্থক্য কিভাবে করব?

Answer is:- দুইটাই কাছাকাছি, খুবই confused করে,

তবে একজিমা শুরু হয় Tiny blister with excessive itching নিয়ে, Top of foot commonly involved হয়, bilateral hoy,

Finger web rarely,,

But Tinea তে bottom of feet commonly involved hoy, cracked হয়ে যায়, Great toe and 4th and 5th toe involved hoy beshi, great toe involvedment one of diagnostic criteria

Raiyyan Tahsan Date:20-01-2025 Monday Time:-10-28-45 Pm

Raiyyan Tahsan

Raiyyan Tahsan