Treatments for Skin, Nail and Hair Infections

Athletes foot

• General advice as posted in the Prevention section
• Topical antifungal creams once or twice a day for 2-4 weeks. Continue for at least 2 weeks after clearing and intermittently thereafter.
• Anti-sweating treatment may be of value to those who sweat a great deal (e.g., Drysol® )
• Topical corticosteroid should only be used if there is a fast secondary eczematous (eczema-like) reaction, and used only in combination with the topical antifungal preparation.
• Systemic therapy should be considered if the athletes foot infection features:

-   If your toe nails are also involved
-   If its severe Moccasin type (fine scales on the soles of your feet with some redness)
-   If you do not respond to topical therapy

Jock itch (groin infection)

• General advice as posted in the Prevention section
• Topical antifungal cream is usually sufficient. Apply on the affected area and 4-6 cm on the surrounding skin
• Use for 2 weeks after the rash has gone
• Also treat your feet if there is evidence of fungus infection
• If the infection spreads to the buttocks and/or abdomen, topical applications may prove difficult; consider oral antifungal drugs instead

Ringworm (skin infection)

• Localized infection
• Topical antifungal cream is usually sufficient. Apply on the affected area and 4-6 cm on the surrounding skin
• Use for 2 weeks after the rash has gone
• If the infection is extensive, and therefore makes topical applications difficult, oral antifungal drugs may be the best method
• If fungal culture indicates that the fungus is animal in origin, a veterinarian should be consulted

Nail infection

• If your nail changes are asymptomatic (you have no symptoms), you may decide against treatment after weighing the risks. In the past prolonged oral treatment was the only option. For early nail fungal infection a new penetrating antifungal lacquer has provided another alternative with no risk of systemic side effects.
• Patients who have diabetes or peripheral vascular disease may be at increased risk of developing complications such as secondary bacterial skin infections from having persistent nail or skin fungal infection
• Terbinafine is the oral treatment of choice. For the toenails a minimum of 3 months treatment is required, whereas 6 weeks may do for the fingernails. Severe liver reactions have been observed rarely with this drug. It is recommended that LFTs be measured before and one month into treatment. This drug can also alter your ability to taste.
• Itraconazole is an alternative drug that can be used. It is effective if there is Candida or in the immunosuppressed patient with non-dermatphyte infection such as Aspergillus. Care must be taken with this drug in those at risk of heart failure, or in the elderly who are on negative inotropic drugs. Liver function tests are recommended if there is a history of liver disease or for treatment periods longer then 1 month . This drug can be taken daily for 1 week out of every month for 3 to 4 cycles.
• Ciclopirox Nail Lacquer is a useful product in treating early nail fungus infection. It avoids the risks of oral medication, it is useful when the infection is limited to part of the nail, as well as for the superficial type of infection showing white nail changes. It has also been useful for treatment of chronic paronychia which causes the skin around the nail to become red and mushy, and can give the nail a green tinge

Scalp infection

• If your child has a scalp infection, there is no need to stay away from school once they have started treatment
• Shampoos containing antifungal ingredients such as Ketoconazole may be helpful in reducing risk of spreading infection.
• Griseofulvin orally is recommended. Treatment is usually for 8-10 weeks. Adult doses are usually used in those older than 12 years. Griseofulvin is contraindicated in pregnancy and men should not father a child for 6 months. It may also reduce the efficacy of the birth control pill.
• Terbinafine is an alternative but this is an "off-label" use.
• A culture should be repeated after 3 months to see if further treatment required.