Fungal skin infections

Prescribing Notes:

• If intractable dermatophyte skin infection or scalp infection send skin scrapings and if infection confirmed use oral terbinafine or itraconazole. Discuss scalp infection with dermatology.

Prescribing Notes:

• Miconazole 2% cream is recommended for the treatment of breast and nipple thrush in lactating women; apply after every breastfeed for 2 weeks. Continue 10 days after improvement is noted. Any residual cream should be gently wiped off before the next feed.
• Infection can spread easily between mother and infant, therefore mother and infant should be treated simultaneously even if no oral lesions are present. See child formulary recommendations on treatment of oral candidiasis.
• In Lothian, for more information refer to RefHelp or the NHS Lothian intranet guideline: ‘Guidelines for the topical treatment of thrush in the breastfeeding mother’.

Prescribing Notes:

• Dermatophytes are fungal organisms that require keratin for growth. These fungi can cause superficial infections of the hair, skin, and nails; tinea capitis (fungal scalp infection); tinea corporis (ringworm) infection, tinea capitis (scalp), tinea cruris (fungal groin infection), tinea pedis (athlete’s foot), tinea manuum (hands), and onychomycosis (nails).
• Mild localised fungal infections of the skin respond to topical therapy. Systemic therapy is appropriate if topical therapy fails, if many areas are affected, or if the site of infection is difficult to treat such as in infections of the nails (onychomycosis) and of the scalp (tinea capitis). See separate formulary recommendations for fungal nail infections.
• If intractable dermatophyte skin infection or scalp infection send skin scrapings and if infection confirmed use systemic therapy. Discuss scalp infection with dermatology, prompt initiation of systemic treatment is recommended for scalp infection in children. Seek advice from dermatology prior to initiating systemic therapy for other skin infections.
• Tinea capitis is treated systemically; additional topical application of an antifungal may reduce transmission.
• In tinea capitis (scalp) all children in the family should use an antifungal shampoo (ketoconazole 2% shampoo), see Pharmacy First – Scalp disorders.
• Topical undecenoic acid with zinc undecenoate may be used to treat tinea pedis (athlete’s foot). A proprietary preparation is available for sale to the public.
• For management and prescribing information refer to NICE CKS Fungal skin recommendations for body and groin, foot and scalp.

Prescribing Notes:

• For more information refer to NICE CKS: Candida - skin.

Prescribing Notes:

• The licences for OTC terbinafine differ depending on the preparation. All versions are licensed to treat tinea pedis (athlete’s foot) and tinea cruris (Jock itch) and the spray and gel are licensed for tinea corporis (ringworm).
• Refer to individual product literature to advise length of treatment with antifungal creams.
• Patients should be advised on good foot hygiene and measures to prevent reinfection.

When to advise patient to contact GP
Severe or widespread infection of the foot.
Recurrent episodes of infection.
Signs of bacterial infection.
Unresponsive to appropriate treatment.
Diabetic patients.
Immunocompromised patient.