30.04.2019

Serie English for PTA: Antimycotic Medicines

von Jane Funke and Hannelore Gießen

Antifungals-- Fungal infections are very common. They can affect various organs and are triggered by several kinds of fungi. The most widespread infections of this kind include athlete’s foot and vaginal thrush.

© Getty Images/iStockphoto

Originalartikel als PDF

About one third of the adults in this country suffer from mycosis of the foot. In most cases, infection is caused by a dermatophyte species that affects the toes and the areas in between. More pronounced, infection spreads to the soles of the feet.

The symptoms are often noticeable between the toes where the infection usually starts before moving onto the heels and soles of the feet. Symptoms include sweating, itching, burning and redness. If left untreated, the infection may cause blistering , peeling, cracking of the skin, bleeding and foot odour .

Fungal infections thrive in a warm moist environment and are more likely to develop in areas that already have skin maceration. Infection spreads by direct contact with contaminated items such as damp towels, wooden benches or shared changing rooms.

Various Antimycotic Medicines

Generally interdigital and blistering forms of foot mycosis can be treated with topical antimycotics, in particular several azole derivatives, e.g. bifonazole or miconazole and allylamines, e.g. terbinafine or naftifine. The available substances differ in their properties: azoles should be applied twice daily for four weeks and an allylamine should be used once a day for one week. The latter is much more practical for patients who don’t have much time and ask for short term medication. There is even a product in liquid form on the market that coats the skin with a superficial film so that one application is sufficient.

Moreover, treatment should be continued even after symptoms have vanished and the skin has recovered, so that the risk of a relapse can be reduced. Due to the fact that a range of topical antimycotics are available without a prescription, the advisory function of the pharmaceutical team is extremely important.

Fungal Nail Infection

Untreated, athlete’s foot can also lead to fungal toenail infec- tions. Onychomycosis is one of the most common dermatological infections and its incidence is increasing. It can be recognized by discolouring and deformation of the nails.

To treat onychomycosis successfully, a lot of patience is required. Even in moderate cases it takes several months to cure; in severe cases one year or more. Self-medication is only advisable if the fungus has not yet affected the root of the nail. Then usually a nail polish containing an antimycotic is applied, e.g. ciclopirox or amorolfine. In severe cases additional systemic medica- tion is unavoidable.

Vaginal Thrush

The other widespread fungal infection that is a regular topic in pharmacies too, is thrush. It is a common yeast infection that affects both men and women but is much more common in women. It’s usually harmless but it can be very uncomfortable and keep coming back. Vaginal thrush is medically referred to as a vulvovaginal candidiasis caused by Candida albicans. This yeast is normally kept under control by harmless bacteria but some- times conditions change and the yeast increases rapidly.

The symptoms include a white discharge , itching and irritation around the vagina, soreness and stinging during sex or when going to the toilet. Women can deal with this trouble alone but only if they recognize the symptoms from a previous occurrence that was diagnosed by a doctor. In these cases, and provided that the symptoms are mild, a short course of antifungal medicine – usually for one to three days – is recommended. A variety of treatment options are available including vaginal suppositories and creams, both of which act equally well.

Vocabulary

English

Deutsch

athlete’s foot

Fußpilz

thrush

Soor

blistering

Blasenbildung

foot odour

Fußgeruch

superficial

oberflächlich

toenail

Fußnagel

yeast

Hefe

discharge

hier: Ausfluss

soreness

Schmerzhaftigkeit

stinging

Brennen

to douche

spülen

fold

Falte

pregnant

schwanger

mucosa

Schleimhaut

tight

eng

furthermore

außerdem, darüber hinaus

Dialogue

Customer: Good afternoon, I’m fairly sure that I have a yeast infection. Can I try some over-the counter medication to see if my symptoms will disappear?

PTA: What are your symptoms?

Customer: A lot of uncomfortable itching and soreness and a thick white discharge that looks like cottage cheese.

PTA: Is there a fishy smell, too?

Customer: No, why?

PTA: Because that is a typical symptom of bacterial vaginosis and not a yeast infection.

Customer: Well, I douche regularly in any case.

PTA: Frequent douching is not a good idea as it changes the acidity levels of the vagina and the balance of the organisms that live in it. You should only wash the outer folds of the vulva with warm water. Have you had a yeast infection before?

Customer: Yes, a couple of times but over a number of years. The last time was after a course of antibiotics in 2015. The symptoms were quite similar.

PTA: Most women are affected at least once at some point in their lives. So, you aren’t taking any medication at the moment?

Customer: That’s right.

PTA: What about the anti-baby pill?

Customer: No. In fact, I could be pregnant .

PTA: Ah, now that makes a difference. Pregnancy can also change the balance of vaginal mucosa which creates a higher risk of developing a yeast infection. In this case, it is better if you consult your doctor first.

Customer: Can a yeast infection damage the embryo?

PTA: No, but some treatments are not recommended during pregnancy. We should also make sure that it is a yeast infection and that everything else is okay.

Customer: And what about my partner? Is he at risk too?

PTA: These problems are much less frequent in men. If your partner develops redness or itching at the tip of the penis, he may need to be treated.

Customer: So, what can I do until I get an appointment with my gynaecologist? Should I eat a lot of yoghurt? I’ve heard that helps.

PTA: Well, it can’t hurt but there is no scientific evidence that it helps either. Make sure that you wear cotton panties – no synthetics – and they should not be too tight . The same applies to jeans and pantyhose. Make sure they sit comfortably.

Customer: Why is cotton better?

PTA: It keeps the body cooler and doesn’t trap sweat like synthetic material does. Cotton is permeable to air which is important. Furthermore , if underwear is too tight, the skin surfaces are damaged and unfriendly yeast organisms are more likely to get out of control.

Customer: Thank you very much. I’ll be back as soon as I get my prescription.

PTA: You’re welcome. Have a good day.


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