Common fungal infections of the feet in patients with diabetes mellitus.
Drug Interactions; Clinical Trials; Administration; Topical; Oral; Foot Diseases – Diagnosis; Antifungal Agents – Therapeutic Use; Antifungal Agents – Administration and Dosage; Diabetes Mellitus – Complications; Antifungal Agents – Adverse Effects; Antifungal Agents – Pharmacokinetics; Foot Diseases – Classification; Foot Diseases – Drug Therapy; Foot Diseases – Epidemiology; Foot Diseases – Etiology; Foot Diseases – Microbiology; Foot Diseases – Symptoms; Mycoses – Classification; Mycoses – Diagnosis; Mycoses – Drug Therapy; Mycoses – Epidemiology; Mycoses – Etiology; Mycoses – Microbiology; Mycoses – Symptoms
Superficial fungal infections of the foot (tinea pedis and onychomycosis) are common among elderly patients. Although most authorities believe that patients with diabetes mellitus have an increased predisposition to dermatophytic infections, some controversies still remain. Because these infections disrupt the skin integrity and provide an avenue for bacterial superinfection, elderly diabetic patients with dermatophytic infection should be promptly treated with an antifungal agent. For most dermatophytic infections of the foot, topical agents are usually effective and less expensive than oral agents. Laboratory diagnosis of fungal infection prior to institution of therapy is recommended. Proper technique for obtaining the specimen is important to ensure a higher chance of isolating the infecting fungus. Commonly used anti-dermatophytic agents that are also active against the yeasts include the imidazoles, the allylamines-benzylamines and the hydroxypyridones, which are also effective against most of the moulds. Oral therapy for tinea pedis, although not well studied, should be limited to patients with more extensive infections, such as vesicobullous and moccasin type, resistant infections or chronic infections. In addition, oral agents should also be considered in diabetic and immunosuppressed patients. On the other hand, treatment of onychomycosis of the foot usually requires systemic therapy. Griseofulvin is the least effective agent when compared with the newer agents. Terbinafine, itraconazole and fluconazole have been shown to have acceptable cure rates. More recently, topical treatment of the nail with 8% ciclopirox nail lacquer, bifonazole with urea and amorolfine have been reported to be successful. Over the past decade, fungal foot infections of the skin and nail are more effectively treated with the introduction of numerous topical and oral agents.
Tan J S; Joseph WS
Drugs & Aging
2004
2004-01-15
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.2165/00002512-200421020-00003" target="_blank" rel="noreferrer noopener">10.2165/00002512-200421020-00003</a>
An update on inflammatory arthropathies including pharmacologic management and preoperative considerations.
*Preoperative Care; Anti-Inflammatory Agents; Antiinflammatory Agents; Arthritis – Diagnosis; Arthritis – Physiopathology; Arthritis – Therapy; Arthritis/diagnosis/physiopathology/*therapy; Diagnosis; Differential; Foot – Physiopathology; Foot Diseases – Diagnosis; Foot Diseases – Therapy; Foot Diseases/diagnosis/*therapy; Foot Joints/physiopathology; Gout – Diagnosis; Gout – Physiopathology; Gout – Therapy; Gout Suppressants – Therapeutic Use; Gout Suppressants/therapeutic use; Gout/diagnosis/physiopathology/*therapy; Humans; Non-Steroidal – Therapeutic Use; Non-Steroidal/therapeutic use; Patient Selection; Physical Examination; Preoperative Care; Synovitis – Diagnosis; Synovitis – Therapy; Synovitis/diagnosis/therapy; Uric Acid – Analysis; Uric Acid/analysis
This article provides an update and overview to the clinical presentations of inflammatory arthropathies. Subtleties to clinical presentations are discussed. Clues are presented which helps the reader arrive at more precise diagnostic labeling. Additionally, pharmacotherapy will be discussed, including precautions in considering the best therapy for the patient with suspected inflammatory, autoimmune, degenerative or neuropathic pain conditions. Finally, preoperative evaluations, management and risks of this patient population are reviewed. Emphasis will be on whether "cardiac clearance" should be requested based on an easy to use algorithm of cardiac risk factors. Finally recommendations based on recent literature of whether immunosuppressants should be withheld preoperatively.
Regule David
Clinics in podiatric medicine and surgery
2010
2010-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.cpm.2009.12.010" target="_blank" rel="noreferrer noopener">10.1016/j.cpm.2009.12.010</a>