[NP-Clinical] help from derm experts

[Andy Craig]

"Me too"!  that sounds like a Powerpoint I'd like to see!
 
And while we're tapping your brain, what do you think about this: I have a
couple of patients who have minimal onchomycotic-appearing changes in 1
toenail only. I'm leery about rx oral antifungals for just one nail,
especially if they are older or on lots of other meds.  I hear that the
topical (Penlac) doesn't work well, though I haven't seen it being used long
enough on enough patients to form an opinion of my own yet. So--what do you
think about surgical removal of the one affected toenail, with or without a
short burst (2-4 weeks?) of oral ketoconazole?  I typically use 200 to 400
mg daily.  It's what we have here at our pharmacy and it's cheap.  Your
thoughts?
 
Andy Craig, NP
Charlotte, NC

-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Theodore Scott
Sent: Friday, May 11, 2007 1:48 AM
To: 'NP Clinical'
Subject: RE: [NP-Clinical] help from derm experts



Well the easiest way to think of the most common pathogens we see is to
classify them into three groups based on shape when you do the KOH prep.

Hyphae, the long thin branching forms, are usually dermatophytes, typically
seen in Tinea pedis, cruris, or corporis. Budding yeast forms are usually
Candida and this can be found in thrush, vaginitis, intertrigo etc.  When
you have Hyphae and spores "Spaghetti and Meatballs", you are looking at
Pityrosporum ovale aka Malassezia furfur which causes Tinea versicolor and
probably seborrheic dermatitis.  If you have a large inbox I can sen you a
POWERPoint I presented to our NP/PA group on the subject (about 4 MB).  

 

Ted Scott NP-C

 

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