Chaya, a young lady, consulted a gynaecologist for a infection in the groin. A corticosteroid ointment (Betnoyate) was prescribed. She did not get any significant relief and returned to hospital after a week. She was asked to continue the same treatment. However, to her good luck, she met a skin specialist who listened to her carefully and collected a scraping from the affected area for microscopic examination. He confirmed the diagnosis as fungal infection (candida) and prescribed the proper medicine which cured her. Very often we buy an ointment or use one lying at home for skin infection. It would be wiser to consult a skin specialist rather than trying self­medication.

Fungal infection, ringworm, and moniliasis, technically called dermatophytosis, may involve any part of the body. In the head it spreads through the barber's instruments, hair brushes, and combs, causing a patchy hair loss. The patient may smell a peculiar odour called a 'mousy' odour. In the skin it starts as a papule which spreads around leaving a central coin­shaped clear area. Another characteristic feature of these fungal infections is an itching sensation.

Griseofulvin (Girfungin-P, Grisovin-FP, Walavin-FP)

This drug is used for treating ringworm infection. It is available as tablets of 125 mg. The total daily dose is 500 mg. The effect starts slowly and if toes and nails are involved, it takes a few months before significant benefits are seen.

Adverse Effects: It is a relatively safe drug. Some patients may complain of headache and gastric upsets. It is also known to cause photosensitivity reactions (allergy to sunlight).

Precoutions

Always take this drug with a fatty meal to allow maximum absorption.

If photosensitivity develops, a doctor must be consulted.

Avoid alcohol as it may cause palpitation and flushing.

Ketoconazole (Ketozole, Phytoral, Nizral), Fluconazole (Syscan)

These have been introduced recently for treatment of fungal disorders. The spectrum of action is wider, that is, these are effective in rignworm, candida, and other fungal infection. The duration of treatment is, considerable, varying from a few days to weeks. Ketoconazole is available as tablet (200 mg) for oral use in a dose of 200 mg once or twice a day for 1-2 weeks or longer. Other topical preparations available are 2% cream, solution, shampoo and ointment. A multi-ingredient shampoo contains ketoconazole 2%, zinc pyrithione 1 % and is commonly recommended for dandruff and seborrheic dermatitis. Fluconazole is used in a dose of 100 to 200 mg/day for 2 weeks (candid infections) to one month (esophageal candida infection). Ketoconazole or Fluconazole is given in a dose of 3 to 6 mg/kg once a day to children.

Miconazole (Darktarin, Zole), Clotrimazole (Mycocid)

These preparations are applied locally in the form of a lotion or ointment and are very effective in controlling most fungal infections.