THRUSH

 

Introduction

 

Thrush is caused by a yeast-like fungus called Candida, one of many organisms that live in the mouth, vagina and bowel. These organisms are harmless until something upsets their normal balance. If this occurs and conditions are right, Candida multiplies and can cause thrush symptoms.

 

The most common types of thrush are oral and vaginal. However having one type of thrush does not mean you will get the others.

 

It is difficult to say with certainly the frequency of Candidal infection in community. However there are times during life when it is more likely to occur. This includes child hood, pregnancy and the elderly. The frequency is higher amongst diabetics than in others. It is also higher in women on the oral contraceptive than in those who are not.

 

Signs and Symptoms

 

The Symptoms associated with candidal infection are variable and related to the area affected and the underlying pre-disposing factors. However in general, candidal infection creates a red glazed or shiny appearance when affecting the moist folds of the skin.

 

The different clinical presentation includes:

 

Candidal Intertrigo (thrush on the skin)

 

This condition can occur in any of the warm moist folds of skin. This includes the inguinal region, axillary region, and submammary region in women, perianal region and inter-digital region of trends.

 

Appears as a shiny red rash, with spot or scaly patches around the edges; skin may become raw and bleed. It may be burning, sore and sometime itchy.

 

 

Oral Candidiasis

 

Oral Candidiasis has many clinical presentations. It presents as multiple, with adherent small plaques on the mucosa, tongue, cheeks, throat and gums.

Red, slightly bleeding areas if these patches are picked or scratched. Sore mouth, particularly on eating. Predisposing factors include immune suppression, corticosteroids and oral antibiotics and dentures.

 

Genital Candidiasis (vaginal candidiasis)

 

Candida infection in the vagina is itchy and may be associated with a whitish vaginal discharge and adherent white plaques on the mucosa, burning around outside of the vagina when passing urine, pain or discomfort during intercourse and swelling at the opening of the vagina.

Vaginal candidiasis is often precipitated by the use of systemic antibiotic and oral contraceptive. Candidiasis can also occur in uncircumcised males under the foreskin.

 

Chronic Paronychia (Nail Infection)

Candidal infection of the nail fold occurs in people whose hands are constantly exposed to water. It causes drying, splitting and then eventual loss of the cuticle. It exposes the nail matrix to water, detergents and other irritates. It is relatively asymptomatic, but may be painful on occasion, associated with extensive inflammation in the nail matrix.

 

The nature of candidiasis depends on the associated risk factors. If these are not dealt with adequately, then candidiasis can become a chronic infection.

 

Diabetes, obesity, underlying inflammatory skin disease, chronic exposure to wet work and oral antibiotics are all important risk factors.

 

 

 

 

 Conclusion

 

It is very important to counter prescribe the right medication for the right condition.

We in the pharmacy must advise the patient on the best treatment available to treat the fungal infection. This may involve referring them to our Pharmacist or GP. As Pharmacy assistance it is important to recognize the common symptoms and being abler to give the appropriate advise as well as right products to our customers.  

  

Treatment

 

Where the underlying pre disposing factors are dealt with adequately, Candida will resolve satisfactorily in most people.

These include, particularly reducing warmth and moisture in folds of skin, eg, for the hands using cotton lined protective gloves where wet work is necessary, and for the body flexures the use of cotton underwear is of value as it keeps the skin folds separated as much as possible.

 

 

Over the counter list

·        Clotrimazole 1% cream, lotion (Canesten cream, lotion)

·        Econazole 1% (Pevaryl 1% cream, liquid)

·        Ketoconazol 2% (Daktagold cream, Nizoral cream and shampoo)

·        Daktozin (Ketoconazol plus zinc oxide)

·        Miconazole 2% (Daktarin cream, lotion, powder)

 

 

All of the listed treatment work in a very similar manner and interfere with fungal growth.

 

Dosage: applied sparingly to the affected area twice a day.

Regular application is essential for successful treatment. It is also important to remind the customers to complete the full treatment course (10-14 days) even if signs of infection have gone.

 

 

Additional advice:

Oral thrush

·        Brush your teeth thoroughly after meals.

·        Some mouthwashes can help.

·        If you wear dentures, clean them well with a brush. Ask your dentist to check their fit.

·        If you use a steroid asthma “preventer” inhaler, rinse your mouth with water after using it.

·        Stop smoking.

Vaginal Thrush

·        Wear loose fitting cotton underwear.

·        Dry your vaginal area well after showers, baths, swimming etc.

·        After going to the toilet, wipe your bottom from front to back using a clean piece of toilet paper each time.

·        Blot rather than wipe with toilet paper when your vagina is sore.

·        You may relieve the symptoms by bathing the area using one teaspoon of salt in a litre of warm water or 20ml of vinegar or lemon juice in a liter of water.

·        Resist sexual intercourse while you have vaginal thrush.

·        Avoid using laundry detergents and fabric softeners that may irritate the area. Soap, deodorants and other perfumed products may also irritate.

Thrush on the skin

·        Wear clothing made of natural fibres, like cotton.

·        Dry skin well after washing.

·        Use a barrier cream or a prickly heat powder to reduce wetness and irritation.

Other core recommended produces     

·        Ego resolve cream (used twice a day for period of 2 weeks)

·        Ego Pinetarsol (can be used to temporary relief the itchy and inflamed skin) and the can be applied as needed especially after bathing and showering.

·        Inner Health (used especially after antibiotics therapy and can be used 1 capsule daily)

·        Bioresearch CND

Important Questions

·        Taking any other medicines?

·        Diabetics?

·        Are you pregnant or breast-feeding?

·        Do you have any Pelvic or lower back pain?

·        Have you had more than two attacks in the last six months?

·        Age (be concern about age less than 16 and over 60)?

·        Is it the first infection?

 

If answer to any of the above question is YES it is best to refer the customer to the Pharmacist or GP.