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close this bookClinical Guidelines and Treatment Manual (Médecins Sans Frontières, 1993)
close this folderChapter 4 - Skin conditions
View the document(introductory text...)
View the documentDermatology
View the documentImpetigo and other purulent dermatoses
View the documentHerpes simplex, Herpes zoster
View the documentScabies
View the documentLeg ulcer
View the documentFungal infection
View the documentAnthrax
View the documentOther skin conditions
View the documentEndemic syphilis, Yaws & Pinta
View the documentLeprosy

Fungal infection

Infant's thrush

Clinical features

Erythema of the buttocks and perineum, sometimes "weeping". Caused by infection with Candida albicans.

Treatment (dispensary)

- Clean with usual soap or an antiseptic (chloramine or chlorhexidine-cetrimide; preparation: see table 25).

- Apply gentian violet solution twice daily.

- Avoid damp clothing (leave buttocks bare).

- Intestinal thrush often co-exists:
Nystatin (PO): 4-600,000 IU/d divided in 3 doses x 10 days (vaginal tabs might be used for this purpose)

Dermatoses

Highly contagious fungal infections. Prevalence is associated with the level of personal hygiene.

Clinical features

BODY

There are several different forms:

- "Ringworm"

- Pityriasis versicolor with depigmented patches.

- Erythematous lesions in the skin folds (e.g. axillae and groin).

HEAD

Associated with loss of hair. Highly contagious in families.

Treatment

BODY (dispensary)

- Wash, dry and then apply whitfield's ointment twice a day.

- Use griseofulvin only in extensive cases (see below).

HEAD (dispensary)

- Cut hair and then shave the head.

- Wash, dry and then apply gentian violet twice a day for several weeks.

- If treatment fails use:
griseofulvin (PO)
Adult: 500 mg to 1 g/d divided in 3 doses
Child: 10 mg/kg/d divided in 3 doses
Treat for 10 days (sometimes treatment has to be continued for 1 month).

- Examine all the family.

- A short course of griseofulvin may be effective for adults:
griseofulvin: 1.5 g taken at the same time as a greasy meal.
However, there is a risk of digestive problems and vertigo.