Page 68 - Retail Pharmacy Assistants - October 2020

66 ANTIFUNGAL FROM PAGE 65 Candida albicans, the most common fungal biofilm found in hospitals, isn’t easy to treat. One study looked at the effectiveness of a group of antifungals (including prescription antifungals such as Nystatin and Diflucan) against Candida biofilms. Researchers found that although the antifungals were effective against Candida initially, they became less effective as the biofilm developed. After 72 hours of biofilm development, the “C. albicans cells were highly resistant”, leading them to conclude that “drug resistance develops over time, coincident with biofilm maturation”. Mr Webster points to a study showing that glucose makes up a third of biofilms, which is of interest in that it means Candida needs sugar to develop and reproduce as well as make biofilms. He adds that science and medicine are also revealing that almost all people who suffer from chronic or systemic Candida have high mercury levels. “Candida is prone to accumulate mercury, which can dampen the immune system and inhibit it from being removed,” Mr Webster said. “Doctors specialising in Candida treatment have reported that they discovered clinically that 98 per cent of their patients with chronic Candida also had mercury toxicity.” Dr John Trowbridge in his book The Yeast Syndrome writes that a person will never get rid of their Candida as long as they have high mercury levels. Michael Biamonte, of the Biamonte Centre for Clinical Nutrition in New York, tested the mercury levels in his patients, who experienced various illnesses. His tests revealed that 84 per cent of his patients with Candida had elevated mercury levels and that these were 60 per cent higher than normal. “The studies are interesting and valuable for pharmacists to keep abreast of, but in the final analysis, Candida and IBS are difficult to diagnose in the pharmacy setting, and hence we’re told to refer patients to their GPs,” he said. “I have access to tests, though, that can provide some indication of what’s going on, and as per usual, it’s so important that pharmacists take time to get information on the patient’s history and what disruptions to the bowel they’re experiencing.” ATHLETE’S FOOT PREDOMINATES WHEN IT COMES TO SUPERFICIAL DERMATOMYCOSES Pharmacies commonly encounter patients with superficial dermatomycoses, commonly known as fungal skin infections. The medical name for infection with tinea depends on which area of the body is affected. For example, if the foot is affected with tinea, it’s called tinea pedis, or athlete’s foot; a tinea infection in the groin area is referred to as tinea cruis, or ‘jock itch’; ringworm of the body is referred to tinea corporis; and ringworm of the scalp is referred to as tinea capitis. Of the fungal skin infections, tinea pedis is especially prominent, with patients often presenting with itchy and scaly feet. Dermatologist Associate Professor Alvin Chong, Director of Education at the Skin & Cancer Foundation, says that people easily pick up fungal infections of the foot through exposure at public pools or gyms. Here, tinea organisms infect the feet by finding blisters or cracks in the skin between the toes, making foot care and keeping the skin on feet intact helpful in preventing a tinea infection. Wearing clean, sterilised cotton socks and steering clear of tight shoes are also well known to help keep feet dry. Dr Chong says that pharmacists can treat patients with tinea pedis with a topical antifungal such as miconazole or terbinafine cream once or twice a day for a couple of weeks. Dr Fabrizio Spada, PhD, Scientific Affairs Manager at Ego Pharmaceuticals, says compliance is a key to increasing the success rate of treatment. “Tebinafine Hydrachloride, the active ingredient in our SolvEasy Tinea range, actually remains in the skin and continues to fight infection for more than seven days after application ceases, and in most cases only needs application for one week,” Dr Spada tells Retail Pharmacy Assistants. “The spray format further increases the ease of application, increasing the chances that it is applied every day as necessary.” Dr Chong advises pharmacists to keep an eye out for tinea pedis when it’s not just in the skin but the nails as well, as an infected nail can act as a reservoir of fungus and a source of recurrent fungal infections. This necessitates that pharmacists examine the infected nails carefully because if there is evidence of a fungal infection the patient will require an oral antifungal treatment such as terbinafine for a few months. He also advises pharmacists to be aware that not “every red and scaly thing” is a fungal infection or eczema. RETAIL PHARMACY ASSISTANTS • OCT 2020