From the Guidelines
The patient's treatment plan should be revised to address the skin tags, fungal infection, and ankle pain effectively, prioritizing evidence-based treatments that minimize morbidity, mortality, and improve quality of life. The treatment plan for this 42-year-old male prison patient includes several components. For the skin tags exacerbated by sun exposure, Miconazole 2% has been prescribed for three months, which is not the most appropriate treatment for skin tags, as they are typically removed physically rather than treated with antifungal medication 1.
Fungal Infection Treatment
For the fungal infection present on his fingernails and toenails, Fluconazole 450 mg per week for at least 6 months may be a useful alternative in patients unable to tolerate terbinafine or itraconazole 1.
Ankle Pain Management
For the left ankle pain, despite showing full range of motion and no inflammation, the patient will receive ibuprofen 400 mg three times daily as needed, along with an ice bandage and medical ice for symptomatic relief. The anti-inflammatory properties of ibuprofen will help reduce any underlying inflammation not visible on examination, while the ice will help with pain management.
Laboratory Tests
Additionally, liver and kidney function panels have been ordered to ensure the patient's organ function is normal before continuing with medication, which is appropriate standard practice, especially in a correctional setting where medical histories may be incomplete 1.
Considerations
It is essential to consider the patient's overall health, potential drug interactions, and the need for monitoring, particularly for high-risk patients, when managing onychomycosis and other conditions 1.
Treatment Adjustments
Adjusting the treatment plan to include evidence-based therapies, such as fluconazole for the fungal infection, and reconsidering the treatment for skin tags, will help improve the patient's quality of life and reduce morbidity.
From the Research
Patient Assessment and Treatment
- The patient presents with skin tags exacerbated by sun exposure, fungal infection on fingernails and toenails, and pain in the left ankle.
- The treatment plan includes Miconazole 2% for three months for the skin tags and fungal infection, and ibuprofen 400 mg TIDPRN, an ice bandage, and medical ice for the ankle pain.
- Laboratory tests, such as liver panel and kidney function panel labs, are prescribed to monitor the patient's condition.
Antifungal Treatment and Hepatotoxicity
- Miconazole is an imidazole antifungal drug that has been shown to be effective in treating systemic fungal infections 2.
- However, antifungal agents, including Miconazole, can cause hepatotoxicity, ranging from mild and asymptomatic abnormalities in liver function tests to substantial liver injury and fulminant hepatic failure 3, 4.
- The risk of developing antifungal-associated hepatotoxicity is multifactorial and can be influenced by pre-existing liver disease, patient demographics, comorbidities, and drug-drug interactions.
Monitoring and Management
- It is essential to monitor the patient's liver function tests and adjust the treatment plan as needed to minimize the risk of hepatotoxicity.
- The patient's kidney function should also be monitored, as some antifungal agents can affect kidney function 5.
- Early detection of liver injury and intervention can help mitigate liver damage and ensure the safe use of antifungal agents.