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Hi. What would be an effective TX for fungal infection of the pannus with a partial thickness open area 2.5cmx1cmx0.1cm. I do not have access to interdry. For now i requested nystatin and placed skin. Prep and silver alginate over open area. Thank
Aug 19, 2020 by Melissa Khoo,
6 replies
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Hi Melissa--these cases of panniculitis/fungal infestation can be so challenging! I love interdry but it's more of a convenient maintenance tool. For fulminant intertriginous fungal infestations, lotrisone or a mix of lotrimin/betamethasone tooically twice daily can get things under control, and will usually improve most cutaneous issues associated, including partial thickness skin loss secondary to skin sloughing from maceration. I would recommend twice daily bathing with either dial antibacterial or hibiclens, allow to air dry well (hold pannus and separate from thighs and pubis in front of a fan if possible), apply lotrisone and separate skin folds with a pillow case or sheet if possible. I would not use the lotrisone for more than 7 days (I believe this is per package instructions), sometimes 3-4 can demonstrate significant improvement. I would suggest considering an oral burst of diflucan as well. The patient should use antimocrobial body was or soap to avoid secondary superimposed bacterial infection as well, and keep skin folds separated with pillowcase or cut up cloth material such as T-shirts.
Aug 19, 2020
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
I failed to mention if the patient is has diabetes, glucose control is crucial to staving off persistent fungus.
Aug 19, 2020
That is some great advise. Would nystatin powder be of use?
Aug 19, 2020
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
I failed to mention if the patient is has diabetes, glucose control is crucial to staving off persistent fungus.
Aug 19, 2020
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Unfortunately, nystatin powder is fungistatic at best. It is used so ubiquitously but shouldn't be the mainstay of treatment in acute phases of panniculitis.

I understand many are reluctant to use a cream given fungus thrives in moisture, but most powders do not deliver active ingredients necessary to heal during the acute phase of fungal infestation. I would recommend miconazole powder for maintenance.
Aug 19, 2020
Wow some useful information, thank you.
Aug 19, 2020
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