Dermatophytosis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
The mainstay of therapy for dermatophytosis is topical antifungals. Topical antifungals include imidazoles, allylnines and other agents including ciclopirox olamine, benzoic acid preparations (Whitfield's ointment), tolnaftate, haloprogin, drying agents and salicylic acid. In some situations, systemic antifungal therapy may be used for dermatophytosis which includes griseofulvin, ketoconazole, terbinafine, itraconazole and fluconazole.
Medical Therapy
Topical antifungals
The following topical antifungal may be used for dermatophytosis:[1][2][3][4][5][6]
1.Imidazoles:
2. Allylamines:
3. Other:
- Ciclopirox olamine
- Benzoic acid preparations (Whitfield's ointment)
- Tolnaftate
- Haloprogin
- Drying agents
- Salicylic acid
| Azoles | Preparation | Infection site | Application frequency | Duration of treatment |
|---|---|---|---|---|
| Clotrimazole | Cream, Lotion | T. corporis/cruris/pedis | BD | 4-6 weeks |
| Econazole | Cream | T. corporis/cruris/pedis | QD-BD | 4-6 weeks |
| Miconazole | Cream, Lotion | T. corporis/cruris/pedis | BD | 4-6 weeks |
| Oxiconazole | Cream, Lotion | T. corporis/cruris/pedis | QD-BD | 4 weeks |
| Sertaconazole | Cream | T. corporis/cruris/pedis | BD | 4 weeks |
| Luliconazole | Cream, Lotion | T. corporis/cruris/pedis | QD | 2 weeks |
| Eberconazole | Cream | T. corporis/cruris/pedis | QD | 2-4 weeks |
| Efinaconazole | Solution | T. pedis | QD | Up to 52 weeks |
| Terbinafine | Cream, Powder | T. corporis | BD | 2 weeks |
| T. cruris | BD | 2 weeks | ||
| T. pedis | BD | 4 weeks | ||
| T. manum | BD | 4 weeks | ||
| Naftifine 1% | Cream | T. corporis/cruris/pedis | QD-BD | 2 weeks beyond symptom resolution |
| Butenafine 1% | Cream | T. corporis/cruris/pedis | QD-BD | 2-4 weeks |
| Amolorfine 0.25% | Cream | T. corporis | BD | 4 weeks |
| Amphotericin B 1mg | Lipid Based Gel | T. corporis | BD | 2 weeks |
| Ciclopirox 8% | Nail Lacquer | Mild onychomycosis | BD | 2 weeks |
Systemic antifungals
Indications of systemic antifungal therapy in dermatophytosis
The following are the situations where systemic antifungal therapy may be preferred:[7]
- Tinea capitis
- Onychomycosis
- Tinea affecting more than one body part simultaneously, for example, tinea cruris and corporis, or tinea cruris and tinea pedis
- Widespread tinea corporis
- Widespread tinea pedis of the sole, heel, or dorsum of the foot or when there is blistering
Common oral drugs
The following antifungals may be used systemically for dermatophytosis:[8][9]
Patients requiring oral antifungal therapy are usually treated with terbinafine, itraconazole, or fluconazole. Typical treatment regimens for adults include [11]:
| Condition | Drug | Dosage | Duration |
|---|---|---|---|
| T. corporis/cruris | Terbinafine | 250 mg QD (3-6mg/kg/day) | 2-3 weeks |
| Itraconazole | 200 mg/day | 1-2 weeks | |
| Fluconazole | 150-300mg/week | 3-4 weeks | |
| Griseofulvin | 500 mg/day (10-20mg/kg/day) | 2-4 weeks | |
| T. pedis | Terbinafine | 250mg QD | 1 week |
| Itraconazole | 100-200 mg/day | 2-4 weeks | |
| Fluconazole | 150 mg/week | 4 weeks | |
| Griseofulvin | 750-1000 mg/day | 4-8 weeks | |
| T.rubrum | Terbinafine | 250 mg QD (Pulse-dosed for 7 days every 3 months) | 12 weeks |
- 1 Tinea corporis/cruris/mannum
- 1.1 Adult[10]
- Preferred regimen (1): Terbinafine 250 mg PO q 24 hours for 2-3 weeks
- Preferred regimen (2): Itraconazole 200 mg PO q 24 hours for 1 week
- Alternative regimen (1): Fluconazole 150 to 200 mg once weekly for 2-4 weeks
- Alternative regimen (2): Griseofulvin microsize 500 to 1000 mg q 24 hours for 2-4 weeks
- Alternative regimen (3): Griseofulvin ultramicrosize 375 to 500 mg q 24 hours for 2-4 weeks
- 1.2 Pediatric
- Preferred regimen (1) Terbinafine:
- 10 to 20 kg: 62.5 mg q 24 hours for 2-3 weeks
- 20 to 40 kg: 125 mg q 24 hours for 2-3 weeks
- Above 40 kg: 250 mg q 24 hours for 2-3 weeks
- Preferred regimen (2): Itraconazole 3 to 5 mg/kg q 24 hours (up to 200 mg per day) for 1 week
- Alternative regimen (1): Fluconazole 6 mg/kg once weekly for 2-4 weeks
- Alternative regimen (2): Griseofulvin microsize 10 to 20 mg/kg per day for 2-4 weeks
- Preferred regimen (1) Terbinafine:
- 1.1 Adult[10]
- 2 Tinea Pedis
- 1.1 Adult
- Preferred regimen (1): Terbinafine 250 mg q 24 hours for 1 week
- Preferred regimen (2): Itraconazole 100-200 mg q 24 hours for 2-4 weeks
- Alternative regimen (1): Fluconazole 150 mg per week for 4 weeks
- Alternative regimen (2): Griseofulvin 750-1000 mg q 24 hous for 4-8 weeks
- 1.1 Adult
Newer oral drugs
- Recently, posaconazole was found to be effective in a patient with extensive dermatophytic skin and nail infection with underlying CARD9 mutation[11]
- Fresh leaves of Eucalyptus globulus Labill[12]
- Demicidin[13]
References
- ↑ Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hardinsky MK; et al. (1996). "Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. Guidelines/Outcomes Committee. American Academy of Dermatology". J Am Acad Dermatol. 34 (2 Pt 1): 282–6. PMID 8642094.
- ↑ Ton JG, Boelens WC, Gallas P (1973). "Resection of the rectum with preservation of the anal sphincter". Arch Chir Neerl. 25 (2): 179–87. PMID 4804599.
- ↑ Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL, Correr CJ (2013). "Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments". JAMA Dermatol. 149 (3): 341–9. doi:10.1001/jamadermatol.2013.1721. PMID 23553036.
- ↑ Sawyer PR, Brogden RN, Pinder RM, Speight TM (1975). "Clotrimazole: a review of its antifungal activity and therapeutic efficacy". Drugs. 9 (6): 424–47. PMID 1097234.
- ↑ Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA; et al. (1988). "Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study". Transplantation. 46 (3): 346–51. PMID 3047923.
- ↑ Bozarth RF, Wood HA, Mandelbrot A (1971). "The Penicillium stoloniferum virus complex: two similar double-stranded RNA virus-like particles in a single cell". Virology. 45 (2): 516–23. PMID 4106353.
- ↑ Ton JG, Boelens WC, Gallas P (1973). "Resection of the rectum with preservation of the anal sphincter". Arch Chir Neerl. 25 (2): 179–87. PMID 4804599.
- ↑ Degreef HJ, DeDoncker PR (1994). "Current therapy of dermatophytosis". J Am Acad Dermatol. 31 (3 Pt 2): S25–30. PMID 8077504.
- ↑ Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA; et al. (1988). "Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study". Transplantation. 46 (3): 346–51. PMID 3047923.
- ↑ Voravutinon V (1993). "Oral treatment of tinea corporis and tinea cruris with terbinafine and griseofulvin: a randomized double blind comparative study". J Med Assoc Thai. 76 (7): 388–93. PMID 8089640.
- ↑ Jachiet M, Lanternier F, Rybojad M, Bagot M, Ibrahim L, Casanova JL; et al. (2015). "Posaconazole treatment of extensive skin and nail dermatophytosis due to autosomal recessive deficiency of CARD9". JAMA Dermatol. 151 (2): 192–4. doi:10.1001/jamadermatol.2014.2154. PMID 25372963.
- ↑ Wong JH, Lau KM, Wu YO, Cheng L, Wong CW, Yew DT; et al. (2015). "Antifungal mode of action of macrocarpal C extracted from Eucalyptus globulus Labill (Lan An) towards the dermatophyte Trichophyton mentagrophytes". Chin Med. 10: 34. doi:10.1186/s13020-015-0068-3. PMC 4654844. PMID 26594235.
- ↑ Arai S, Yoshino T, Fujimura T, Maruyama S, Nakano T, Mukuno A; et al. (2015). "Mycostatic effect of recombinant dermcidin against Trichophyton rubrum and reduced dermcidin expression in the sweat of tinea pedis patients". J Dermatol. 42 (1): 70–6. doi:10.1111/1346-8138.12664. PMID 25384912.