Dermatophytosis medical therapy: Difference between revisions

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Latest revision as of 21:18, 29 July 2020

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
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

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.

Template:WikiDoc Sources

[pmid8642094-1] 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.

[pmid48045993-2] 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.

[pmid23553036-3] 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.

[pmid1097234-4] 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.

[pmid3047923-5] 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.

[pmid4106353-6] 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.

[pmid4804599-7] 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.

[pmid80775042-8] Degreef HJ, DeDoncker PR (1994). "Current therapy of dermatophytosis". J Am Acad Dermatol. 31 (3 Pt 2): S25–30. PMID 8077504.

[pmid30479232-9] 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.

[pmid8089640-10] 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.

[pmid25372963-11] 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.

[pmid26594235-12] 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.

[pmid25384912-13] 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.

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@@ Line 10: / Line 10: @@
 === Topical antifungals ===
-The following topical antifungal may be used for dermatophytosis<ref name="pmid8642094">{{cite journal| author=Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hardinsky MK et al.| title=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. | journal=J Am Acad Dermatol | year= 1996 | volume= 34 | issue= 2 Pt 1 | pages= 282-6 | pmid=8642094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8642094  }}</ref><ref name="pmid48045993">{{cite journal| author=Ton JG, Boelens WC, Gallas P| title=Resection of the rectum with preservation of the anal sphincter. | journal=Arch Chir Neerl | year= 1973 | volume= 25 | issue= 2 | pages= 179-87 | pmid=4804599 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4804599  }}</ref><ref name="pmid23553036">{{cite journal| author=Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL, Correr CJ| title=Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. | journal=JAMA Dermatol | year= 2013 | volume= 149 | issue= 3 | pages= 341-9 | pmid=23553036 | doi=10.1001/jamadermatol.2013.1721 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23553036  }}</ref><ref name="pmid1097234">{{cite journal| author=Sawyer PR, Brogden RN, Pinder RM, Speight TM| title=Clotrimazole: a review of its antifungal activity and therapeutic efficacy. | journal=Drugs | year= 1975 | volume= 9 | issue= 6 | pages= 424-47 | pmid=1097234 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1097234  }}</ref><ref name="pmid3047923">{{cite journal| author=Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA et al.| title=Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study. | journal=Transplantation | year= 1988 | volume= 46 | issue= 3 | pages= 346-51 | pmid=3047923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047923  }}</ref><ref name="pmid4106353">{{cite journal| author=Bozarth RF, Wood HA, Mandelbrot A| title=The Penicillium stoloniferum virus complex: two similar double-stranded RNA virus-like particles in a single cell. | journal=Virology | year= 1971 | volume= 45 | issue= 2 | pages= 516-23 | pmid=4106353 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4106353  }}</ref>:
+The following topical antifungal may be used for dermatophytosis:<ref name="pmid8642094">{{cite journal| author=Drake LA, Dinehart SM, Farmer ER, Goltz RW, Graham GF, Hardinsky MK et al.| title=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. | journal=J Am Acad Dermatol | year= 1996 | volume= 34 | issue= 2 Pt 1 | pages= 282-6 | pmid=8642094 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8642094  }}</ref><ref name="pmid48045993">{{cite journal| author=Ton JG, Boelens WC, Gallas P| title=Resection of the rectum with preservation of the anal sphincter. | journal=Arch Chir Neerl | year= 1973 | volume= 25 | issue= 2 | pages= 179-87 | pmid=4804599 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4804599  }}</ref><ref name="pmid23553036">{{cite journal| author=Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL, Correr CJ| title=Efficacy of topical antifungals in the treatment of dermatophytosis: a mixed-treatment comparison meta-analysis involving 14 treatments. | journal=JAMA Dermatol | year= 2013 | volume= 149 | issue= 3 | pages= 341-9 | pmid=23553036 | doi=10.1001/jamadermatol.2013.1721 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23553036  }}</ref><ref name="pmid1097234">{{cite journal| author=Sawyer PR, Brogden RN, Pinder RM, Speight TM| title=Clotrimazole: a review of its antifungal activity and therapeutic efficacy. | journal=Drugs | year= 1975 | volume= 9 | issue= 6 | pages= 424-47 | pmid=1097234 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1097234  }}</ref><ref name="pmid3047923">{{cite journal| author=Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA et al.| title=Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study. | journal=Transplantation | year= 1988 | volume= 46 | issue= 3 | pages= 346-51 | pmid=3047923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047923  }}</ref><ref name="pmid4106353">{{cite journal| author=Bozarth RF, Wood HA, Mandelbrot A| title=The Penicillium stoloniferum virus complex: two similar double-stranded RNA virus-like particles in a single cell. | journal=Virology | year= 1971 | volume= 45 | issue= 2 | pages= 516-23 | pmid=4106353 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4106353  }}</ref>
 '''1.[[Imidazole|Imidazoles]]:'''
@@ Line 19: / Line 19: @@
 * [[Oxiconazole]]
 * [[Sulconazole]]
-'''2. Allylnines:'''
+'''2. Allylamines:'''
-* Naftifine
+* [[Naftifine]]
-* Terbinafine
+* [[Terbinafine]]
 '''3. Other:'''
 * [[Ciclopirox|Ciclopirox olamine]]
@@ Line 30: / Line 30: @@
 * [[Salicylic acid]]
 {| class="wikitable"
-!Azoles
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Azoles
-!Preparation
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Preparation
-!Infection site
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Infection site
-!Application frequency
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Application frequency
-!Duration of treatment
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration of treatment
 |-
 |[[Clotrimazole]]
 |Cream, Lotion
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
 |BD
 |4-6 weeks
@@ Line 44: / Line 44: @@
 |[[Econazole]]
 |Cream
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea Cruris|cruris]]/[[Tinea pedis|pedis]]
 |QD-BD
 |4-6 weeks
@@ Line 50: / Line 50: @@
 |[[Miconazole]]
 |Cream, Lotion
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
 |BD
 |4-6 weeks
@@ Line 56: / Line 56: @@
 |[[Oxiconazole]]
 |Cream, Lotion
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
 |QD-BD
 |4 weeks
@@ Line 62: / Line 62: @@
 |[[Sertaconazole]]
 |Cream
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea Cruris|cruris]]/[[Tinea pedis|pedis]]
 |BD
 |4 weeks
@@ Line 68: / Line 68: @@
 |[[Luliconazole]]
 |Cream, Lotion
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/cruris/pedis
 |QD
 |2 weeks
@@ Line 74: / Line 74: @@
 |Eberconazole
 |Cream
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
 |QD
 |2-4 weeks
@@ Line 80: / Line 80: @@
 |[[Efinaconazole]]
 |Solution
-|T. pedis
+|[[Tinea pedis|T. pedis]]
 |QD
 |Up to 52 weeks
@@ Line 86: / Line 86: @@
 | rowspan="4" |[[Terbinafine]]
 | rowspan="4" |Cream, Powder
-|T. corporis
+|[[Tinea corporis|T. corporis]]
 |BD
 |2 weeks
 |-
-|T. cruris
+|[[Tinea cruris|T. cruris]]
 |BD
 |2 weeks
 |-
-|T. pedis
+|[[Tinea pedis|T. pedis]]
 |BD
 |4 weeks
 |-
-|T. manum
+|[[Tinea manum|T. manum]]
 |BD
 |4 weeks
@@ Line 104: / Line 104: @@
 |[[Naftifine|Naftifine 1%]]
 |Cream
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[cruris]]/[[Tinea pedis|pedis]]
 |QD-BD
 |2 weeks beyond symptom resolution
@@ Line 110: / Line 110: @@
 |[[Butenafine]] 1%
 |Cream
-|T. corporis/cruris/pedis
+|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
 |QD-BD
 |2-4 weeks
@@ Line 116: / Line 116: @@
 |Amolorfine 0.25%
 |Cream
-|T. corporis
+|[[Tinea corporis|T. corporis]]
 |BD
 |4 weeks
@@ Line 122: / Line 122: @@
 |[[Amphotericin B]] 1mg
 |Lipid Based Gel
-|T. corporis
+|[[Tinea corporis|T. corporis]]
 |BD
 |2 weeks
@@ Line 128: / Line 128: @@
 |[[Ciclopirox]] 8%
 |Nail Lacquer
-|Mild oncychomycosis
+|Mild [[onychomycosis]]
 |BD
 |2 weeks
@@ Line 136: / Line 136: @@
 ==== Indications of systemic antifungal therapy in dermatophytosis ====
-The following are the situations where systemic antifungal therapy may be preferred<ref name="pmid4804599">{{cite journal| author=Ton JG, Boelens WC, Gallas P| title=Resection of the rectum with preservation of the anal sphincter. | journal=Arch Chir Neerl | year= 1973 | volume= 25 | issue= 2 | pages= 179-87 | pmid=4804599 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4804599  }}</ref>:
+The following are the situations where systemic antifungal therapy may be preferred:<ref name="pmid4804599">{{cite journal| author=Ton JG, Boelens WC, Gallas P| title=Resection of the rectum with preservation of the anal sphincter. | journal=Arch Chir Neerl | year= 1973 | volume= 25 | issue= 2 | pages= 179-87 | pmid=4804599 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4804599  }}</ref>
-* [[Tinea capitis]].
+* [[Tinea capitis]]
-* [[Onychomycosis]].
+* [[Onychomycosis]]
-* Tinea affecting more than one body part simultaneously, for example, [[tinea cruris]] and [[Tinea corporis|corporis]], or [[tinea cruris]] and [[tinea pedis]].
+* Tinea affecting more than one body part simultaneously, for example, [[tinea cruris]] and [[Tinea corporis|corporis]], or [[tinea cruris]] and [[tinea pedis]]
-* Widespread [[tinea corporis]].
+* Widespread [[tinea corporis]]
-* Widespread [[tinea pedis]] of the sole, heel, or dorsum of the foot or when there is [[Blister|blistering]].
+* Widespread [[tinea pedis]] of the sole, heel, or dorsum of the foot or when there is [[Blister|blistering]]
 ==== Common oral drugs ====
-The following [[Antifungal drug|antifungals]] may be used [[Systemic|systemically]] for dermatophytosis<ref name="pmid80775042">{{cite journal| author=Degreef HJ, DeDoncker PR| title=Current therapy of dermatophytosis. | journal=J Am Acad Dermatol | year= 1994 | volume= 31 | issue= 3 Pt 2 | pages= S25-30 | pmid=8077504 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8077504  }}</ref><ref name="pmid30479232">{{cite journal| author=Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA et al.| title=Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study. | journal=Transplantation | year= 1988 | volume= 46 | issue= 3 | pages= 346-51 | pmid=3047923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047923  }}</ref> :
+The following [[Antifungal drug|antifungals]] may be used [[Systemic|systemically]] for dermatophytosis:<ref name="pmid80775042">{{cite journal| author=Degreef HJ, DeDoncker PR| title=Current therapy of dermatophytosis. | journal=J Am Acad Dermatol | year= 1994 | volume= 31 | issue= 3 Pt 2 | pages= S25-30 | pmid=8077504 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8077504  }}</ref><ref name="pmid30479232">{{cite journal| author=Fraser CD, Chacko VP, Jacobus WE, Soulen RL, Hutchins GM, Reitz BA et al.| title=Metabolic changes preceding functional and morphologic indices of rejection in heterotopic cardiac allografts. A 31P nuclear magnetic resonance study. | journal=Transplantation | year= 1988 | volume= 46 | issue= 3 | pages= 346-51 | pmid=3047923 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3047923  }}</ref>
+Patients requiring oral antifungal therapy are usually treated with terbinafine, itraconazole, or fluconazole. Typical treatment regimens for adults include [11]:
 * [[Griseofulvin]]
 * [[Ketoconazole]]
@@ Line 151: / Line 153: @@
 * [[Fluconazole]]
 {| class="wikitable"
-!Condition
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Condition
-!Drug
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Drug
-!Dosage
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Dosage
-!Duration
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Duration
 |-
 | rowspan="4" |[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]
@@ Line 190: / Line 192: @@
 |4-8 weeks
 |-
-|T.rubrum
+|[[T.rubrum]]
 |[[Terbinafine]]
 |250 mg QD (Pulse-dosed for 7 days every 3 months)
 |12 weeks
 |}
+* 1 '''Tinea corporis/cruris/mannum'''
+** 1.1 '''Adult'''<ref name="pmid8089640">{{cite journal |vauthors=Voravutinon V |title=Oral treatment of tinea corporis and tinea cruris with terbinafine and griseofulvin: a randomized double blind comparative study |journal=J Med Assoc Thai |volume=76 |issue=7 |pages=388–93 |year=1993 |pmid=8089640 |doi= |url=}}</ref>
+*** 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
+* 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
 ==== Newer oral drugs ====
-* Recently, [[posaconazole]] was found to be effective in a patient with extensive dermatophytic skin and nail infection with underlying CARD9 [[mutation]].<ref name="pmid25372963">{{cite journal| author=Jachiet M, Lanternier F, Rybojad M, Bagot M, Ibrahim L, Casanova JL et al.| title=Posaconazole treatment of extensive skin and nail dermatophytosis due to autosomal recessive deficiency of CARD9. | journal=JAMA Dermatol | year= 2015 | volume= 151 | issue= 2 | pages= 192-4 | pmid=25372963 | doi=10.1001/jamadermatol.2014.2154 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25372963  }}</ref>
+* Recently, [[posaconazole]] was found to be effective in a patient with extensive dermatophytic [[skin]] and nail infection with underlying CARD9 [[mutation]]<ref name="pmid25372963">{{cite journal| author=Jachiet M, Lanternier F, Rybojad M, Bagot M, Ibrahim L, Casanova JL et al.| title=Posaconazole treatment of extensive skin and nail dermatophytosis due to autosomal recessive deficiency of CARD9. | journal=JAMA Dermatol | year= 2015 | volume= 151 | issue= 2 | pages= 192-4 | pmid=25372963 | doi=10.1001/jamadermatol.2014.2154 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25372963  }}</ref>
-* Fresh leaves of ''Eucalyptus globulus Labill.''<ref name="pmid26594235">{{cite journal| author=Wong JH, Lau KM, Wu YO, Cheng L, Wong CW, Yew DT et al.| title=Antifungal mode of action of macrocarpal C extracted from Eucalyptus globulus Labill (Lan An) towards the dermatophyte Trichophyton mentagrophytes. | journal=Chin Med | year= 2015 | volume= 10 | issue=  | pages= 34 | pmid=26594235 | doi=10.1186/s13020-015-0068-3 | pmc=4654844 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26594235  }}</ref>
+* Fresh leaves of ''Eucalyptus globulus Labill''<ref name="pmid26594235">{{cite journal| author=Wong JH, Lau KM, Wu YO, Cheng L, Wong CW, Yew DT et al.| title=Antifungal mode of action of macrocarpal C extracted from Eucalyptus globulus Labill (Lan An) towards the dermatophyte Trichophyton mentagrophytes. | journal=Chin Med | year= 2015 | volume= 10 | issue=  | pages= 34 | pmid=26594235 | doi=10.1186/s13020-015-0068-3 | pmc=4654844 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26594235  }}</ref>
-* Demicidin.<ref name="pmid25384912">{{cite journal| author=Arai S, Yoshino T, Fujimura T, Maruyama S, Nakano T, Mukuno A et al.| title=Mycostatic effect of recombinant dermcidin against Trichophyton rubrum and reduced dermcidin expression in the sweat of tinea pedis patients. | journal=J Dermatol | year= 2015 | volume= 42 | issue= 1 | pages= 70-6 | pmid=25384912 | doi=10.1111/1346-8138.12664 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25384912  }}</ref>
+* Demicidin<ref name="pmid25384912">{{cite journal| author=Arai S, Yoshino T, Fujimura T, Maruyama S, Nakano T, Mukuno A et al.| title=Mycostatic effect of recombinant dermcidin against Trichophyton rubrum and reduced dermcidin expression in the sweat of tinea pedis patients. | journal=J Dermatol | year= 2015 | volume= 42 | issue= 1 | pages= 70-6 | pmid=25384912 | doi=10.1111/1346-8138.12664 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25384912  }}</ref>
 ==References==
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