Dermatophytosis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical Therapy

Topical antifungals

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	OD-BD	4-6 weeks
Miconazole	Cream, lotion	T. corporis/cruris/pedis	BD	4-6 weeks
Oxiconazole	Cream, lotion	T. corporis/cruris/pedis	OD-BD	4 weeks
Sertaconazole	Cream	T. corporis/cruris/pedis	BD	4 weeks
Luliconazole	Cream, lotion	T. corporis/cruris/pedis	OD	2 weeks
Eberconazole	Cream	T. corporis/cruris/pedis	OD	2-4 weeks
Efinaconazole	Solution	T. pedis	OD	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	OD-BD	2 weeks beyond symptom resolution
Butenafine 1%	Cream	T. corporis/cruris/pedis	OD-BD	2-4 weeks
Amolorfine 0.25%	Cream	T. corporis	BD	4 weeks
Amphotericin B 1mg	Lipid based gel	T. corporis	BD	2 weeks

Systemic antifungals

Indications of systemic antifungal therapy in dermatophytosis

The following are the situations where systemic antifungal therapy may be preferred

• 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

Condition	Drug	Dosage	Duration
T. corporis/cruris	Terbinafine	250 mg OD (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 OD	1 week
	Itraconazole	100-200 mg/day	2-4 weeks
	Fluconazole	150 mg/weel	4 weeks
	Griseofulvin	750-1000 mg/day	4-8 weeks

Newer oral drugs

• Recently, posoconazole was found to be effective in a patient with extensive dermatophytic skin and nail infection with underlying CARD9 mutation.