Dermatophytosis medical therapy: Difference between revisions
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=== Topical antifungals === | === Topical antifungals === | ||
The following topical antifungal may be used for dermatophytosis<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>: | |||
{| class="wikitable" | {| class="wikitable" | ||
!Azoles | !Azoles | ||
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==== Indications of systemic antifungal therapy in dermatophytosis ==== | ==== Indications of systemic antifungal therapy in dermatophytosis ==== | ||
The following are the situations where systemic antifungal therapy may be preferred | 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. | ||
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==== Common oral drugs ==== | ==== Common oral drugs ==== | ||
The following antifungals may be used 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> : | |||
{| class="wikitable" | {| class="wikitable" | ||
!Condition | !Condition | ||
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==== Newer oral drugs ==== | ==== Newer oral drugs ==== | ||
* Recently, posoconazole was found to be effective in a patient with extensive dermatophytic skin and nail infection with underlying CARD9 mutation. | * Recently, posoconazole 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> | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
Topical antifungals
The following topical antifungal may be used for dermatophytosis[1]:
| 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[2]:
- 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[3] :
| 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.[4]
References
- ↑ 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.
- ↑ 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.
- ↑ 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.