Dermatophytosis medical therapy
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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][2][3][4][5][6]:
1.Imidazoles
- Clotfimazole
- Econazole
- Ketoconazole
- Miconazole
- Oxiconazole 39
- Sulconazole
2. Allyl~nines a)
- Naftifine
- Terbinafine
3. Other
- Ciclopirox olamine
- Benzoic acid preparations (Whitfield's ointment)
- Tolnaftate
- Haloprogin
- Drying agents
- Powders
- Antibiotics (where applicable)
- 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 | 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 |
| Ciclopirox 8% | Nail lacquer | Mild oncychomycosis | 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] :
- Griseofulvin
- Ketoconazole
- Terbinafine
- Itraconazole
- Fluconazole
| 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 | |
| T.rubrum | Terbinafine | 250 mg OD (Pulse-dosed for 7 days every 3 months) | 12 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.[10]
- Fresh leaves of Eucalyptus globulus Labill.[11]
- Demicidin.[12]
Special situations
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.
- ↑ 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.