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

  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.
  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.
  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.
  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.
  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.
  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.
  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.
  8. Degreef HJ, DeDoncker PR (1994). "Current therapy of dermatophytosis". J Am Acad Dermatol. 31 (3 Pt 2): S25–30. PMID 8077504.
  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.
  10. 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.
  11. 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.
  12. 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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