Dermatophytosis medical therapy: Difference between revisions

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{{Dermatophytosis}}
{{Dermatophytosis}}


{{CMG}}
{{CMG}}; {{AE}}{{HK}}


== Overview ==
== Overview ==
The mainstay of therapy for dermatophytosis is [[topical]] [[Antifungal drug|antifungals]]. [[Topical]] [[Antifungal drug|antifungals]] include [[Imidazole|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 drug|antifungal therapy]] may be used for dermatophytosis which includes [[griseofulvin]], [[ketoconazole]], [[terbinafine]], [[itraconazole]] and [[fluconazole]].


==Medical Therapy==
==Medical Therapy==


=== Topical antifungals ===
=== 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>
'''1.[[Imidazole|Imidazoles]]:'''
*[[ Clotrimazole]]
* [[Econazole]]
* [[Ketoconazole]]
* [[Miconazole]]
* [[Oxiconazole]] 
* [[Sulconazole]] 
'''2. Allylamines:'''
* [[Naftifine]]
* [[Terbinafine]]
'''3. Other:'''
* [[Ciclopirox|Ciclopirox olamine]]
* [[Benzoic acid]] preparations ([[Whitfield's ointment]])
* [[Tolnaftate]]
* [[Haloprogin]]
* Drying agents
* [[Salicylic acid]]
{| class="wikitable"
{| 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
|[[Clotrimazole]]
|Cream, lotion
|Cream, Lotion
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
|BD
|BD
|4-6 weeks
|4-6 weeks
|-
|-
|Econazole
|[[Econazole]]
|Cream
|Cream
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea Cruris|cruris]]/[[Tinea pedis|pedis]]
|OD-BD
|QD-BD
|4-6 weeks
|4-6 weeks
|-
|-
|Miconazole
|[[Miconazole]]
|Cream, lotion
|Cream, Lotion
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
|BD
|BD
|4-6 weeks
|4-6 weeks
|-
|-
|Oxiconazole
|[[Oxiconazole]]
|Cream, lotion
|Cream, Lotion
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
|OD-BD
|QD-BD
|4 weeks
|4 weeks
|-
|-
|Sertaconazole
|[[Sertaconazole]]
|Cream
|Cream
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea Cruris|cruris]]/[[Tinea pedis|pedis]]
|BD
|BD
|4 weeks
|4 weeks
|-
|-
|Luliconazole
|[[Luliconazole]]
|Cream, lotion
|Cream, Lotion
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/cruris/pedis
|OD
|QD
|2 weeks
|2 weeks
|-
|-
|Eberconazole
|Eberconazole
|Cream
|Cream
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
|OD
|QD
|2-4 weeks
|2-4 weeks
|-
|-
|Efinaconazole
|[[Efinaconazole]]
|Solution
|Solution
|T. pedis
|[[Tinea pedis|T. pedis]]
|OD
|QD
|Up to 52 weeks
|Up to 52 weeks
|-
|-
| rowspan="4" |Terbinafine
| rowspan="4" |[[Terbinafine]]
| rowspan="4" |Cream, powder
| rowspan="4" |Cream, Powder
|T. corporis
|[[Tinea corporis|T. corporis]]
|BD
|BD
|2 weeks
|2 weeks
|-
|-
|T. cruris
|[[Tinea cruris|T. cruris]]
|BD
|BD
|2 weeks
|2 weeks
|-
|-
|T. pedis
|[[Tinea pedis|T. pedis]]
|BD
|BD
|4 weeks
|4 weeks
|-
|-
|T. manum
|[[Tinea manum|T. manum]]
|BD
|BD
|4 weeks
|4 weeks
|-
|-
|Naftifine 1%
|[[Naftifine|Naftifine 1%]]
|Cream
|Cream
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[cruris]]/[[Tinea pedis|pedis]]
|OD-BD
|QD-BD
|2 weeks beyond symptom resolution
|2 weeks beyond symptom resolution
|-
|-
|Butenafine 1%
|[[Butenafine]] 1%
|Cream
|Cream
|T. corporis/cruris/pedis
|[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]/[[Tinea pedis|pedis]]
|OD-BD
|QD-BD
|2-4 weeks
|2-4 weeks
|-
|-
|Amolorfine 0.25%
|Amolorfine 0.25%
|Cream
|Cream
|T. corporis
|[[Tinea corporis|T. corporis]]
|BD
|BD
|4 weeks
|4 weeks
|-
|-
|Amphotericin B 1mg
|[[Amphotericin B]] 1mg
|Lipid based gel
|Lipid Based Gel
|T. corporis
|[[Tinea corporis|T. corporis]]
|BD
|2 weeks
|-
|[[Ciclopirox]] 8%
|Nail Lacquer
|Mild [[onychomycosis]]
|BD
|BD
|2 weeks
|2 weeks
Line 110: Line 136:


==== 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]]
* Tinea affecting more than one body part simultaneously, for example, tinea cruris and 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 blistering.
* Widespread [[tinea pedis]] of the sole, heel, or dorsum of the foot or when there is [[Blister|blistering]]


==== Common oral drugs ====
==== 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>
Patients requiring oral antifungal therapy are usually treated with terbinafine, itraconazole, or fluconazole. Typical treatment regimens for adults include [11]:
* [[Griseofulvin]]
* [[Ketoconazole]]
* [[Terbinafine]]
* [[Itraconazole]]
* [[Fluconazole]]
{| class="wikitable"
{| 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" |T. corporis/cruris
| rowspan="4" |[[Tinea corporis|T. corporis]]/[[Tinea cruris|cruris]]
|Terbinafine
|[[Terbinafine]]
|250 mg OD (3-6mg/kg/day)
|250 mg QD (3-6mg/kg/day)
|2-3 weeks
|2-3 weeks
|-
|-
|Itraconazole
|[[Itraconazole]]
|200 mg/day
|200 mg/day
|1-2 weeks
|1-2 weeks
|-
|-
|Fluconazole
|[[Fluconazole]]
|150-300mg/week
|150-300mg/week
|3-4 weeks
|3-4 weeks
|-
|-
|Griseofulvin
|[[Griseofulvin]]
|500 mg/day (10-20mg/kg/day)
|500 mg/day (10-20mg/kg/day)
|2-4 weeks
|2-4 weeks
|-
|-
| rowspan="4" |T. pedis
| rowspan="4" |[[Tinea pedis|T. pedis]]
|Terbinafine
|[[Terbinafine]]
|250mg OD
|250mg QD
|1 week
|1 week
|-
|-
|Itraconazole
|[[Itraconazole]]
|100-200 mg/day
|100-200 mg/day
|2-4 weeks
|2-4 weeks
|-
|-
|Fluconazole
|[[Fluconazole]]
|150 mg/weel
|150 mg/week
|4 weeks
|4 weeks
|-
|-
|Griseofulvin
|[[Griseofulvin]]
|750-1000 mg/day
|750-1000 mg/day
|4-8 weeks
|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'''<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 ====
==== 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, [[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>
* 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==
==References==
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Latest revision as of 21:18, 29 July 2020

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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:

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]

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

  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.
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