Dermatophytosis medical therapy

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

Overview

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.

References

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