Skip to main content
Log in

Update in Antifungal Therapy of Dermatophytosis

Mycopathologia Aims and scope Submit manuscript

Abstract

Treatment of dermatophyte infection involves primarily oral and/or topical formulations of azoles or allylamines, particularly itraconazole and terbinafine. Topical medications applied once or twice daily are the primary treatment indicated for tinea corporis/cruris, and tinea pedis/manuum. Use of oral antifungals may be practical where the tinea involvement is extensive or chronic, or where application of a topical is not feasible. For tinea unguium (onychomycosis) and tinea capitis, oral therapies are the primary treatments provided. Recently, topical amorolfine and ciclopirox formulations have been approved for use in milder onychomycosis cases, and their role in the treatment of the different clinical forms of onychomycosis is currently being defined. Relapse of infection remains a problem, particularly with tinea pedis/unguium. Appropriate follow-up duration and education of patients on proper foot hygiene are also important components in providing effective therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Loo DS. Systemic antifungal agents: an update of established and new therapies. Adv Dermatol. 2006;22:101–24.

    Article  PubMed  Google Scholar 

  2. Lecha M, Effendy I, Feuilhade de Chauvin M, Di Chiacchio N, Baran R. Treatment options—development of consensus guidelines. J Eur Acad Dermatol Venereol. 2005;19(Suppl 1):25–33.

    Article  PubMed  Google Scholar 

  3. TARO Pharmaceuticals Inc. Clotrimazole cream USP, 1%. Prescribing information. Bramalea, Ontario, Canada, June 1996.

  4. TARO Pharmaceuticals Inc. Econazole nitrate cream 1%. Prescribing information. Brampton, Ontario, Canada, September 2001.

  5. Merz Pharmaceuticals. Naftin® Naftifine HCl 1% gel/cream. Prescribing information. Greensboro, NC, USA, May 2007.

  6. McNeil Consumer & Specialty Pharmaceuticals. Nizoral® (ketoconazole) 2% shampoo. Prescribing information. Fort Washington, PA, USA, October 2003.

  7. TARO Pharmaceuticals Inc. Ciclopirox olamine cream USP, 0.77%. Prescribing information. Brampton, Ontario, Canada, March 2005.

  8. MEDICIS, The Dermatology Company. Loprox® Gel (ciclopirox) 0.77%. Prescribing information. Scottsdale, AZ, USA, July 2005.

  9. BERTEK Pharmaceuticals Inc. Mentax®-TC (butenafine HCl) cream, 1%. Prescribing information. Research Triangle Park, NC, USA, October 2002.

  10. GlaxoSmithKline Consumer Healthcare LP. Oxistat® (oxiconazole nitrate cream) cream 1%; Oxistat® (oxiconazole nitrate lotion) lotion 1%. Prescribing information. Pittsburgh, PA, USA, January 2004.

  11. Gupta AK, Chow M, Daniel CR, Aly R. Treatments of tinea pedis. Dermatol Clin. 2003;21:431–62.

    Article  PubMed  CAS  Google Scholar 

  12. Lamisil® (terbinafine hydrochloride tablets) Prescribing information. Novartis Pharmaceuticals Corporation. East Hanover, NJ, November 2005.

  13. Sporanox® (itraconazole) Capsules prescribing information (Ortho-McNeil Inc). Janssen Pharmaceutica Products, L.P. Titusville, NJ, June 2006.

  14. Diflucan® (fluconazole tablets) (fluconazole injection—for intravenous infusion only) (fluconazole for oral suspension) Prescribing information. Pfizer Inc, August 2004.

  15. Griseofulvin (Systemic). In: Drug information for the health care professional, USP DI, The United States Pharmacopeial Convention, Inc., ed 24, Taunton MA, 2004, Micromedex, p. 1493–6.

  16. Miscellaneous Antifungals—Griseofulvin. In: AHFS Drug Information® 2005. Bethesda, MD, 2005, American Society of Health-System Pharmacists, Inc., p. 535–7.

  17. Azoles—Ketoconazole. In: AHFS Drug Information® 2005. Bethesda, MD, 2005, American Society of Health-System Pharmacists, Inc., p. 510–6.

  18. Gupta AK, Cooper EA, Montero-Gei F. The use of fluconazole to treat superficial fungal infections in children. Dermatol Clin. 2003;21:537–42.

    Article  PubMed  CAS  Google Scholar 

  19. Gupta AK, Cooper EA, Ginter G. Efficacy and safety of itraconazole use in children. Dermatol Clin. 2003;21:521–35.

    Article  PubMed  CAS  Google Scholar 

  20. Gupta AK, Cooper EA, Lynde CW. The efficacy and safety of terbinafine in children. Dermatol Clin. 2003;21:511–20.

    Article  PubMed  CAS  Google Scholar 

  21. Gupta AK, Ryder JE. The use of oral antifungal agents to treat onychomycosis. Dermatol Clin. 2003;21:469–79.

    Article  PubMed  CAS  Google Scholar 

  22. Antifungals, Azole (Systemic). In: Drug information for the health care professional, USP DI, The United States Pharmacopeial Convention, Inc., ed 24, Taunton MA, 2004, Micromedex. p. 315–23.

  23. Padhye AA, Weitzman I. The dermatophytes. In: Collier L, Balows A, Sussman M, Ajello L, Hay RJ, editors. Topley and Wilson’s medical mycology. New York: Oxford University Press; 1998. p. 215–36.

    Google Scholar 

  24. Noble SL, Forbes RC, Stamm PL. Diagnosis and management of common tinea infections. Am Fam Physician. 1998;58:163–8.

    PubMed  CAS  Google Scholar 

  25. Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001434.

  26. Gupta AK, Cooper EA, Ryder JE, et al. Optimal management of fungal infections of the skin, hair, and nails. Am J Clin Dermatol. 2004;5:225–37.

    Article  PubMed  Google Scholar 

  27. Crawford F. Athlete’s foot. In: Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B, editors. Evidence based dermatology. London: BMJ Books; 2003. p. 436–40.

    Google Scholar 

  28. Gupta AK, Chaudhry M, Elewski B. Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatol Clin. 2003;21:395–400.

    Article  PubMed  Google Scholar 

  29. Gupta AK, De Doncker P, Heremans A, et al. Itraconazole for the treatment of tinea pedis: a dose of 400 mg/day given for 1 week is similar in efficacy to 100 or 200 mg/day given for 2 to 4 weeks. J Am Acad Dermatol. 1997;36:789–92.

    Article  PubMed  CAS  Google Scholar 

  30. Faergemann J, Mork NJ, Haglund A, et al. A multicentre (double-blind) comparative study to assess the safety and efficacy of fluconazole and griseofulvin in the treatment of tinea corporis and tinea cruris. Br J Dermatol. 1997;136:575–7.

    Article  PubMed  CAS  Google Scholar 

  31. Stary A, Sarnow E. Fluconazole in the treatment of tinea corporis and tinea cruris. Dermatology. 1998;196:237–41.

    Article  PubMed  CAS  Google Scholar 

  32. Suchil P, Montero Gei F, Robles M, et al. Once-weekly oral doses of fluconazole 150 mg in the treatment of tinea corporis/cruris and cutaneous candidiasis. Clin Exp Dermatol. 1992;17:397–401.

    Article  PubMed  CAS  Google Scholar 

  33. Haroon TS, Asghar HA, Aman S, et al. An open, non-comparative study for the evaluation of oral fluconazole in the treatment of tinea corporis. Specialist. 1997;13:417–23.

    Google Scholar 

  34. Papini M, Difonzo EM, Cilli P, et al. Itraconazole versus fluconazole, a double-blind comparison in tinea corporis. J Mycol Méd. 1997;7:77–80.

    Google Scholar 

  35. Kotogyan A, Harmanyeri Y, Tahsin Gunes A, et al. Efficacy and safety of oral fluconazole in the treatment of patients with tinea corporis, cruris or pedis or cutaneous candidiasis. A multicentre, open, non-comparative study. Clin Drug Investig. 1996;12:59–66.

    Article  CAS  Google Scholar 

  36. Gomez M, Arenas R, Salazar JJ, et al. Tinea pedis. A multicentre trial to evaluate the efficacy and tolerance of a weekly dose of fluconazole. Dermatol Rev Mex. 1996;40:251–5 (Spanish).

    Google Scholar 

  37. Del Aguila R, Montero Gei F, Robles M, et al. Once-weekly oral doses of fluconazole 150 mg in the treatment of tinea pedis. Clin Exp Dermatol. 1992;17:402–6.

    Article  PubMed  Google Scholar 

  38. Gupta AK, Ryder JE, Chow M, Cooper EA. Dermatophytosis: the management of fungal infections. Skinmed. 2005;4:305–10.

    Article  PubMed  Google Scholar 

  39. Trent JT, Federman D, Kirsner RS. Common viral and fungal skin infections. Ostomy Wound Manage. 2001;47:28–34.

    PubMed  CAS  Google Scholar 

  40. De Doncker P, Gupta AK, Marynissen G, et al. Itraconazole pulse therapy for onychomycosis and dermatomycoses: an overview. J Am Acad Dermatol. 1997;37:969–74.

    Article  PubMed  CAS  Google Scholar 

  41. Parent D, Decroix J, Heenen M. Clinical experience with short schedules of itraconazole in the treatment of tinea corporis and/or tinea cruris. Dermatology. 1994;189:378–81.

    Article  PubMed  CAS  Google Scholar 

  42. Gupta AK, Summerbell RC. Tinea capitis. Med Mycol. 2000;38:255–87.

    Article  PubMed  CAS  Google Scholar 

  43. Roberts BJ, Friedlander SF. Tinea capitis: a treatment update. Pediatr Ann. 2005;34:191–200.

    PubMed  Google Scholar 

  44. Lipozencic J, Skerlev M, Orofino-Costa R, et al. A randomized, double-blind, parallel-group, duration-finding study of oral terbinafine and open-label, high-dose griseofulvin in children with tinea capitis due to Microsporum species. Br J Dermatol. 2002;146:816–23.

    Article  PubMed  CAS  Google Scholar 

  45. Gupta AK, Skinner AR. Onychomycosis in children: a brief overview with treatment strategies. Pediatr Dermatol. 2004;21:74–9.

    Article  PubMed  Google Scholar 

  46. Tosti A, Piraccini BM, Iorizzo M. Management of onychomycosis in children. Dermatol Clin. 2003;21:507–9.

    Article  PubMed  Google Scholar 

  47. Chan Y, Friedlander SF. New treatments for tinea capitis. Curr Opin Infect Dis. 2004;17:97–103.

    Article  PubMed  CAS  Google Scholar 

  48. Haroon TS, Hussain I, Aman S, et al. A randomized double-blind comparative study of terbinafine for 1, 2 and 4 weeks in tinea capitis. Br J Dermatol. 1996;135:86–8.

    Article  PubMed  CAS  Google Scholar 

  49. Friedlander SF, Aly R, Krafchik B, et al. Terbinafine in the treatment of Trichophyton tinea capitis: a randomized, double-blind, parallel-group, duration-finding study. Pediatrics. 2002;109:602–7.

    Article  PubMed  Google Scholar 

  50. Lipozencic J, Skerlev M, Orofino-Costa R, et al. A randomized, double-blind, parallel-group, duration-finding study of oral terbinafine and open-label, high-dose griseofulvin in children with tinea capitis due to Microsporum species. Br J Dermatol. 2002;146:816–23.

    Article  PubMed  CAS  Google Scholar 

  51. Gupta AK, Solomon RS, Adam P. Itraconazole oral solution for the treatment of tinea capitis. Br J Dermatol. 1998;139:104–6.

    Article  PubMed  CAS  Google Scholar 

  52. Dastghaib L, Azizzadeh M, Jafari P. Therapeutic options for the treatment of tinea capitis: griseofulvin versus fluconazole. J Dermatolog Treat. 2005;16:43–6.

    Article  PubMed  CAS  Google Scholar 

  53. Montero Gei F. Fluconazole in the treatment of tinea capitis. Int J Dermatol. 1998;37:870–1.

    Article  PubMed  CAS  Google Scholar 

  54. Gupta AK, Dlova N, Taborda P, et al. Once weekly fluconazole is effective in the treatment of tinea capitis: a prospective, multicentre study. Br J Dermatol. 2000;142:965–8.

    Article  PubMed  CAS  Google Scholar 

  55. Gupta AK, Scher RK. Management of onychomycosis: a North American perspective. Dermatol Ther. 1997;3:58–65.

    Google Scholar 

  56. Gupta AK, Ryder J, Bluhm R. Onychomycosis. In: Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B, editors. Evidence based dermatology. London: BMJ Books; 2003. p. 441–68.

    Google Scholar 

  57. Tavakkol A, Fellman S, Kianifard F. Safety and efficacy of oral terbinafine in the treatment of onychomycosis: analysis of the elderly subgroup in Improving Results in Onychomycosis-Concomitant Lamisil® and Debridement (IRONCLAD®), an open-label, randomized trial. Am J Geriatr Pharmacother. 2006;4:1–13.

    Article  PubMed  CAS  Google Scholar 

  58. Potter LP, Mathias SD, Raut M, et al. The impact of aggressive debridement used as an adjunct therapy with terbinafine on perceptions of patients undergoing treatment for toenail onychomycosis. J Dermatolog Treat. 2007;18:46–52.

    Article  PubMed  CAS  Google Scholar 

  59. Daniel CR III. Traditional management of onychomycosis. J Am Acad Dermatol. 1996;35:S21–5.

    Article  PubMed  Google Scholar 

  60. King B. Pain at first dressing change after toenail avulsion: the experience of nurses, patients and an observer: 1. J Wound Care. 2003;12:5–10.

    PubMed  CAS  Google Scholar 

  61. Seebacher C, Brasch D, Abeck O, et al. Onychomycosis. Mycoses. 2007;50:321–7.

    Article  PubMed  CAS  Google Scholar 

  62. Baran R, Hay RJ, Haneke E, Tosti A. Review of current antifungal treatment. Onychomycosis: the current approach to diagnosis and therapy. London: Martin Dunitz Ltd.; 1999. p. 44–69.

    Google Scholar 

  63. Hay RJ, Baran R, Haneke E. Fungal (onychomycosis) and other infections involving the nail apparatus. In: Baran R, Dawber RPR, de Berker DAR, Haneke E, Tosti A, editors. Baran and Dawber’s diseases of the nails and their management. Osney Mead, Oxford: Blackwell Science Ltd.; 2001. p. 129–71.

    Chapter  Google Scholar 

  64. Grover C, Bansal S, Nanda S, et al. Combination of surgical avulsion and topical therapy for single nail onychomycosis: a randomized controlled trial. Br J Dermatol. 2007;157:364–8.

    Article  PubMed  CAS  Google Scholar 

  65. Baran R, Kaoukhov A. Topical antifungal drugs for the treatment of onychomycosis: an overview of current strategies for monotherapy and combination therapy. J Eur Acad Dermatol Venereol. 2005;19:21–9.

    Article  PubMed  CAS  Google Scholar 

  66. Penlac® Nail Lacquer (ciclopirox) Topical Solution, 8% Prescribing information. Dermik Laboratories (a division of Sanofi-Aventis). Bridgewater, NJ, July 2006.

  67. Gupta AK, Ryder JE, Skinner AR. Treatment of onychomycosis: pros and cons of antifungal agents. J Cutan Med Surg. 2004;8:25–30.

    Article  PubMed  Google Scholar 

  68. Warshaw EM, St Clair KR. Prevention of onychomycosis reinfection for patients with complete cure of all 10 toenails: results of a double-blind, placebo-controlled, pilot study of prophylactic miconazole powder 2%. J Am Acad Dermatol. 2005;53:717–20.

    Article  PubMed  Google Scholar 

  69. Daniel CR, Gupta AK, Daniel MP, Daniel CM. Two feet-one hand syndrome: a retrospective multicenter survey. Int J Dermatol. 1997;36:658–60.

    Article  PubMed  Google Scholar 

  70. Sigurgeirsson B, Elewski BE, Rich PA, et al. Intermittent versus continuous terbinafine in the treatment of toenail onychomycosis: a randomized, double-blind comparison. J Dermatolog Treat. 2006;17:38–44.

    Article  PubMed  CAS  Google Scholar 

  71. Finch JJ, Warshaw EM. Toenail onychomycosis: current and future treatment options. Dermatol Ther. 2007;20:31–46.

    Article  PubMed  Google Scholar 

  72. Olafsson JH, Sigurgeirsson B, Baran R. Combination therapy for onychomycosis. Br J Dermatol. 2003;149(Suppl 65):15–8.

    Article  PubMed  CAS  Google Scholar 

  73. Evans EGV. Drug synergies and the potential for combination therapy in onychomycosis. Br J Dermatol. 2003;149(Suppl 65):11–3.

    Article  PubMed  CAS  Google Scholar 

  74. Nandedkar-Thomas MA, Scher RK. An update on disorders of the nails. J Am Acad Dermatol. 2005;52:877–87.

    Article  PubMed  Google Scholar 

  75. Gupta AK, Onychomycosis Combination Therapy Study Group. Ciclopirox topical solution, 8% combined with oral terbinafine to treat onychomycosis: a randomized, evaluator-blinded study. J Drugs Dermatol. 2005;4:481–5.

    PubMed  Google Scholar 

  76. Baran R. Topical amorolfine for 15 months combined with 12 weeks of oral terbinafine, a cost-effective treatment for onychomycosis. Br J Dermatol. 2001;145(Suppl 60):15–9.

    PubMed  CAS  Google Scholar 

  77. Lecha M. Amorolfine and itraconazole combination for severe toenail onychomycosis: results of an open randomized trial in Spain. Br J Dermatol. 2001;145(Suppl 60):21–6.

    PubMed  CAS  Google Scholar 

  78. Binstock JM. Molecular biology techniques for identifying dermatophytes and their possible use in diagnosing onychomycosis in human toenails. J Am Podiatr Med Assoc. 2007;97:134–44.

    PubMed  Google Scholar 

  79. de Assis Santos D, de Carvalho Araujo RA, Kohler LM, et al. Molecular typing and antifungal susceptibility of Trichophyton rubrum isolates from patients with onychomycosis pre- and post-treatment. Int J Antimicrob Agents. 2007;29:563–9.

    Article  PubMed  CAS  Google Scholar 

  80. Brillowska-Dabrowska A, Saunte DM, Arendrup MC. Five-hour diagnosis of dermatophyte nail infections with specific detection of Trichophyton rubrum. J Clin Microbiol. 2007;45:1200–4.

    Article  PubMed  CAS  Google Scholar 

  81. Savin C, Huck S, Rolland C, et al. Multicenter evaluation of a commercial PCR-enzyme-linked immunosorbent assay diagnostic kit (Onychodiag) for diagnosis of dermatophytic onychomycosis. J Clin Microbiol. 2007;45:1205–10.

    Article  PubMed  CAS  Google Scholar 

  82. Gupta AK, Zaman M, Singh J. Fast and sensitive detection of Trichophyton rubrum DNA from the nail samples of patients with onychomycosis by a double-round polymerase chain reaction-based assay. Br J Dermatol. 2007;157:698–703.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Aditya K. Gupta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gupta, A.K., Cooper, E.A. Update in Antifungal Therapy of Dermatophytosis. Mycopathologia 166, 353–367 (2008). https://doi.org/10.1007/s11046-008-9109-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-008-9109-0

Keywords

Navigation