Fitzpatrick’s Therapeutics: A Clinician’s Guide to Dermatologic Treatment

Chapter 138: Superficial Fungal Infections

Christina Hopkins; Usman Asad; Ted Rosen

SUPERFICIAL FUNGAL INFECTIONS

Therapeutic Approach

Superficial fungal infections of the skin and nails are a common dermatologic complaint globally.¹

Topical therapies are generally used as first-line treatments for uncomplicated, superficial fungal infections given their efficacy and relatively safe adverse effect profiles. Systemic therapies are used for the treatment of tinea capitis, onychomycosis, and other recalcitrant superficial fungal infections.² See Table 138-1.

Table 138-1Superficial Fungal Treatment Table^a

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Table 138-1 Superficial Fungal Treatment Table^a

MEDICATION NAME

INDICATION

MECHANISM OF ACTION

DOSING

ADVERSE EFFECTS (% PATIENTS AFFECTED)

SUGGESTED MONITORING

LEVEL OF EVIDENCE (REFERENCE)

Topical Treatment

Nystatin

CC^a

Binds irreversibly to membrane sterols

Cream, ointment, powder; BID

Burning, eczema, pain w/appl, pruritus, rash (<0.1%). Rarely HS rxn

None

CC: IB³

Miconazole

TP,^a Tcor,^a Tcru,^a TV,^a CC^a

Block biosynthesis of ergosterol via inhibition of lanosterol 14α-demethylase, a cytochrome p450-dependent enzyme. This results in dysfunction of the fungal cell membrane.

2% cream, gel, powder, solution, spray; BID for all except QD in TV

Rare burning, irritation, maceration, allergic dermatitis at application site

None

TP: IB^4,5

Tcor,cru: IB⁵

TV: IB⁶

CC: IB³

Clotrimazole

TP,^a Tcor,^a Tcru,^a TV,^a CC^a

1% cream, 1% lotion, 1% solution; BID

Rare burning, blistering edema, erythema, irritation, peeling, pruritus, stinging, urticaria w/appl

None

TP: IB⁷

Tcor,cru: IB⁸

TV: IB⁹

CC: IB³

Ketoconazole

TP,^a Tcor,^a Tcru,^a TV,^a CC^a

2% cream; QD

Irritation, pruritus, stinging; rarely allergic rxn or contact dermatitis at application site

None

TP, Tcor,Tcru: IB¹⁰

TV: IA¹¹

CC: IB¹⁰

SD^a

2% cream, 2% foam; QD

2% shampoo, 1% OTC shampoo; twice weekly

SD: IA¹²

Econazole

TP,^a Tcor,^a Tcru,^a TV,^a CC^a

1% cream, 1% foam; QD

Burning, erythema, pruritus, stinging (3%), application site rx (<1%)

None

TP, Tcor,Tcru: IB¹³

TV: IB¹⁴

CC: IB¹⁵

Oxiconazole

TP,^a Tcor,^a Tcru,^a TV^a

1% cream, 1% lotion, QD or BID

Burning, pruritus (<2%), erythema, fissuring, irritation, maceration (<1%)

None

TP, Tcor, Tcru: IB¹⁶

TV: IB¹⁷

Sulconazole

TP,^a Tcor,^a Tcru,^a TV^a

1% cream, 1% solution; QD or BID

Rarely allergic contact dermatitis

None

TP: IB¹⁸

Tcor,Tcru: IB¹⁹

TV: IB⁶

Sertaconazole

Interdigital TP^a

2% cream; BID

Rarely allergic contact dermatitis

None

IB²⁰

Luliconazole

Interdigital TP^a

1% cream; QD 2wk

Rarely cellulitis and contact dermatitis (<1%)

None

IA²¹

Tcor,^a Tcru^a

1% cream; QD 1wk

None

Efinacon-azole

Dermatophyte toenail OM^a

10% soln; QD 48wk

Primarily application site reactions (2%)

None

IA²²

Naftifine

TP,^a Tcor,^a Tcru^a

Block synthesis of ergosterol ...

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Chapter 138: Superficial Fungal Infections

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SUPERFICIAL FUNGAL INFECTIONS

Therapeutic Approach

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