Superficial mycoses

Naftifine. Nafdfine (8) belongs to the aHylamines, a new class of antimycotics (14). It is used to treat superficial mycoses and is particularly active against dermatophytes. 

Ketoconazole. Initial observations indicating that oral administration of ketocona2ole (10) produced good results in seborrheic ec2ema and dandruff, led to the development of a 2% cream and a 2% shampoo (scalp gel) of this antimycotic (17,18). Naturally, these two topical forms of ketocona2ole [65277-42-1] are highly active against superficial mycoses. 

All three of these are dermatophytes, i.e. filamentous fungi which can utilize keratin for their nutrition. Keratin is the chief protein in skin, hair and nail. Hence, all of these organisms are responsible for superficial mycoses in mammals. It is often stated that dermatophytes are the only fungi to have evolved which rely upon infection for then-own survival. This mistaken belief results from a view which is too human-centred and neglects, for example, the presence of symbiotic fungi in the stomachs of ruminants. 

The so-called superficial mycoses are characterized by invasion restricted to the stratum comeum and thus are usually not associated with a remarkable inflammatory response of the host. 

Assaf RR, Weil ML The superficial mycoses. Dermatol Clin 1996 14 57-67. 

Lackner TE, Clissold SP. Bifonazole. A review of its antimicrobial activity and therapeutic use in superficial mycoses. Drugs 1989 38(2) 204-25. 

Balfour JA, Faulds D. Terbinafine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial mycoses. Drugs 1992 43(2) 259-84. Erratum in Drugs 1992 43(5) 699. 

There are a number of nonspecific topical drugs, some some of which have been in use for most of this century. Early therapy of superficial mycoses utilized topical fungicides such as salicylic acid, salicylanilide, iodine tincture, and even weak fungistatic compounds such as benzoic acid. Salicylic acid is mainly a keratolytic agent that also removes the softened, loosened infected epithelial layers. In combination with benzoic acid (Whitfield s ointment), it has been a useful product for years. 

A plethora of topical agents is available for the treatment of superficial mycoses, the preferred formulations of which usually are creams or solutions. Powders, whether applied by shake containers or aerosols, largely are used for the feet and moist lesions of the groin and other intertriginous areas. 

Many fungi are able to infect man, provoking common superficial mycoses or subcutaneous and systemic infections. Dermatophytoses, candidosis and pityriasis versicolor are the most common cutaneous mycoses systemic mycoses such as cryptococcosis are also of prime importance in some parts of the world. In the following sections, we refer only to mycotic infections that are provoked or significantly worsened by the work environment. 

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