Tinea infection treatment

Treatment is typically initiated based on symptoms, rather than on microscopic evaluation. Since several species can cause tinea infections, the choice of antifungal agent is not always clear. For infections accompanied by inflammation, combination therapy with a topical steroid can be considered. 

Nonprescription topical antifungal agent not effective in the treatment of deeper fungal infections of the skin, nor is it reliable in the treatment of fungal infections involving the scalp or nail beds Candida is resistant useful for patients desiring self-medication of mild tinea infections patients must be advised of limitations... 

Cyclopirox olamine is used in the treatment of tinea infections, dermal and vaginal candidiasis. 

Tolnaftate (Aftate, Tinactin) is available as a cream, solution, powder, or powder aerosol for application twice daily to infected areas. Recurrences following cessation of therapy are common, and infections of the palms, soles, and nails are usually unresponsive to tolnaftate alone. The powder or powder aerosol may be used chronically following initial treatment in patients susceptible to tinea infections. Tolnaftate is generally well tolerated and rarely causes irritation or allergic contact sensitization. 

Antifungal spectrum The drug is principally fungistatic. It is effective only against the dermatophytes—Trichophyton. Microsporum. and Epidermophyton. It is used in the treatment of severe tinea infections that do not respond to other antifungal agents. 

Haloprogin, USP. 3-lodo-2-propynyl-2.4,5-trichloro-phenyl ether (Halotcx) crystallizes as white to pale yellow forms that are sparingly soluble in water and very soluble in ethanol. It is an ethereal derivative of a phenol. Haloprogin is used as a 1% cream for the treatment of superficial tinea infections. Formulations of haloprogin should be protected... 

Econazole is used as a 1% cream for the topical treatment of local tinea infections and cutaneous candidiasis. 

Sulconazole Nitrate, U5P. l-[2.4-Dichlon>- y>-chlor-ohenzyl)thio phenethyl imidazole mononitrate (Exelderm) is the white crystalline nitric acid salt of. sulconazole. It is sparingly. soluble in water but soluble in ethanol. The salt is used in a solution and a cream in 1% concentration for the treatment of local tinea infections, such as jock itch, athlete s foot, and ringworm. 

Miconazole nitrute is supplied in a variety of dosage fonns (cream, lotion, powder, and spray) for the treatment of tinea infections and cuiiineous candidiasis. Vaginal creams and. suppositories are also available for the treatment of vaginal candidiasis. A conceiiiraiion of 2% of the salt is u.sed in moii topical preparations. 

Tinea cruris is an infection of the proximal thighs and buttocks." It is referred to as jock itch and is more common in males. The scrotum and penis often are spared from infection. Treatment with topical therapy is recommended and shonld continne for 1 to 2 weeks after symptom resolntion. Severe infections may reqnire oral therapy (see Table 118-8). Relief of pruritus and burning may be facilitated by the use of short-term (2 to 3 days) topical steroids (2.5% hydrocortisone)." ... 

Dermatophyte fungi are moulds that spedfically infect the keratinised layers of the skin by virtue of their ability to degrade keratin. Three genera, Epidermophyton, Miao-sporum and Trichophyton, are responsible for causing ringworm or tinea infections (dermatophytosis). Griseofulvin is used exclusively for the oral treatment of dermatophyte infections where topical therapies have failed or are inappropriate. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

Ciclopirox olamine (Loprox) is a pyridone derivative available for the treatment of cutaneous dermatophyte infections, cutaneous C. albicans infections, and tinea versicolor caused by Malassezia furfur. It interferes with fungal growth by inhibiting macromolecule synthesis. 

Tolnaftate (Tinactin, others) is a nonprescription antifungal agent effective in the topical treatment of dermatophyte infections and tinea. The mechaitism of action is unknown. 

The two azoles most commonly used topically are clotrimazole and miconazole several others are available (see Preparations Available). Both are available over-the-counter and are often used for vulvovaginal candidiasis. Oral clotrimazole troches are available for treatment of oral thrush and are a pleasant-tasting alternative to nystatin. In cream form, both agents are useful for dermatophytic infections, including tinea corporis, tinea pedis, and tinea cruris. Absorption is negligible, and adverse effects are rare. 

Blumer JL. Pharmacologic basis for the treatment of tinea capitis. Pediatr Infect Dis J 1999 18(2) 191-9. 

Itraconazole 100 mg/day has been studied in 24 children with Trichophyton tonsurans tinea capitis (51). Itraconazole was well tolerated, but 15 children required re-treatment due to persistent infection. 

Collectively, the dermatophytoses are called tinea, or ring-nvim. Since these infections tend to be topical, their treatment has been directed to surface areas of the skin. The. skin is a formidable barrier to drug penetration, and many of the topical agents work best if an adjuvant is added that opens the barrier function of the. skin. Keratolytic agents such as silicylic acid or other o-hydroxy compounds perform this lonclion reasonably well. 

Data is also available suggesting efficacy of topical garlic on fungal infections. For tinea pedis, 1-week topical treatment with ajoene 1% twice daily resulted in mycological cure 60 days later in 100% of patients, compared to 94% for 1% topical terbinafine and 72% for 0.6% topical ajoene (43). Another study showed that 0.6% topical ajoene was as effective as 1% terbinafine cream, both applied twice daily for 1 week, for the treatment of tinea cruris and corposis. After 60 days, effectiveness (clinical plus mycological cure) was 73 vs 71 %,respectively (44). In addition, a0.4% cream was also shown to be effective (45). Although a topical preparation is not available commercially, it could likely be compounded. 

Indications Anticancer (stomach, colorectal, lung, prostate), arthritis, asthma, heart disease, HIV inhibitor. Treatment of dandruff, fungal infections (tinea versicolor), and seborrhea Category Antioxidant Trace element... 

Salicylic acid (3) has kertolytic properties and is applied topically in the treatment of hyperkeratic and scaling skin conditions such as dandruff, ichthyosis, and psoriasis. Initially a concentration of about 2% is used, increased to about 5% if necessary. It is often used in conjunction with many other agents, such as benzoic acid, coal tar, resorcinol, and sulpher. Salicylic acid is also used in the form of a paint in a collodion basis (10 to 14%) or as a plaster (20 to 250%) to destroy warts or corns. It also possesses fungicidal properties and is used topically in the treatment of such fungal skin infections as tinea. 

Topical agents are first-line agents for fungal skin infections. Exceptions are for the treatment of extensive or severe infection or those of tinea capitis or onychomycosis. Oral therapy is preferred in such situations. 

A general approach to treatment of superficial mycotic infections includes keeping the infected area dry and clean and limiting exposure to the infected reservoir. Topical agents generally are considered to be first-line therapy for infections of the skin. Oral therapy is preferred when the infection is extensive or severe or when treating tinea capitis or onychomycosis." " Table 118-8 lists spe-... 

Tinea pedis is the most common dermatophytoses (affecting approximately 70% of adults). It is better known as athletes foot and occurs in hot weather, with exposure to surface reservoirs (locker room floors), and with use of occlusive footwear." Treatment with topical therapy for 2 to 4 weeks often is adequate for mild infections however, severe infections or involvement of the nails requires oral therapy (see Table 118-8). Recurrence of infection occurs in up to 70% of individuals. Prolonged treatment with either topical or systemic therapy may be required." " ... 

Tinea manuum usually involves the palmar surface of the hands, is unilateral, and may involve the feet. Treatment of this infection is similar to tinea pedis (see Table 118-8). Emollients that contain lactic acid also may be useful." ... 

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