Fungal Skin Disease (Tinea, Dermatophytosis): Drug Therapy

Therapeutic target

• Elimination of the pathogens

Therapy recommendations

• Local therapy with antifungals (antifungal agents; azoles: ketoconazole; hydroxpyridone derivatives: ciclopiroxolamine) for localized, uncomplicated tinea corporisNote: Topical therapy alone (local therapy) of tinea capitis is not sufficient!
• Tinea capitis: combination of local therapy and systemic therapy:
  • Local therapy: shampoos containing selenium (di)sulfide (1%), ciclopirox (1%), clotrimazole (2%), or ketoconazole (2%).
  • Systemic therapy (orientation to the pathogen detected):
    • Microsporum/Nannizzia spp. (esp. M. audouinii, M. canis, N. gypsea): griseofulvin or itraconazole.
    • Trichophyton species: primarily terbinafine.
• Fungal disease in the genital area (see also under vulvitis / inflammation of the external genital and vaginitis / vaginitis).
  • Local therapy:
    • Nystatin (spectrum of activity: all relevant Candida species; in contrast to clotrimazole or miconazole, also germs such as C. glabrata and C. krusei).
    • Chlorhexidine (spectrum of activity: bacteria, yeasts, dermatophytes, molds and lipophilic viruses).
    • Combination of the active ingredients nystatin, chlorhexidine and dexamethasone.
  • Systemic therapy
    • Fluconazole (spectrum of activity: C albicans, C africana).
    • Itraconazole (spectrum of activity: C. albicans, C. africana, T. mentagrophytes type VII T. mentagrophytes type VIII, T. benhamiae).
• In severe infection: systemic therapy (azoles: itraconazole or allylamines: terbonafine); griseofulvin is hardly used anymore (only in therapy-resistant dermatophyte infections and after mycological pathogen detection).
• Local therapy should usually be continued for 3-4 weeks beyond cure to avoid recurrence (except terbinafine).

Further notes

• Children with tinea capitis: griseoflulvin and itraconazole.
• Meta-analysis: terbinafine performed better than azoles and griseofulvin as oral therapy for mycosis, resulting in fewer side effects with a similar recurrence rate (disease recurrence).
• During oral antifungal therapy with terbinafine or griseofulvin, there was rarely transaminase elevation, anemia (anemia), lymphopenia (lack of lymphocytes in the blood), or neutropenia (decrease in neutrophil granulocytes in the blood) in liver-healthy children and adults; Laboratory values for aspartate aminotransferase (AST, ASAT; also called glutamate oxaloacetate transaminase (GOT)) and for parameters of anemia, lymphopenia, and neutropenia were similar to those before treatment.