Antifungal azoles for skin disorders

Abstract

The output from the pharmaceutical industry of new antifungals to treat superficial infections over the last decade has been limited. Notwithstanding the fact that the need to combat life-threatening deep fungal infections is of great importance, there remains an unmet need for compounds to treat superficial infections, especially chronic ones such as onychomycosis and tinea capitis. Azoles still have a pivotal role to fulfill. Both new azole derivatives, with a favourable risk–benefit ratio, and new formulations of older azoles are currently under development in various companies. In the search for novel properties to make azoles attractive, special attention has been paid to mechanisms of action ancillary to the well known ergosterol biosynthesis inhibition and broadened the activity spectrum, including other microorganisms, more favourable pharmacokinetics, fewer drug–drug interactions and more acceptable irritation profiles for drugs intended for topical application. The most recent list of new azoles in early and late clinical development is given in this review, preceded by an overview of presently used medications to treat fungal infections of the skin.