Do today's therapies provide perfect solutions to fungal skin infections?

Abstract

Dermatophyte infections are common superficial infections. The prevalence of tinea capitis has remained static in many parts of the world, but has increased in cities in the UK. While short and effective treatments are available for most of the common infections, treatment for tinea capitis is still suboptimal. To improve therapy of all dermatophyte infections requires prediction of which subtypes of infection require different durations of treatment, different drugs or, in the case of nail infections, a combination of nail surgery and chemotherapy. In the case of yeast infections, treatment of cutaneous candidosis is highly satisfactory, while Malassezia yeasts are associated with high relapse rates even after treatment has apparently been successful.Although laboratory diagnosis of superficial mycoses is regarded as being satisfactory and an essential prerequisite of treatment, failure rates with onychomycosis and tinea capitis are very high. There is, therefore, a need to improve laboratory diagnosis of fungal infections. This may involve introducing new but simple tests or providing diagnostic algorithms which perform better than current methods. The synergetic and additive effects of different antifungals, such as terbina-fine and the azoles, may improve treatment responses for infections that respond poorly, or for shortening the duration of therapy still further in others. (J Dermatol Treat (1998) 9(Suppl 1): S17–S21)