Abstract
Treatment of superficial fungal infections has come a long way. This has, in part, been through the development and evaluation of new drugs. However, utilising new strategies, such as identifying variation between different species in responsiveness, e.g., in tinea capitis, as well as seeking better ways of ensuring adequate concentrations of drug in the skin or nail, and combining different treatment methods, have played equally important roles in ensuring steady improvements in the results of treatment. Yet there are still areas where we look for improvement, such as better remission and cure rates in fungal nail disease, and the development of effective community treatment programmes to address endemic scalp ringworm.
Highlights
Fungal infections of the skin and its adnexal structures, such as hair and nails, are common in all regions of the world
The results of medical treatment of most dermatophyte infections affecting the skin are excellent, with cure rates ranging from 80–90%, and there is a correspondingly wide range of antifungal agents in use as both topical or oral formulations [1,2,3,4]
Itraconazole is active against a wide range of dermatophytes, and is effective in regimens of 100 mg for 2 weeks in tinea cruris and corporis, or 30 days in dry type tinea pedis [23]
Summary
Fungal infections of the skin and its adnexal structures, such as hair and nails, are common in all regions of the world. The course to modern treatment has not been without its problems, the complications, commonly encountered amongst antibacterials, drug resistance, have not had a major impact on the currently used antifungals, with the possible exception of the superficial Candida infections, where azole resistance is well recognised. The rise of Candida auris as a pathogen, which is frequently multidrug resistant, is a further worry, to date, it has not had a major impact on skin infection, but superficial carriage is well documented. Drug toxicity is not a major problem, when encountered, even rarely, in the context of the management of non-life-threatening conditions, it presents a particular dilemma in risk management. The risk benefit ratio is different to that encountered with systemic mycoses; the withdrawal of recognition of oral ketoconazole for the treatment of superficial infections by regulatory authorities in Europe and the United States illustrates the point
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