[Modern antimycotics. What the treating physician needs to know].

Area of Science:

• Mycology
• Dermatology
• Pharmacology

Background:

• Dermatophytoses treatment is complex, depending on antimycotic properties, causative agents, and patient factors.
• Treatment success hinges on minimal inhibitory concentration and drug levels within infected tissues.
• Dermatophytes exist as arthrospores in skin, nails, or hair, affecting susceptibility to antifungals.

Purpose of the Study:

• To explore factors influencing the efficacy of antimycotic treatments for dermatophytoses.
• To understand the differential susceptibility of dermatophyte forms to antifungal agents.
• To highlight challenges in treating specific dermatophytoses, such as pediatric tinea capitis.

Main Methods:

• Review of existing literature on dermatophyte susceptibility and antimycotic pharmacokinetics.
• Analysis of drug penetration into various skin layers and appendages.
• Consideration of host factors, including age-related physiological differences (sebaceous gland function).

Main Results:

• Non-proliferating dermatophytes (arthrospores) are less susceptible to antimycotics than proliferating forms.
• Antimycotics targeting ergosterol synthesis are less effective against non-proliferating dermatophytes lacking ergosterol synthesis.
• High concentrations of terbinafine and itraconazole in sebum benefit treatment of infections in stratum corneum and hair follicles.
• Lack of functioning sebaceous glands in preadolescent children complicates pediatric tinea capitis treatment.

Conclusions:

• Dermatophyte morphology and location critically influence treatment outcomes.
• Drug concentration in infected tissues and sebum penetration are key determinants of therapeutic success.
• Patient-specific factors, like age and sebaceous gland activity, necessitate tailored treatment strategies for dermatophytoses.