[Dermatomycoses: topical and systemic antifungal treatment]

Area of Science:

• Dermatology
• Mycology
• Pharmacology

Background:

• Fungal infections, including those caused by dermatophytes and yeasts, are common and require effective antifungal therapies.
• Topical and oral antifungal medications are the mainstay of treatment, with various classes available for different types of infections.
• Emerging challenges include antifungal resistance, necessitating accurate diagnosis and tailored treatment strategies.

Purpose of the Study:

• To provide a comprehensive overview of current antifungal therapies for superficial fungal infections.
• To highlight the importance of species and genotype identification in guiding treatment decisions, particularly in cases of resistance.
• To discuss alternative and emerging treatment modalities for refractory fungal infections.

Main Methods:

• Review of existing literature on topical and oral antifungal agents.
• Analysis of treatment guidelines for common fungal infections like candidiasis, pityriasis versicolor, dermatophytoses, tinea capitis, and onychomycosis.
• Inclusion of information on drug resistance patterns and alternative therapies such as laser and photodynamic therapy.

Main Results:

• Topical antifungals (e.g., amorolfine, azoles) are effective for dermatophyte infections, while polyenes (e.g., nystatin) are used for yeast infections.
• Oral triazoles (e.g., fluconazole, itraconazole) are reserved for severe yeast infections and systemic dermatophytoses like tinea capitis and onychomycosis.
• Terbinafine resistance in certain *Trichophyton* species (e.g., *T. mentagrophytes* ITS genotype VIII, *T. rubrum*) necessitates resistance testing and alternative treatments like itraconazole.

Conclusions:

• Accurate identification of fungal species and resistance testing are critical for successful treatment of superficial mycoses.
• Combination therapy with oral and topical antifungals is generally recommended.
• Emerging therapies like laser and photodynamic therapy offer alternatives for treatment-refractory cases.