Current therapy of dermatophytosis

In the past dermatophytes were treated with topical agents or, in the case of more recalcitrant or extensive disease, with oral antifungals (griseofulvin or ketoconazole). Topical therapies may be effective in many cases, but they have limitations. They may be viewed as inconvenient by the patient, thereby affecting compliance. Therapy with early oral antifungals entails long treatment periods until complete cure is obtained. For ketoconazole rare but serious side effects can occur, particularly with prolonged use. Griseofulvin is still the drug of choice for the treatment of tinea capitis of the Microsporum type. In recent years a few new antimycotic agents have been developed for systemic therapy of superficial fungal infections. Itraconazole is a broad-spectrum triazole. Fluconazole belongs to the same chemical class and was used mainly in systemic yeast infections and mucosal candidosis. Terbinafine is an allylamine and has been found to be effective and safe in brief therapy of dermatophyte infections. Short-duration therapy of most dermatophyte infections is also possible with itraconazole. The high and specific activity against the causative agents, together with their pharmacokinetic properties, explains the good results obtained with these new drugs and their improved safety profile. Their mode of action, pharmacokinetics, and treatment schedules will be discussed.