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Antifungal therapy of yeast infections
1Department of Dermatology, United Medical Schools, Guy's Hospital, London, United Kingdom.
Abstract:
Candida infections of the skin and mucous membranes are common in both healthy and immunocompromised patients. Management with topical azole or polyene therapy is generally straightforward except in immunocompromised patients with oropharyngeal infections and in Candida onychomycosis. Oral candidosis in patients with AIDS generally requires oral therapy with fluconazole, itraconazole, or ketoconazole. Continuous suppressive therapy carries the risk of the development of clinical tolerance or secondary drug resistance. In nail disease, oral antifungal therapy is appropriate except in paronychia, for which topical azole antifungals appear to be equally effective. In any case it is important to determine whether Candida isolated from nail material is a true nail pathogen or merely colonizing the nail plate. Distal erosion of the nail plate, the presence of underlying host abnormalities such as Raynaud's disease, and hyphae in the nail plate are clues that organism is invading the nail plate.
Insights
Managing common Candida infections, especially in immunocompromised individuals, requires careful antifungal selection. Oral therapies are key for oropharyngeal and nail infections, but resistance is a concern.
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Candida species commonly cause skin and mucous membrane infections in diverse patient populations.
- Topical azole or polyene treatments are standard for uncomplicated cases.
- Immunocompromised patients, particularly those with oropharyngeal infections or onychomycosis, present management challenges.
Purpose of the Study:
- To review the management strategies for Candida infections, focusing on challenging cases.
- To highlight the role of oral antifungal agents in specific Candida infections.
- To discuss the implications of drug resistance and colonization versus true infection.
Main Methods:
- Literature review of antifungal therapies for Candida infections.
- Analysis of treatment guidelines for oropharyngeal candidosis and onychomycosis.
- Discussion of diagnostic considerations in nail infections.
Main Results:
- Oral antifungal therapy (fluconazole, itraconazole, ketoconazole) is indicated for oral candidosis in AIDS patients.
- Oral antifungals are appropriate for nail infections, with topical azoles effective for paronychia.
- Distinguishing true nail pathogens from colonizers requires clinical and mycological assessment.
Conclusions:
- Effective management of Candida infections, particularly in immunocompromised hosts, necessitates appropriate antifungal selection.
- Continuous suppressive therapy for Candida infections carries a risk of developing drug resistance.
- Accurate diagnosis, differentiating colonization from invasion, is crucial for successful treatment of nail candidosis.