From the Guidelines
Skin fungal infections can be effectively treated with antifungal medications, with terbinafine being the preferred treatment option due to its high cure rates and low relapse rates, as supported by the most recent and highest quality study 1.
Treatment Options
- For common infections like athlete's foot, ringworm, or jock itch, start with topical antifungals such as clotrimazole (Lotrimin), miconazole (Micatin), or terbinafine (Lamisil) applied twice daily for 1-4 weeks.
- For more severe or widespread infections, oral medications like fluconazole (150-300mg weekly), itraconazole (200mg daily), or terbinafine (250mg daily for 2-6 weeks) may be necessary.
Prevention and Management
- Keep the affected area clean and dry, as fungi thrive in warm, moist environments.
- Wear loose-fitting clothing and change socks and underwear daily.
- Avoid sharing personal items like towels or shoes that could spread the infection.
Important Considerations
- If symptoms worsen, show no improvement after two weeks of treatment, or if you have diabetes or a weakened immune system, consult a healthcare provider promptly as you may need stronger prescription treatments.
- Terbinafine has been shown to be superior to itraconazole for dermatophyte onychomycosis, with cure rates of 80–90% for fingernail infection and 70–80% for toenail infection, as reported in the study 1.
- Itraconazole may be considered as an alternative treatment option, particularly for nondermatophyte moulds, as it has broader antimicrobial coverage, as noted in the study 1.
From the Research
Types of Antifungal Agents
- The four main classes of antifungal drugs are the polyenes, azoles, allylamines, and echinocandins 2
- Clinically useful "older" agents include topical azole formulations, first-generation triazoles, amphotericin B formulations, and terbinafine 2
- Clinically important "newer" agents include members of the echinocandin class and second-generation triazoles, such as voriconazole and posaconazole 2
Treatment of Skin Fungal Infections
- Topical therapies work well to rid the skin of topical fungi and yeasts, with azole drugs being fungistatic and allylamines being fungicidal 3
- Fungicidal drugs are often preferred over fungistatic drugs for treatment of dermatophytic fungal infections, as they can provide high cure rates with short treatment times 3
- Yeast infections, such as those caused by Candida albicans, respond less well to allylamine drugs and are often treated with azole drugs 3
New Generation Azole Antifungals
- New generation azoles, such as voriconazole, posaconazole, fosravuconazole, and oteseconazole, may be considered for off-label use in cases where traditional agents are ineffective or cannot be used 4
- Antifungal stewardship should be the top priority when prescribing new-generation azoles, with first-line antifungal therapy being terbinafine and itraconazole 4
Topical Delivery of Antifungal Drugs
- Topical treatment of fungal infections has proven to be advantageous due to factors such as targeting the site of infection, minimizing systemic side effects, and improved patient compliance 5
- Novel delivery carriers, such as nanoparticulate and vesicular carriers, have been developed to facilitate the delivery of antifungal drugs and improve treatment aspects 5
Alternative Therapies for Onychomycosis and Superficial Fungal Infections
- Posaconazole, fosravuconazole, voriconazole, and oteseconazole are alternative therapies that may be considered for the treatment of onychomycosis and superficial fungal infections 6
- The efficacies of these antifungal agents vary, with posaconazole and fosravuconazole showing high complete cure and mycologic cure rates for dermatophyte great toenail onychomycosis treatment 6