Is oral fluconazole (Diflucan) 150 mg every 5 days and topical clotrimazole (Lotrimin) 1% cream twice daily effective for extensive balanitis?

From the Guidelines

For extensive Baal, I strongly recommend against prescribing oral difucan 150 mg once every 5 days for 2 times and topical lotrimin 1% cream bid, as the evidence suggests a single 150-mg dose of fluconazole is recommended for the treatment of uncomplicated Candida VVC 1. Instead, consider the following treatment approach:

• A single 150-mg dose of fluconazole for the treatment of uncomplicated Candida VVC, as recommended by the Infectious Diseases Society of America 1.
• For recurring Candida VVC, 10–14 days of induction therapy with a topical or oral azole, followed by fluconazole at a dosage of 150 mg once per week for 6 months, is recommended 1.
• Topical lotrimin 1% cream can be used for nongenital mucocutaneous candidiasis, but the recommended treatment duration is 7–14 days 1. It's essential to note that the treatment approach should be based on the specific condition being treated, and the recommended dosages and durations should be followed to ensure effective treatment and minimize the risk of adverse effects. When applying the cream, ensure the skin is clean and dry, and cover all affected areas completely. Be aware that skin color changes may persist for weeks or months after successful treatment of the infection itself. In addition, it's crucial to monitor for potential side effects and adjust the treatment plan as needed. The antifungal medications work by disrupting the fungal cell membrane, preventing further growth and eventually eliminating the infection. For optimal results, continue the topical treatment for at least 2-4 weeks, even if symptoms improve sooner. This dual approach is effective because tinea versicolor is caused by Malassezia yeasts that normally live on skin but can overgrow under certain conditions.

From the Research

Treatment of Extensive Tinea Infections

• The treatment of extensive tinea infections may require systemic antifungal therapy, especially if the infection covers a large area or is resistant to topical treatment 2, 3.
• Oral antifungal agents such as terbinafine and itraconazole may be indicated for extensive disease, failed topical treatment, immunocompromised patients, or severe moccasin-type tinea pedis 3.
• The use of oral difucan (fluconazole) 150 mg once every 5 days for 2 times, in combination with topical lotrimin 1% cream bid, may be considered for the treatment of extensive tinea infections, although the specific dosage and treatment duration may vary depending on the individual case and the severity of the infection.

Efficacy of Antifungal Agents

• Itraconazole has been shown to be more effective than terbinafine in the treatment of tinea infections, with higher cure rates at 4 and 8 weeks 4.
• The combination of oral terbinafine and itraconazole therapy may be an effective and safe therapeutic strategy in the management of dermatophytosis, with maximum clinical and mycological cure achieved in patients receiving combination therapy 5.
• The standard treatment of tinea corporis is with topical antifungals, but systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient 6.

Considerations for Treatment

• The diagnosis of tinea corporis is usually clinical, but may be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids, and may require confirmation by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings or fungal culture 2, 6.
• Treatment should continue for at least one week after clinical clearing of infection, and prolonged duration of treatment may be required for complete cure 2, 4.