From the Guidelines
Fungal skin infections should be treated with a single 150-mg dose of fluconazole for uncomplicated cases, as recommended by the Infectious Diseases Society of America 1. When it comes to treating fungal skin infections, the goal is to alleviate symptoms, prevent recurrence, and improve quality of life.
- For uncomplicated cases, a single dose of fluconazole is effective, with no need for prolonged treatment 1.
- For recurring cases, induction therapy with a topical or oral azole for 10-14 days, followed by fluconazole at a dosage of 150 mg once per week for 6 months, is recommended 1. Key considerations in treatment include:
- Keeping the affected area clean and dry to prevent fungal growth
- Wearing loose-fitting clothing and changing socks and underwear daily to reduce moisture
- Monitoring symptoms and seeking further evaluation if they don't improve after two weeks of treatment or worsen at any point. It's essential to note that the choice of treatment may vary depending on the severity and type of infection, as well as individual patient factors, but fluconazole remains a first-line treatment option for uncomplicated fungal skin infections 1.
From the FDA Drug Label
- 2 Candidemia in Non-neutropenic Patients and Other Deep Tissue Candida Infections Voriconazole tablets are indicated in adults and pediatric patients (aged 12 to 14 years weighing greater than or equal to 50 kg and those aged 15 years and older regardless of body weight) for the treatment of candidemia in non-neutropenic patients and the following Candida infections: disseminated infections in skin and infections in abdomen, kidney, bladder wall, and wounds
- 5 Usage Specimens for fungal culture and other relevant laboratory studies (including histopathology) should be obtained prior to therapy to isolate and identify causative organism(s). Therapy may be instituted before the results of the cultures and other laboratory studies are known. However, once these results become available, antifungal therapy should be adjusted accordingly.
The treatment for a fungal skin infection may include voriconazole as indicated for disseminated infections in skin, however, specimens for fungal culture and other relevant laboratory studies should be obtained prior to therapy to isolate and identify the causative organism(s) and adjust antifungal therapy accordingly 2.
- Key points:
- Voriconazole is indicated for the treatment of candidemia and deep tissue Candida infections, including disseminated infections in skin.
- Specimens for fungal culture should be obtained prior to therapy.
- Antifungal therapy should be adjusted according to the results of the cultures and other laboratory studies.
From the Research
Treatment Options for Fungal Skin Infections
- Oral antifungal agents such as fluconazole, itraconazole, and terbinafine are effective in treating fungal skin infections, including pityriasis versicolor, tinea corporis, tinea cruris, and tinea pedis 3
- Topical therapies, including azole drugs and allylamines, can also be used to treat fungal skin infections, with fungicidal drugs often preferred over fungistatic drugs for treatment of dermatophytic fungal infections 4
- New generation azole antifungals, such as voriconazole and posaconazole, may be considered for difficult-to-treat skin fungal infections and onychomycosis that have failed traditional treatments 5
Effectiveness of Antifungal Drugs
- A randomized pragmatic trial found that itraconazole was the most effective oral antifungal drug in treating chronic and chronic relapsing dermatophytosis in India, followed by fluconazole, terbinafine, and griseofulvin 6
- A prospective, randomized comparative study found that itraconazole and terbinafine were equally effective and safe in treating tinea cruris and tinea corporis, with itraconazole showing better clinical global improvement 7
Considerations for Treatment
- The choice of antifungal drug and treatment duration may depend on the specific type of fungal infection, its severity, and the patient's medical history and current medications 3, 4, 5
- Antifungal stewardship should be a top priority when prescribing antifungal drugs, with first-line therapies preferred over off-label use of new generation azoles 5