What treatment is recommended for a fungal infection of the arm?

From the Guidelines

For a fungal infection of the arm, I recommend treating it with fluconazole, 400 mg (6 mg/kg) daily, for 6 weeks, as this is the most effective treatment based on recent guidelines. This treatment is recommended by the Infectious Diseases Society of America in their 2016 clinical practice guideline for the management of candidiasis 1. The guideline suggests that fluconazole is a strong recommendation with low-quality evidence, but it is the most effective treatment available.

Treatment Options

• Fluconazole, 400 mg (6 mg/kg) daily, for 6 weeks is the recommended treatment for fungal infections of the arm, including candidiasis 1.
• An echinocandin, such as caspofungin 50–70 mg daily, micafungin 100 mg daily, or anidulafungin 100 mg daily, for 2 weeks followed by fluconazole, 400 mg (6 mg/kg) daily, for at least 4 weeks is also an option, but it is not as effective as fluconazole alone 1.
• Lipid formulation AmB, 3–5 mg/kg daily, for 2 weeks, followed by fluconazole, 400 mg (6 mg/kg) daily, for at least 4 weeks is a less attractive alternative, but it can be used in certain cases 1.

Important Considerations

• Surgical drainage is indicated in all cases of septic arthritis, including fungal infections of the arm 1.
• If the infection involves a prosthetic device, device removal is recommended, and chronic suppression with fluconazole, 400 mg (6 mg/kg) daily, is necessary if the device cannot be removed 1.
• It is essential to keep the infected area clean and dry, as fungi thrive in warm, moist environments, and to avoid sharing towels or personal items that may contact the affected area to prevent spreading the infection.
• If the infection doesn't improve after two weeks of treatment, shows signs of bacterial infection, or if you have diabetes or a weakened immune system, consult a healthcare provider promptly, as these conditions can affect the treatment outcome 2.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment Options for Fungal Infections of the Arm

The treatment for fungal infections of the arm can vary depending on the type and severity of the infection.

• Topical antifungal agents, such as azole formulations, can be effective for superficial yeast and dermatophyte infections 3.
• Oral antifungal agents, such as terbinafine and itraconazole, can be used to treat more severe or extensive infections 4, 5.
• Combination therapy, using both topical and oral antifungal agents, may be necessary for recalcitrant or severe infections 5.

Specific Treatment Recommendations

• For tinea corporis and cruris infections, treatment with an azole or allylamine medication for 2-4 weeks is usually effective 6.
• For more severe or extensive infections, oral terbinafine or itraconazole may be necessary, with treatment durations ranging from 4-12 weeks 4, 5, 7.
• The use of combination antifungal therapy, such as terbinafine and itraconazole, may be beneficial for recalcitrant infections, but further studies are needed to confirm its efficacy 5.

Considerations for Treatment

• The choice of antifungal agent and treatment duration should be based on the severity and extent of the infection, as well as the presence of any underlying medical conditions 3, 6.
• Topical antifungal agents with inherent anti-inflammatory properties or combination antifungal/steroid agents may be necessary for infections with significant inflammation 6.
• Oral terbinafine doses of 250 mg or 500 mg daily may be effective for treating tinea corporis and cruris, but higher doses do not appear to offer additional benefits 7.