Fluconazole Dosing for Skin Fungal Infections
For cutaneous candidiasis (skin yeast infections), fluconazole 50-150 mg daily for several weeks achieves over 90% clinical cure or improvement, while dermatophyte infections (tinea corporis/cruris) respond to 50-100 mg daily or 150 mg once weekly for 2-3 weeks. 1, 2
Specific Dosing by Skin Infection Type
Cutaneous Candidiasis (Yeast Infections of Skin)
- Standard dose: 50-150 mg daily for weeks to months, depending on severity and extent of involvement 1
- Clinical cure or improvement exceeds 90% with this regimen 1
- Response may be delayed when there is extensive skin involvement 3
Dermatophyte Infections (Tinea Corporis/Cruris)
- Option 1: 50-100 mg daily for 2-3 weeks 2
- Option 2: 150 mg once weekly for 2-3 weeks 2
- Both regimens demonstrate effective treatment outcomes 2
Tinea Pedis (Athlete's Foot)
- Pulse dosing: 150 mg once weekly has proven effective 2
- Alternative continuous dosing may be considered based on severity 2
Pityriasis Versicolor
- Single-dose option: 400 mg as a single oral dose 2
- This represents a convenient treatment approach for this superficial fungal infection 2
Important Clinical Considerations
Species-Specific Activity
- Fluconazole has no activity against Candida krusei and variable activity against C. glabrata 4
- For C. parapsilosis skin infections, fluconazole demonstrates 93% efficacy 5
- C. glabrata infections show only 50% efficacy and may require higher doses 5
Onychomycosis (Nail Infections)
- Requires prolonged therapy: 150 mg once weekly for 6-12 months 1
- Response is significantly delayed due to slow nail growth 3
- Most patients with chronic mucocutaneous candidiasis require chronic suppressive therapy due to intrinsic immunodeficiency 3
Special Populations
- Diabetic patients: Standard dosing of 100-200 mg daily achieves 90% success rates for cutaneous candidiasis 6
- Immunocompromised patients: May require higher doses (up to 800 mg daily) and longer treatment duration 6
- Relapse is common in chronically immunocompromised patients regardless of antifungal used 7
Common Pitfalls to Avoid
- Inadequate treatment duration leads to recurrence of active infection; continue until clinical resolution is complete 8
- Do not use fluconazole for suspected dermatophyte infections without confirmation, as terbinafine or itraconazole may be more appropriate for certain tinea infections 2
- For extensive skin involvement or nail disease, anticipate delayed response and counsel patients accordingly 3
- In diabetic patients, appropriate diabetes control remains the best preventive measure alongside antifungal therapy 6