From the Guidelines
Taking breaks between oral antifungal treatments for a fungal skin wound is strongly discouraged, as it can lead to treatment failure, development of drug-resistant infections, and increased morbidity and mortality. According to the Infectious Diseases Society of America guidelines 1, the standard doses of antifungal agents should be followed to effectively eliminate the infection. For example, fluconazole can be prescribed at a dose of 100–400 mg every 24 hours 1. It is essential to complete the full prescribed course without interruption to ensure that all fungal organisms are eliminated. Stopping treatment prematurely or taking breaks allows surviving fungal organisms to multiply, potentially leading to treatment failure or development of drug-resistant infections, such as those caused by Candida krusei and Candida glabrata, which are resistant to certain antifungal agents 1.
Some key points to consider when treating fungal skin wounds include:
- Completing the full prescribed course of antifungal treatment without interruption
- Keeping the wound clean and dry, as fungi thrive in warm, moist environments
- Considering alternative medication or topical treatment options, such as clotrimazole, miconazole, or terbinafine creams, if side effects occur 1
- Being aware of the potential for drug-resistant infections and the importance of proper treatment to prevent morbidity and mortality
It is crucial to consult a healthcare provider immediately if side effects occur or if there are concerns about the treatment regimen, rather than self-adjusting the regimen. They can provide guidance on the best course of treatment and help prevent complications. Additionally, blood cultures and skin lesion evaluations should be performed to identify the causative pathogen and guide treatment 1. By following the recommended treatment guidelines and completing the full course of antifungal therapy, patients can effectively eliminate the infection and reduce the risk of morbidity and mortality.
From the FDA Drug Label
The drug is tightly bound to the new keratin which becomes highly resistant to fungal invasions. When the drug is discontinued, griseofulvin concentrations in the skin decline less rapidly than those in plasma Griseofulvin may be active against most strains of the following dermatophytes as described in the INDICATIONS AND USAGE section: Epidermophyton floccosum, Microsporum audouinii, Microsporum canis, Microsporum gypseum, Trichophyton crateriformis, Trichophyton gallinae, Trichophyton interdigitalis, Trichophyton megnini, Trichophyton mentagrophytes, Trichophyton rubrum, Trichophyton sulphureum, Trichophyton schoenleini, Trichophyton tonsurans, and Trichophyton verrucosum.
Treatment of Fungal Skin Wound with Griseofulvin: The FDA drug label indicates that griseofulvin is effective against various dermatophytes that cause fungal skin infections, including tinea corporis, tinea pedis, and tinea cruris 2.
- Key Points:
- Griseofulvin binds to microtubular proteins, preventing mitosis in dermatophytes.
- The drug is deposited in keratin precursor cells, making new keratin resistant to fungal invasions.
- Griseofulvin concentrations in the skin decline less rapidly than in plasma when the drug is discontinued. Given that griseofulvin is effective against dermatophytes and remains in the skin for an extended period, taking breaks between oral treatments may not be ideal, as this could potentially lead to reduced efficacy or the development of resistance 2.
From the Research
Fungal Skin Wound Treatment
Taking breaks between oral treatment for fungal skin wounds may impact the effectiveness of the treatment. The following points summarize the available evidence:
- The standard treatment guidelines for dermatophytosis may no longer be effective in achieving clearance, resulting in high failure rates 3.
- Combination therapy of oral terbinafine and itraconazole may be an effective and safe therapeutic strategy in the management of dermatophytosis 3.
- Continuous treatment of onychomycosis with terbinafine represents the most effective systemic therapy 4.
- Terbinafine, itraconazole, and fluconazole are effective in treating various fungal infections, but their effectiveness may vary depending on the specific infection and strain 4, 5, 6.
- A study found limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole, and terbinafine) in the current epidemic of altered dermatophytosis in India, with itraconazole being the most effective 7.
Treatment Options
Some treatment options for fungal skin wounds include:
- Oral terbinafine
- Oral itraconazole
- Oral fluconazole
- Combination therapy of oral terbinafine and itraconazole
- Topical treatments, such as antimycotic nail lacquer or urea ointment
Considerations
When taking breaks between oral treatment for fungal skin wounds, consider the following: