Fungal infections of the skin and nail: new treatment options

Abstract

Knowledge of the currently available antifungal agents, along with clinical, microbiologic and histopathologic methods, can help the medical professional optimally manage skin and nail fungal infections. With regards to treatment of fungal disease of the skin or nail, there are a variety of systemic antifungal agents, including several newer agents that have different formulations, tolerability, adverse effect profiles and spectrum of activity. This review will highlight the clinically important fungal infections of the skin and nail and describe the activity and role of antifungal treatment.

Keywords::

• antifungal therapy
• cutaneous infection
• dermatophyte
• fluconazole
• isavuconazole
• itraconazole
• posaconazole
• voriconazole

Financial & competing interests disclosure

Dr Thompson has acted as a consultant for Astellas. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Dermatophyte infections are the most common cause of superficial fungal infections.

• Most dermatophyte infections respond favorably to topical antifungal therapy.

• Griseofulvin is the first choice for treatment of dermatophyte infections caused by Microsporum spp., while terbinafine is preferred for those secondary to Trichophyton species, a distinction often necessary in the treatment of tinea capitis.

• Onychomycosis must be differentiated from nail dystrophy secondary to non-infectious causes. Infection frequently requires a 6- to 12-week course of antifungal therapy, with terbinafine recommended as the first-line agent of choice.

• Eumycetoma and chromoblastomycosis are more commonly found in tropical and subtropical regions reiterating the importance of travel history during the evaluation of skin lesions.

• Cutaneous manifestations of invasive mycoses occur primarily in the severely immunocompromised and are often a sign of widespread disseminated disease requiring systemic therapy.

• Innate and acquired resistance to antifungal agents has been increasingly recognized and for those unfamiliar with a particular pathogen, consultation with an expert is advised.

Notes