Chronic Mucocutaneous Candidiasis Medication

  • Author: David T Robles, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Sep 29, 2011
 

Medication Summary

Many good antifungal agents are available and usually are effective; however, upon cessation of therapy, most patients relapse. Specific immunotherapies are under investigation and have been used with some success. This area needs further research.

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Antifungals

Class Summary

Ketoconazole and amphotericin B are commonly used to treat candidiasis. Patients being treated with systemic antifungal agents should be closely monitored for adverse effects.

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Ketoconazole (Nizoral)

 

A broad-spectrum imidazole antifungal agent, which functions by inhibiting the synthesis of ergosterol and results in leakage of cellular components and fungal cell death. Readily absorbed in an acidic pH environment (eg, with orange juice) and with a fatty meal.

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Amphotericin B (Fungizone)

 

Polyene antibiotic that binds to sterol in fungal membranes and alters membrane permeability. Often reserved for severely ill patients with disseminated disease. As an IV medication, it requires drug monitoring during infusion. Newer formulations incorporate active drug into a liposomal delivery system.

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Immunomodulators

Class Summary

Immune modulators used in CMC attempt to improve or correct cell-mediated immune dysfunction.

Transfer factor

 

Small proteins extracted from human donor lymphocytes sensitized to Candida species.

Candida -specific cell immunity may be transferred by this approach. Not effective in all cases. Long-term remissions have occurred when combined with antifungal medications.

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Contributor Information and Disclosures
Author

David T Robles, MD, PhD  Dermatologist, Chaparral Medical Group

David T Robles, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Robin L Hornung, MD, MPH  Assistant Professor, Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine; Director, Department of Pediatric Dermatology, Children's Hospital and Regional Medical Center, Seattle

Robin L Hornung, MD, MPH is a member of the following medical societies: American Academy of Dermatology, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Jonathan M Olson, MD  Resident Physician, Division of Dermatology, University of Washington Medical Center

Jonathan M Olson, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Carrie L Kovarik, MD  Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Michael G. Bryan, MD and Lester F. Libow, MD to the development and writing of this article.

References

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Thickened, fragmented, hyperkeratotic nails and erythematous periungual skin. Courtesy of Walter Reed Army Medical Center.
Crusted hyperkeratotic plaques on and around the nose. Courtesy of Walter Reed Army Medical Center.
Crusted hyperkeratotic plaques on eyebrow, forehead, and scalp. Courtesy of Walter Reed Army Medical Center.
 
 
 
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