eMedicine Specialties > Dermatology > Fungal Infections

Tinea Nigra: Treatment & Medication

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
Contributor Information and Disclosures

Updated: Jul 24, 2009

Treatment

Medical Care

After tinea nigra is diagnosed on the basis of the findings from the patient's history, physical examination, and appropriate laboratory test, a topical medication designed to eradicate the fungal infection should be applied to the respective area.

Surgical Care

To aid the effectiveness of the topical medication in eradicating the dermatomycosis, the affected skin area should be scraped with a No. 15 scalpel blade prior to the initial application of the medicine.

Medication

Because tinea nigra is caused by a superficial fungal infection of the skin, topical medicines designed to eradicate the dermatomycosis are used.

Dermatologic agents

These agents are used to treat tinea nigra because of their action on the skin. They may either aid in the removal of excessive keratin in hyperkeratotic skin disorders or increase epithelial cell turnover. These agents are used in conjunction with fungicidal or fungistatic medications.


Salicylic acid (Compound W, Salactic Film, Sal-Plant, Panscol)

Causes desquamation of the horny layer of skin by dissolving intercellular cement substance, while not affecting structure of viable epidermis. Hydrate skin and enhance effects of medication by soaking affected area in warm water for 5 min prior to use; remove any loose tissue with brush, washcloth, or emery board, and dry thoroughly. Improvement should occur in 1-2 wk.

Adult

Apply to affected area; maximum resolution expected after 4-6 wk

Pediatric

Administer as in adults

Documented hypersensitivity; prolonged use in infants, patients with diabetes, and those with impaired circulation not recommended; do not use on moles, birthmarks, warts with hair growing from them, genital or facial warts, warts on mucous membranes, irritated skin or any area infected or reddened

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Avoid contact with mucous membranes, normal skin surrounding tinea nigra lesion, and eyes; immediately flush with water for 15 min if contact with eyes or mucous membranes occurs; avoid inhaling vapors


Tretinoin (Avita, Retin-A)

Topical tretinoin decreases cohesiveness of follicular epithelial cells and stimulates their mitotic activity, resulting in quicker turnover of the epithelial layer.

Adult

Apply 0.1% cream or gel bid/qid; decrease frequency if irritation develops

Pediatric

<12 years: Not established
>12 years: Administer as in adults

Toxicity increases with coadministration of benzoyl peroxide, salicylic acid, and resorcinol; avoid topical sulfur, resorcinol, salicylic acid, other keratolytics, abrasives, astringents, spices, and lime

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with excessive sunlight exposure; caution in eczema; do not apply to mucous membranes, mouth, and angles of nose

Topical imidazoles

These medications are broad-spectrum antifungals that are commonly used in the treatment of tinea pedis, but they are also effective in the treatment of tinea nigra.11,12


Clotrimazole (Lotrimin, Mycelex, Femizole-7)

Broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing death of fungal cells. Reevaluate diagnosis if no clinical improvement after 4 wk.

Adult

Gently massage onto affected area and surrounding skin bid for 2-4 wk

Pediatric

Children: Not established
Adolescents: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Not for treatment of systemic fungal infections; avoid contact with the eyes; if irritation or sensitivity develops, discontinue and initiate appropriate therapy


Ketoconazole (Nizoral)

Imidazole broad-spectrum antifungal agent; inhibits synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.

Adult

Rub gently into affected area qd/bid for 2-4 wk

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue if sensitivity or irritation develops; for external use only; avoid contact with eyes


Miconazole (Micatin, Femizol-M)

Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Increases membrane permeability, causing nutrients to leak out and resulting in fungal cell death.

Adult

Apply cream or lotion to affected areas bid for 2-4 wk

Pediatric

Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

If sensitivity or chemical irritation occurs, discontinue use; for external use only; avoid contact with eyes

Topical pyridones

Topical pyridones are broad-spectrum agents with antidermatophyte, antibacterial, and anticandidal activity.


Ciclopirox (Loprox)

Interferes with synthesis of DNA, RNA, and protein by inhibiting the transport of essential elements in fungal cells.

Adult

Massage into affected areas bid; reevaluate diagnosis if no improvement after 4 wk

Pediatric

<10 years: Not established
>10 years: Administer as in adults

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Avoid contact with eyes and other internal routes

Topical allylamines

These drugs are effective in treating a variety of fungal infections. Because they have demonstrated potent activity against dermatophytes, they are often used in recalcitrant infections.13


Terbinafine (Lamisil)

Allylamine derivative that inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This effect results in a deficiency in ergosterol in the fungal cell wall, causing fungal cell death.

Adult

Apply to affected area bid for at least 1-2 wk

Pediatric

Not established

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Discontinue if sensitivity or irritation occurs; for external use only; avoid contact with eyes

Fungistatic agents

These medications do not kill the fungus, but rather, they prevent their growth and replication.


Undecylenic acid

Fungistatic agent.

Adult

Cleanse and dry affected areas; apply a thin film of 25% solution to the affected area bid

Pediatric

<2 years: Not recommended
>2 years: Administer as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Discontinue if reaction suggesting hypersensitivity or chemical irritation occurs; not for ophthalmic or optic use; avoid inhalation and contact with eyes or other mucous membranes; not to be applied over blistered, raw, or oozing areas of skin or over deep puncture wounds

More on Tinea Nigra

Overview: Tinea Nigra
Differential Diagnoses & Workup: Tinea Nigra
Treatment & Medication: Tinea Nigra
Follow-up: Tinea Nigra
Multimedia: Tinea Nigra
References
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References

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  5. Lenassi M, Vaupotic T, Gunde-Cimerman N, Plemenitas A. The MAP kinase HwHog1 from the halophilic black yeast Hortaea werneckii: coping with stresses in solar salterns. Saline Systems. 2007;3:3. [Medline].

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Further Reading

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Keywords

tinea nigra palmaris, tinea nigra plantaris, keratomycosis nigricans palmaris, dermatomycosis nigricans, mycosis of the stratum corneum, Hortaea werneckii, H werneckii, Phaeoannellomyces werneckii, P werneckii, Exophiala werneckii, E werneckii, Cladosporium werneckii, C werneckii

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Neil Shear, MD, Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada
Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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