Medication Summary
The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.
Antifungals
Class Summary
The mechanism of action usually involves inhibiting pathways (enzymes, substrates, transport) necessary for sterol/cell membrane synthesis or altering the permeability of the cell membrane (polyenes) of the fungal cell.
Griseofulvin (Fulvicin P/G, Grifulvin V)
Griseofulvin has fungistatic activity. Dermatophytes are sensitive, but yeastlike fungi and molds are resistant. Fungal cell division is impaired by interfering with microtubule. Griseofulvin binds to keratin precursor cells. Keratin is gradually replaced by noninfected tissue, which is highly resistant to fungal invasions.
Terbinafine (Lamisil)
Terbinafine is a fungicidal agent and member of the allylamine family. It inhibits squalene epoxidase, which decreases ergosterol synthesis, causing fungal-cell death. Use until symptoms significantly improve.
In young children, the tablet may be split and hidden in food.
Itraconazole (Sporanox)
Itraconazole has fungistatic activity. It is a synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P-450-dependent synthesis of ergosterol, a vital component of fungal cell membranes.
Itraconazole is not registered for administration in children in most countries.
Fluconazole (Diflucan)
Fluconazole has fungistatic activity. It is a synthetic oral antifungal (broad-spectrum bistriazole) that selectively inhibits fungal cytochrome P-450 and sterol C-14 alpha-demethylation, which prevents conversion of lanosterol to ergosterol, thereby disrupting cellular membranes.
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Tinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle.
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Favus of the scalp shows extensive lesions with scarring alopecia.
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Typical fluorescence under Wood lamp examination.
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Favus, wax montage. Courtesy of Professor Dr Feliks Wasik, Dermatology, Medical University of Wroclaw, Poland.
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Black man, aged 45 years, with favuslike yellow crusting of scalp. Potassium hydroxide and fungal culture were negative.
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Culture of Trichophyton schoenleinii on Sabouraud agar. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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Culture of Trichophyton schoenleinii on Sabouraud agar. Note pleomorphism of the culture. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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Microculture of Trichophyton schoenleinii shows dichotomic branching and terminal swelling. Light-field microscopy, original magnification X 1000. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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Microculture of Trichophyton schoenleinii shows characteristic dichotomic branching. Light-field microscopy, original magnification X 1000. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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Microculture of Trichophyton schoenleinii shows numerous terminal chlamydospores. Light-field microscopy, original magnification X 1200. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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Infected hair filled with hyphae shows bubbles of gas and gas tunnels (light field microscopy, original magnification X 2300).
