Tinea%20corporis,%20cruris%20-and-%20pedis Treatment
Principles of Therapy
Topical Antifungals
- Most tinea corporis, cruris and pedis infections can be treated topically
- Choice of agent will depend on cost, physician and patient preference
- There are few direct comparison studies between agents of different groups; it is difficult to justify choice of one agent over another
- For tinea pedis, treatment is targeted towards control of symptoms and spread to other parts of the body
- Topical therapy is the preferred route of treatment
Topical Corticosteroids
- Should only be used in combination with antifungal and limited only to confirmed fungal infections in patients suffering from symptomatic inflammation, itching, erythema and burning sensation
- Should be used only in the first few days of treatment
- Effects: There is usually rapid symptomatic relief
- Use with caution when treating areas of thin skin and naturally occluded body areas (eg groin, axillae, breast and face)
- Combination topical corticosteroids with antifungal should not be administered in children <12 years
- Topical antifungals combined with corticosteroids are available. Please see prescribing information for specific formulations in the latest MIMS.
Pharmacotherapy
Topical Antifungals
Allylamines
- Eg Naftifine, Terbinafine
- Actions: Fungicidal in vitro
- Effects: Allylamines may produce a faster response and slightly more effective than azoles
- Naftifine has anti-inflammatory properties
Azoles
- Eg Clotrimazole, Bifonazole, Eberconazole, Econazole, Efinaconazole, Fluconazole, Itraconazole, Ketoconazole, Luliconazole, Miconazole, Oxiconazole, Sertaconazole, Sulconazole
- Many imidazoles and triazoles are available and these agents have broad-spectrum activity
- Actions: Bind to phospholipids in the fungal cell wall membrane resulting in loss of essential intracellular elements, fungistatic in vitro
- Effects: Typically result in cure when treating tinea infections
- Sertaconazole and Luliconazole possess potent anti-inflammatory effects comparable to antifungal-corticosteroid combinations
- Efinaconazole is a treatment option for patients with co-existing tinea unguium infection
Benzylamines
- Butenafine is similar in structure to the allylamines
- Actions: Fungicidal in vitro
- Effects: Has high cure rates and long disease-free intervals in treating interdigital tinea pedis
Others
- Amorolfine
- Alternative treatment option for patients with tinea pedis
- Effects: Active against dermatophytes, dimorphic fungi, yeasts, other filamentous and dematiaceous fungi
- Amphotericin B
- Treatment option for various mucocutaneous fungal infections including dermatophytosis, with minimal adverse events seen
- Effects: Has broad-spectrum antifungal activity against most pathogenic fungi
- Ciclopirox
- Effects: Has broad-spectrum coverage against dermatophytes, yeasts and some bacteria
- Haloprogin
- Effects: Has equivalent efficacy with Tolnaftate but has a broader fungal spectrum including yeasts
- Tolnaftate
- Effects: Effective in most dermatophytoses and tinea versicolor but has narrow-spectrum antifungal activity; no antibacterial or anti-candidal activity
Optimal Vehicles of Topical Treatment
Creams
- Recommended for non-oozing and moderately scaling lesions
Lotions
- Easily spread on hairy areas
- Recommended for intertriginous areas or oozing lesions
Ointments
- Useful for hyperkeratotic lesions
Powders and Sprays
- May be used to prevent reinfection; should be applied to the feet rather than to the shoes
- Typically not very effective in treating active infection
Oral Antifungals
- Eg Fluconazole, Griseofulvin, Itraconazole, Terbinafine
- May be considered in patients with extensive disease, unresponsive to treatments, immunocompromised, or severe moccasin-type tinea of the plantar surface
- Recommended dose of oral Terbinafine has been shown to produce sustained cure rates of 71-94%
- Griseofulvin use resulted in a 27-35% cure rate
- Oral antifungals have been used to control acute vesicular tinea pedis
- Pulse doses of Fluconazole, Itraconazole and Terbinafine have been shown effective
- Use of Fluconazole in immunocompromised patients should be done sparingly
- Observe caution in patients being treated with CYP3A4 substrates, HMG-CoA reductase inhibitors, and anticoagulants