Fungal infections: Current therapies and solutions

Patients falling prey to the diverse mycoses present in our environment is a common occurrence and high up on the list of why patients visit their dermatologist for help.

Superficial fungi are the most common fungi causing infection in humans, including the dermatophytes, candida, malassezia furfur, piedraia hotae, and trichosporon beigelii, and are of the highest interest to the practicing physician because of their frequency of infection in patients, according to Mahmoud A. Ghannoum M.D., professor in the department of dermatology, director of the Center for Medical Mycology and co-director of the Skin Diseases Research Center at Case Western Reserve University Cleveland, Ohio.

Modern medicine today has armed physicians with very effective topical and oral anti-fungal agents to combat these sometimes cumbersome infections. Dr. Ghannoum says that the effectiveness of the topical agents have a comparable activity, but they can be differentiated by their cost, base (cream or lotion) and vehicle (potential sensitizers).

Topical agents commonly prescribed are the imidazoles (e.g. econazole, miconazole, ketoconazole), ciclopyroxolamine, and the naphthiomates (e.g. tolnaftate - only effective against dermatophytes). For harder to treat infections, Dr. Ghannoum claims that terbinafine cream or naftifine gel work very effectively, and as an adjunct therapy, maintenance with oral anti-fungal agents can be additionally used.

Oral therapy options consist of fluconazole, griseofulvin, itraconazole, and terbinafine, and are dosed differently depending on location, type of mycotic infection, as well as age of the patient. Therapy duration lasts from a couple of weeks to several months, mostly depending on the location and depth of infection, as well as the immune status and compliance of the patient. DT

Dr. Ghannoum will present "Fungal Infections" at FOC809 today from 12:15 to 1:45 p.m.