Antifungal Therapy

The topical antifungal agents are only useful for superficial mycoses. Griseofulvin is also useful for superficial mycoses and nothing else. Azoles are really the only antifungal agents which can go across the board and have utility in superficial, cutaneous and systemic mycoses. Among the polyenes, nystatin is useful only in superficial candidiasis, for example, such as thrush. Amphotericin B is typically reserved for more serious cutaneous disease and systemic therapy.
derivative, is quite useful in ringworm, provided it is not on the scalp, in tinea versicolor, and in candidiasis. Clotrimazole is a representative of the azole category, and it also is useful for all three types of superficial mycoses. Nystatin, on the other hand, is a polyene and of no utility in ringworm or tinea versicolor and must be reserved for superficial candidiasis such as thrush.
cutaneous mycoses. Now, here they are yet again. This is naftifine.
This is an allylamine derivative. The other allylamine that you may encounter is terbinafine and these of course, as allylamine derivatives, inhibit fungal metabolism very high up in the pathway of fungal cell-wall construction. They inhibit really the first step in the conversion of squalene to lanosterol. The imidazoles and the triazoles inhibit at a secondary step in the building of the fungal
cell wall. The imidazoles and the triazoles inhibit 14 alpha
demethylase, which mediates the conversion of lanosterol to ergosterol. The polyenes, nystatin (a topical antifungal agent) and amphotericin as (systemic antifungal agent), inhibit the actual synthesis of ergosterol, the major component of the fungal cell membrane.
superficial dermatophyte infections as well as for superficial
candidiasis. Such things as Candida diaper rash, mild intertrigo. The creams, the gels and solutions are very helpful in inflamed intertriginous areas such as the toe webs, the groin and the scrotum. Powder formulations are useful for milder lesions in the identical areas. If it’s wet, dry it, if it’s dry, wet it - so that if this is a wet diaper area then a powder may be very helpful. The powders,
like clotrimazole powders, the imidazole powders, are extremely useful in stoma infections. So if you have for example a cancer
patient with a colectomy or a child with short-gut syndrome who has a stoma and then has a bag. Those are typically very, very wet areas. Ointments and creams really don’t get the job done. The powders are very useful in those wet areas. Ointments in particular
are typically much too occlusive and the dermatophytes and particularly Candida love that sort of moist area. So usually I don’t
use the ointment formulations of these topical antifungals. The major exception to the use of topical antifungal agents are dermatophyte lesions of the head. Ringworm of the scalp, tinea capitus and kerion will require oral therapy, usually with
griseofulvin.
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