Antifungal Therapy for Skin and Nails

Clinical diagnosis of skin and fungal nail infections are not always straightforward or easy. Inappropriate antifungal therapy has a significant cost implication for the NHS.

Fungi of dermatological importance can be divided into yeasts (such as Candida and Pityrosporum) and dermatophytes (such as the fungi which causes ringworm and athlete's foot). Because some agents, such as imidazoles (e.g. miconazole, clotrimazole), will kill either of these two types of fungi, there is a clinical tendency for all anti-fungal therapies to be lumped together and viewed as equal. This is not correct. Anti-fungal treatments differ in their action against various types of fungi in a similar manner to the way antibiotics have different abilities to kill a variety of bacteria (broad or narrow spectrum antibiotics). Some medicines, notably terbinafine, also differ in the way they act depending on whether terbinafine is used orally or topically especially in the case of fungal nail infection.

Do all patients have a fungal infection?
There are a number of patterns and differential diagnoses that need to be considered.

Ringworm / Annular Rashes
This is typically called ringworm because the lesions are typically annular or ring-like.

Fungal toenails are infected about four times as often as fungal fingernails. Fungal Nail Infection will spread relentlessly until the whole nail becomes thickened and distorted. There is usually underlying sufungal hyperkeratosis and onycholysis. Significant destruction of the nail plate is not typical and may suggest an alternative diagnosis such as psoriasis, eczema, paronychia or lichen planus.

Treatment Regimes for fungal nail infection
1. Fungal toenails (Toenail Fungus) usually respond better to terbinafine than to itraconazole.
2. For terbinafine: Fingernail fungal infection requires six week's therapy whilst toenail fungal infection necessitates six weeks' treatment therapy with terbinafine.

Tags :   Fungal Nail Infection Toenail Fungus
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