Antifungal therapy:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2003
|
| Schriftenreihe: | Dermatologic clinics
21,3 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | VIII S., S. 396 - 593 Ill. |
Internformat
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| 245 | 1 | 0 | |a Antifungal therapy |c Aditya K. Gupta, guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2003 | |
| 300 | |a VIII S., S. 396 - 593 |b Ill. | ||
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| 490 | 1 | |a Dermatologic clinics |v 21,3 | |
| 650 | 4 | |a Antifungal Agents |x therapeutic use | |
| 650 | 4 | |a Dermatomycoses | |
| 650 | 4 | |a Onychomycosis | |
| 650 | 4 | |a Tinea | |
| 700 | 1 | |a Gupta, Aditya K. |e Sonstige |4 oth | |
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Datensatz im Suchindex
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| adam_text | CONTENTS
Preface xi
Aditya K. Gupta
Tinea Corporis, Tinea Cruris, Tinea Nigra, and Piedra 395
Aditya K. Gupta, Maria Chaudhry, and Boni Elewski
Tinea infections are among the most common dermatologic conditions throughout the
world. To avoid a misdiagnosis, identification of dermatophyte infections requires both
a fungal culture on Sabouraud s agar media, and a light microscopic mycologic exami¬
nation from skin scrapings. Topical antifungals may be sufficient for treatment of tinea
corporis and cruris and tinea nigra, and the shaving of hair infected by piedra may also
be beneficial. Systemic therapy, however, may be required when the infected areas are
large, macerated with a secondary infection, or in immunocompromised individuals.
Preventative measures of tinea infections include practicing good personal hygiene;
keeping the skin dry and cool at all times; and avoiding sharing towels, clothing, or hair
accessories with infected individuals.
Seborrheic Dermatitis 401
Aditya K. Gupta, Robyn Bluhm, Elizabeth A. Cooper,
Richard C. Summerbell, and Roma Batra
Seborrheic dermatitis presents as erythematous, greasy looking lesions with fine scaling
found most frequently on the scalp, nasolabial folds, eyebrows, ears, and chest. This condi¬
tion may be seen in conjunction with other skin diseases, such as rosacea, blepharitis or
ocular rosacea, and acne vulgaris. Malassezia yeasts have been associated with seborrheic
dermatitis. Abnormal or inflammatory immune system reactions to these yeasts may be
related to the development of seborrheic dermatitis. Antifungal and anti inflammatory
preparations have been used to treat seborrheic dermatitis effectively and safely. Prolonged
use of antimycotics does not carry the risk of skin atrophy or telangiectasia, making them a
more desirable treatment modality than corticosteroid preparations.
Pityriasis Versicolor 413
Aditya K. Gupta, Roma Batra, Robyn Bluhm, and Jan Faergemann
Pityriasis versicolor is a mild or chronic condition characterized by scaly hypopigmented
or hyperpigmented lesions usually affecting the trunk. The lesions vary depending on
tropical or temperate climates. The disease seems to occur mainly at adolescence when
VOLUME 21 • NUMBER 3 • JULY 2003 v
the sebaceous glands are more active. Malassezia yeasts have been implicated in the
pathogenesis of this disease. The mycelial form of the fungus has been suggested to be
the cause of lesions. Antifungal preparations have been used to treat the initial presen¬
tation effectively, although in a proportion of patients the disease tends to reoccur. They
are available in a wide range of formulations and have been shown to be safe.
Treatments of Tinea Pedis 431
Aditya K. Gupta, Melody Chow, C. Ralph Daniel, and Raza Aly
Tinea pedis is a common infection of the feet generally caused by dermatophytes. It may
present as an interdigital, moccasin, or vesicobullous disease. There may be secondary
bacterial involvement, resulting in dermatophytosis complex. There have been different
treatments over the past quarter century, including many topical and oral agents.
Although oral treatments have generally demonstrated a greater ability to reach deeper
layers of skin, topical agents have less potential for adverse events. Complex infections
may require treatment for both the fungal and bacterial components of the infection.
The Diagnosis of Onychomycosis 463
James M. Mahoney, John Bennet, and Benjy Olsen
Onychomycosis is a fungal infection of the nail that is often chronic and difficult to treat.
The incidence of onychomycosis is increasing and the primary pathogens include
dermatophytes, nondermatophyte molds, and Candida species. Laboratory testing (light
microscopy and culture) enables the correct diagnosis of onychomycosis to be made;
alternatively, histopathology allows for a permanent record of invasive nail plate infection.
This article focuses on the need for proper diagnosis of onychomycosis.
The Use of Oral Antifungal Agents to Treat Onychomycosis 469
Aditya K. Gupta and Jennifer E. Ryder
Onychomycosis has been treated for years with oral antifungal agents, and more recently
in the United States with a topical nail lacquer. Griseofulvin was the first significant oral
agent available to manage onychomycosis. The introduction of the azoles (ketoconazole,
itraconazole, and fluconazole) and the allylamine, terbinafine, led to improved cure rates
and a broad spectrum of activity. Pharmacokinetic studies have shown that the newer
oral agents penetrate the nail within approximately one to two weeks after the start of
therapy and remain for several months after the end of treatment. This article reviews
the oral antifungal agents used to treat onychomycosis.
The Use of Topical Therapies to Treat Onychomycosis 481
Aditya K. Gupta, Jennifer E. Ryder, and Robert Baran
Topical antifungal agents have had success in the treatment of onychomycosis. To deter¬
mine the extent of the literature relating to the use of topical agents for the management
of onychomycosis, a Medline search was conducted for the years 1966 to June 2002.
Studies were excluded for the following reasons: retrospective nature; those reporting
preliminary data; non English language; those involving predominantly special popula¬
tions (eg, transplant patients, diabetic patients, and so forth); trials involving clinical
presentations other than the distal lateral onychomycosis type; and those treating only
fingernail onychomycosis. Twenty six studies were included in this evaluation.
Ciclopirox and amorolfine nail lacquers have a broad spectrum of activity in vitro; fur¬
thermore, they are effective and safe when used for this indication.
vi CONTENTS
Treatment of Nondermatophyte Mold and Candida Onychomycosis 491
Antonella Tosti, Bianca Maria Piraccini, Sandra Lorenzi, and Matilde Iorizzo
Mold onychomycosis often can be clinically suspected because of the presence of
periungual inflammation. Treatment with systemic antifungals is very effective in
onychomycosis caused by Aspergillus sp. Scopulariopsis breiricaulis and Fusarium sp. infection
are difficult to eradicate and treatment with systemic antifungals should always be asso¬
ciated with topical treatment with nail lacquers. Candida onychomycosis is always a sign
of immunodepression. Systemic treatment with itraconazole or fluconazole is usually
effective, but relapses are very common.
How to Improve Cure Rates for the Management of Onychomycosis 499
Aditya K. Gupta and Jennifer E. Ryder
To improve the treatment of onychomycosis clinicians need to identify correctly the
causative organism, choose a therapy that is effective against the pathogen, and take into
consideration the pharmacokinetics (eg, bioavailability, drug interactions) of the oral
agent. In addition, variations of the standard regimens may need to be considered (ie,
booster or supplemental therapy). To reduce the recurrence of onychomycosis, once
mycologic cure has been achieved, clinicians should educate their patients about proper
foot care. Familiarity with the symptoms and signs of tinea pedis and onychomycosis
may enable patients to seek appropriate care when the disease is at an early stage.
Management of Onychomycosis in Children 507
Antonella Tosti, Bianca Maria Piraccini, and Matilde Iorizzo
Terbinafine, itraconazole, and fluconazole are effective and well tolerated for treating
onychomycosis in children. Dosage depends on body weight. Duration of treatment is
the same for adults.
The Efficacy and Safety of Terbinafine in Children 511
Aditya K. Gupta, Elizabeth A. Cooper, and Charles W. Lynde
Terbinafine is an allylamine antifungal agent that has been effective and safe in the treat¬
ment of superficial and some deep mycotic infections in adults. The data suggest that
terbinafine is effective and safe in the pediatric population using treatment regimens that
involve short duration therapy, leading to an increased compliance and providing a cost
effective means of treating superficial fungal infections. The adverse events profile for
children is similar to that in adults with few adverse effects associated with its use. The
evidence favors the use of terbinafine in the treatment of superficial infections in children.
Efficacy and Safety of Itraconazole Use in Children 521
Aditya K. Gupta, Elizabeth A. Cooper, and Gabriele Ginter
Itraconazole capsules have been approved in the United States for the treatment of
adults with some systemic mycoses and onychomycosis. Itraconazole is also available in
an oral solution for treatment of oropharyngeal and esophageal candidiasis. Although
the triazole has not been approved by the Food and Drug Administration for the treat¬
ment of mycotic infections in children, there are a significant number of reports in the
literature on the use of itraconazole for superficial and systemic fungal infections in chil¬
dren. This article summarizes the use of itraconazole in pediatric fungal infection, con¬
centrating particularly on superficial fungal infection, such as tinea capitis.
CONTENTS vii
The Use of Fluconazole to Treat Superficial Fungal Infections in Children 537
Aditya K. Gupta, Elizabeth A. Cooper, and Fernando Montero Gei
Oral fluconazole is a triazole antifungal agent with good penetration into tissues that
suggests it may be effective in treating superficial fungal infections. It is currently indicated
in the United States for oropharyngeal or esophageal candidiasis, vaginal candidiasis,
and cryptococcal meningitis. Tinea capitis is the predominant superficial fungal infection
in pediatric populations, and fluconazole has been used successfully in tinea capitis
infection, using either a daily or a weekly fluconazole regimen. Fluconazole has also been
effective in the treatment of other superficial infections that affect children less commonly,
including tinea pedis and onychomycosis. Use of fluconazole caused few adverse events
when treating tinea capitis. The success in treating both Trichophyton and Microsporum
tinea capitis suggests that fluconazole is a suitable alternative to griseofulvin. Further
study should be performed for this indication, to determine optimum dosing regimens.
Oral Antifungal Drug Interactions: A Mechanistic Approach to
Understanding Their Cause 543
H. Irving Katz and Aditya K. Gupta
Oral antifungal drugs are generally regarded as effective and safe when used according
to their manufacturer s recommendation. However, when an oral antifungal agent is
administered with certain interacting agents or classes of drugs, rare severe iatrogenic
adverse experiences including death may occur. This article alerts and demystifies some
of the clinically significant oral antifungal drug interactions by exploring their underlying
pharmacological basis.
New Antifungal Agents 565
Aditya K. Gupta and Elizabeth Tomas
The prevalence of fungal infections has been increasing over the past few decades, but
the spectrum of new antifungal agents has also been increasing in response to these
new demands. To improve current methods of systemic antifungal therapy, modified
versions of the systemic polyene antifungal amphotericin B have been created. Also,
several second generation azole antifungal agents are in various stages of development,
with the current emphasis on systemic infections rather than superficial infections.
There may be some potential for cross resistance among these azoles, but more work
needs to be done to further the understanding of azole mechanisms of action and azole
resistance. A new class of antifungal agents, the echinocandins and pneumocandins,
target the fungal cell wall.
Antifungal Drugs Used for Systemic Mycoses 577
Roderick J. Hay
The systemic mycoses present a real therapeutic challenge because mortality and relapse
rates remain high in the presence of continuing immunosuppression. The drugs
currently available are mainly derived from the azole or polyene antifungal families and
latterly there has been a renewed interest in the role of new azoles in the management of
these conditions. At present there are few drugs from other antimicrobial families that
have clinical indications, but developments among the cell wall inhibitors may make
important contributions in the future.
Index 589
viii CONTENTS
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| spelling | Antifungal therapy Aditya K. Gupta, guest ed. Philadelphia [u.a.] Saunders 2003 VIII S., S. 396 - 593 Ill. txt rdacontent n rdamedia nc rdacarrier Dermatologic clinics 21,3 Antifungal Agents therapeutic use Dermatomycoses Onychomycosis Tinea Gupta, Aditya K. Sonstige oth Dermatologic clinics 21,3 (DE-604)BV000004924 21,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010554953&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Antifungal therapy Dermatologic clinics Antifungal Agents therapeutic use Dermatomycoses Onychomycosis Tinea |
| title | Antifungal therapy |
| title_auth | Antifungal therapy |
| title_exact_search | Antifungal therapy |
| title_full | Antifungal therapy Aditya K. Gupta, guest ed. |
| title_fullStr | Antifungal therapy Aditya K. Gupta, guest ed. |
| title_full_unstemmed | Antifungal therapy Aditya K. Gupta, guest ed. |
| title_short | Antifungal therapy |
| title_sort | antifungal therapy |
| topic | Antifungal Agents therapeutic use Dermatomycoses Onychomycosis Tinea |
| topic_facet | Antifungal Agents therapeutic use Dermatomycoses Onychomycosis Tinea |
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