tailieunhanh - Chapter 053. Eczema and Dermatitis (Part 11)

Dermatophytosis: Treatment Both topical and systemic therapies may be used to treat dermatophyte infections. Treatment depends on the site involved and the type of infection. Topical therapy is generally effective for uncomplicated tinea corporis, tinea cruris, and limited tinea pedis. It is not effective as a monotherapy for tinea capitis or onychomycosis. Topical imidazoles, triazoles, and allylamines may be effective therapies for dermatophyte infections, but nystatin is not active against dermatophytes. Topicals are generally applied twice daily, and treatment should continue 1 week beyond clinical resolution of the infection. Tinea pedis often requires longer treatment courses and frequently relapses. Oral. | Chapter 053. Eczema and Dermatitis Part 11 Dermatophytosis Treatment Both topical and systemic therapies may be used to treat dermatophyte infections. Treatment depends on the site involved and the type of infection. Topical therapy is generally effective for uncomplicated tinea corporis tinea cruris and limited tinea pedis. It is not effective as a monotherapy for tinea capitis or onychomycosis. Topical imidazoles triazoles and allylamines may be effective therapies for dermatophyte infections but nystatin is not active against dermatophytes. Topicals are generally applied twice daily and treatment should continue 1 week beyond clinical resolution of the infection. Tinea pedis often requires longer treatment courses and frequently relapses. Oral antifungal agents may be required for recalcitrant tinea pedis or tinea corporis. Oral antifungal agents are required for dermatophyte infections involving the hair and nails and for other infections unresponsive to topical therapy. A fungal etiology should be confirmed by direct microscopic examination or by culture prior to prescribing oral antifungal agents. All of the oral agents may cause hepatotoxicity and should not be used in women who are pregnant or breastfeeding. Griseofulvin is the only oral agent approved in the United States for dermatophyte infections involving the skin hair or nails. When griseofulvin is used a daily dose of 500 mg microsized or 375 mg ultramicrosized griseofulvin administered with a fatty meal is an adequate dose for most dermatophyte infections. Higher doses are required for some cases of tinea pedis and tinea capitis. The usual adult dose of griseofulvin for tinea capitis is 1 g microsized or g ultramicrosized given daily. Markedly inflammatory tinea capitis may result in scarring and hair loss and systemic or topical glucocorticoids may be helpful in preventing these sequelae. The duration of therapy may be 2 weeks for uncomplicated tinea corporis 8-12 weeks for tinea capitis or as