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Durdu M, Ilkit M, Tamadon Y, Tolooe A, Rafati H, Seyedmousavi S. Topical and systemic antifungals in dermatology practice. Expert Rev Clin Pharmacol 2016; 10:225-237. [DOI: 10.1080/17512433.2017.1263564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Murat Durdu
- Department of Dermatology, Faculty of Medicine, Başkent University Adana Hospital, Adana, Turkey
| | - Macit Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Yalda Tamadon
- Department of Small Animal Internal Medicine, Faculty of Specialized Veterinary Sciences, Science and Research Branch, Islamic Azad University (IAU), Tehran, Iran
| | - Ali Tolooe
- Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Haleh Rafati
- Department of Biochemistry, Erasmus University Medical Center, the Netherlands
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
- Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Deng S, de Hoog GS, Verweij PE, Zoll J, Ilkit M, Morsali F, Abliz P, Wang X, Zhan P, Yang L, Hasimu H, Liao W, Pan W, Seyedmousavi S. In vitro antifungal susceptibility of Trichophyton violaceum isolated from tinea capitis patients. J Antimicrob Chemother 2014; 70:1072-5. [PMID: 25492394 DOI: 10.1093/jac/dku503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Trichophyton violaceum is an anthropophilic dermatophyte that is endemic to parts of Africa and Asia and is sporadic in Europe. T. violaceum mainly causes tinea capitis in both children and adolescents. Although the infections caused by T. violaceum are of considerable medical importance, its antifungal susceptibility profile remains poorly examined. METHODS In this study, we tested the in vitro antifungal susceptibility of a set of clinical T. violaceum isolates obtained from tinea capitis patients, using the CLSI broth microdilution method. We tested eight antifungals and used isolates collected from Western China (21), Eastern China (12), the Middle East (1), Europe (20), South Africa (7) and Canada (1). RESULTS The geometric means of the MICs of the antifungals for all isolates were as follows (in increasing order): posaconazole, 0.021 mg/L; terbinafine, 0.023 mg/L; voriconazole, 0.062 mg/L; amphotericin B, 0.20 mg/L; itraconazole, 0.34 mg/L; caspofungin, 0.56 mg/L; fluconazole, 4.23 mg/L; and flucytosine, 8.46 mg/L. No statistically significant differences in the susceptibility profiles of T. violaceum were detected within the geographical regions tested. CONCLUSIONS Posaconazole, terbinafine and voriconazole were shown to be the most potent antifungal agents against T. violaceum isolates obtained from tinea capitis patients worldwide. These results might help clinicians in developing appropriate therapies that have a high probability of successfully treating tinea capitis due to T. violaceum.
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Affiliation(s)
- S Deng
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China First Hospital of Xinjiang Medical University, Urumqi, China CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - G S de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands Peking University Health Science Center, Research Center for Medical Mycology, Beijing, China Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China King Abdulaziz University, Jeddah, Saudi Arabia
| | - P E Verweij
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - J Zoll
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - M Ilkit
- Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - F Morsali
- Department of Medical Mycology and Parasitology, Faculty of Medicine and Medical Sciences, Islamic Azad University, Ardabil Branch, Ardabil, Iran
| | - P Abliz
- First Hospital of Xinjiang Medical University, Urumqi, China
| | - X Wang
- First Hospital of Xinjiang Medical University, Urumqi, China
| | - P Zhan
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - L Yang
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
| | - H Hasimu
- First Hospital of Xinjiang Medical University, Urumqi, China
| | - W Liao
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - W Pan
- Shanghai Institute of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - S Seyedmousavi
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands Department of Medical Mycology and Parasitology, Faculty of Medicine and Medical Sciences, Islamic Azad University, Ardabil Branch, Ardabil, Iran Invasive Fungi Research Center, Mazandaran University of Medical Sciences, Sari, Iran Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
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Binder B, Richtig E, Weger W, Ginter-Hanselmayer G. Tinea capitis in early infancy treated with itraconazole: a pilot study. J Eur Acad Dermatol Venereol 2009; 23:1161-3. [PMID: 19453785 DOI: 10.1111/j.1468-3083.2009.03271.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tinea capitis is the most common fungal infection of the scalp in childhood, but a very rare disorder in the first year of life. OBJECTIVE To evaluate the efficacy, tolerability and safety of itraconazole in 7 children aged between 3 and 46 weeks (median: 36 weeks) suffering from tinea capitis caused by Microsporum canis. METHODS Prospective case note study. In all patients KOH testing and fungal cultivation on Sabouraud dextrose agar were performed. RESULTS 7 patients (5 girls and 2 boys) were included in the period between 2001 and 2008. The causative etiologic agent was Microsporum canis in all children. The patients received itraconazole 5mg/kg bodyweight daily for 3 to 6 weeks with no clinically side effects being noted. In all patients clinical and mycological cure could be achieved. CONCLUSION Itraconazole proved to be a safe and effective treatment option for Microsporum canis induced tinea capitis in children in their first year of life.
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Affiliation(s)
- B Binder
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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Abstract
Various nonfollicular scalp conditions can cause secondary scarring or permanent alopecia. Possible causes are congenital defects, trauma, inflammatory conditions, infections, and neoplasms (rarely drugs). Associated signs and symptoms and other diagnostic procedures such as histopathology may aid in the diagnosis. Detection of the underlying disorder may be difficult in end-stage lesions. Treatment is specific for active conditions. Surgery and hair transplantation are options for localized scars.
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Foster KW, Friedlander SF, Panzer H, Ghannoum MA, Elewski BE. A randomized controlled trial assessing the efficacy of fluconazole in the treatment of pediatric tinea capitis. J Am Acad Dermatol 2006; 53:798-809. [PMID: 16243128 DOI: 10.1016/j.jaad.2005.07.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 06/21/2005] [Accepted: 07/09/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Griseofulvin is considered first-line therapy for tinea capitis, and the Physician's Desk Reference currently recommends 11 mg/kg per day microsize formulation for use in children. Diverse selective pressures have resulted in waning clinical efficacy of griseofulvin, such that higher doses and longer courses of treatment are required. These events have prompted the search for therapeutic alternatives. Fluconazole is one such treatment option, and a variety of studies using this drug have shown promise in the treatment of pediatric tinea capitis. OBJECTIVE We sought to assess the efficacy, safety, and optimal dose and duration of fluconazole therapy compared with standard-dose griseofulvin (11 mg/kg per day microsize formulation) in the treatment of pediatric tinea capitis. METHODS This randomized, multicenter, third-party-blind, 3-arm trial was designed as a superiority study to identify a therapeutically superior agent/regimen from the 3 treatment arms: (1) fluconazole 6 mg/kg per day for 3 weeks followed by 3 weeks of placebo, (2) fluconazole 6 mg/kg per day for 6 weeks, and (3) griseofulvin 11 mg/kg per day for 6 weeks. Efficacy variables included mycological, clinical, and combined outcomes. The primary efficacy variable was the combined outcome of the modified intent-to-treat population at week 6. Patient safety was assessed throughout the study. Statistical analysis of the efficacy variables was conducted by means of the Cochran-Mantel-Haenszel test. RESULTS At the end of treatment, mycological cures were present in 44.5%, 49.6%, and 52.2% of the fluconazole 3-week, fluconazole 6-week, and griseofulvin groups, respectively. Analysis of the primary efficacy variable failed to identify any superior agent, and differences between the combined outcomes of the fluconazole 6-week and griseofulvin groups at week 6 were not significant (P = .32). Regarding mycological, clinical, and combined outcomes, no significant differences between the fluconazole 6-week and griseofulvin groups were detected at any time point in the study. No new safety concerns were raised by this trial, and the incidence of treatment-related adverse events noted in this study is concordant with previous reports. Patients in the fluconazole arms of the study fared similarly. At the end of the trial, the difference in mycological cures between the fluconazole arms was only 7.5%, and increases in the incidence of certain treatment-related adverse events were observed in the fluconazole 6-week group. LIMITATIONS Adjunctive topical therapies and the impact of infected contacts were not assessed in this trial. CONCLUSION Systemic therapy with fluconazole 6 mg/kg per day and standard-dose griseofulvin produces comparable but low mycological and clinical cure rates. The limited efficacy of standard-dose griseofulvin and the lack of consensus regarding dose and duration of griseofulvin therapy in tinea capitis emphasize the need for controlled trials to identify optimal treatment parameters. Although the efficacy of fluconazole is no better than that of standard-dose griseofulvin, it may still be useful in select patients with a contraindication or intolerance to high-dose griseofulvin. The outcomes observed in this trial highlight the need to more clearly define the relative importance of adjunctive topical therapies and the evaluation and treatment of infected contacts as factors affecting cure rates.
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Affiliation(s)
- K Wade Foster
- Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294-0009, USA
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Morera-López Y, Torres-Rodríguez JM, Jiménez-Cabello T, Baró-Tomás T. Cryptococcus gattii: in vitro susceptibility to the new antifungal albaconazole versus fluconazole and voriconazole. Med Mycol 2006; 43:505-10. [PMID: 16320494 DOI: 10.1080/13693780400029528] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Minimal inhibitory concentrations (MIC) and minimal fungicidal activity of albaconazole, voriconazole and fluconazole against 55 strains of Cryptococcus gattii, clinically or environmentally isolated in Spain and some Latin American countries, were assessed. By means of the microbroth method (National Committee for Clinical Laboratory Standards; document M27-A2), the geometric mean value for fluconazole was 5.01 microg/ml; however, MIC for 12.7% of isolates ranged from 16 to 32 microg/ml, suggesting increased resistance against fluconazole. Geometric mean values of 0.02 and 0.03 microg/ml for albaconazole and voriconazole, respectively, were found, indicating not only a higher susceptibility to these new azoles but also a better performance of albaconazole (P = 0.003). Minimal fungicidal concentrations were also very low for albaconazole and voriconazole (P<0.001; geometric mean values of 0.023 microg/ml and 0.07 microg/ml, respectively). Both azoles may be good alternatives for the treatment of C. gattii cryptococcosis.
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Affiliation(s)
- Yolanda Morera-López
- Clinical and Experimental Mycology Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
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Fernandez-Obregon AC, Rohrback J, Reichel MA, Willis C. Current use of anti-infectives in dermatology. Expert Rev Anti Infect Ther 2005; 3:557-91. [PMID: 16107197 DOI: 10.1586/14787210.3.4.557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.
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Abstract
Current dosing regimens for itraconazole are effective, safe, and versatile for use in superficial fungal infections in children, particularly tinea capitis. Good efficacy rates have been noted in both Trichophyton and Microsporum tinea capitis infections. Itraconazole has a high affinity for keratin, and accumulates to high levels at the site of superficial fungal infections. A pulse regimen may be chosen over continuous dosing, because the accumulation persists after dosing of itraconazole has been stopped. An oral solution of itraconazole is available, and may be more convenient for children who cannot swallow capsules. The oral solution also produces good rates of efficacy, but may be associated with a somewhat higher potential for gastrointestinal adverse events than the capsules. The range of adverse events noted with itraconazole capsules or oral solution use in children is similar to the range in adults. Events are generally mild and transient. Attention must be taken to note any medications that the child is using, because itraconazole is associated with a range of potential drug interactions. This safety of use, in combination with itraconazole's wide antifungal spectrum and pharmacokinetic properties, which allow for shorter dosing regimens, may make itraconazole a suitable alternative to griseofulvin for pediatric superficial fungal infections.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook Site), University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
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