Topical treatment is useful in many superficial fungal infections—i.e., those confined to the stratum comeum, squamous mucosa, or cornea, including dermatophytosis (ringworm), candidiasis, tinea versicolor, piedra, tinea nigra, and fungal keratitis. Topical administration usually is unsuccessful for mycoses of the nails (onychomycosis) and hair (tinea capitis) and has no place in the treatment of subcutaneous mycoses, such as sporotrichosis and chromoblastomycosis. The efficacy of topical agents depends not only on the type of lesion and the mechanism of drug action, but also on the viscosity, hydrophobicity, and acidity of the formulation. Regardless of formulation, penetration of topical drugs into hyperkeratotic lesions often is poor. Removal of thick, infected keratin may be a useful adjunct to therapy.
A plethora of topical agents is available for the treatment of superficial mycoses, the preferred formulations of which usually are creams or solutions. Powders, whether applied by shake containers or aerosols, largely are used for the feet and moist lesions of the groin and other intertriginous areas.
Indications for topical use include ringworm, tinea versicolor, and mucocutaneous candidiasis. Resistance to imidazoles or triazoles is very rare among the fungi that cause ringworm. Agents for topical use should be selected based on cost and availability.
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