Topical antifungal‐corticosteroid combination therapy for the treatment of superficial mycoses: conclusions of an expert panel meeting

Abstract

Superficial fungal infections affect 20-25% of people worldwide and can cause considerable morbidity, particularly if an inflammatory component is present. As superficial fungal infections can be diverse, the treatment should be tailored to the individual needs of the patient and several factors should be taken into account when deciding on the most appropriate treatment option. These include the type, location and surface area of the infection, patient age, degree of inflammation and underlying comorbidities. Although several meta-analyses have shown that there are no significant differences between the numerous available topical antifungal agents with regard to mycological cure, agents differ in their specific intrinsic properties, which can affect their clinical use. The addition of a corticosteroid to an antifungal agent at the initiation of treatment can attenuate the inflammatory symptoms of the infection and is thought to increase patient compliance, reduce the risk of bacterial superinfection and enhance the efficacy of the antifungal agent. However, incorrect use of antifungal-corticosteroid therapy may be associated with treatment failure and adverse effects. This review summarises available treatment options for superficial fungal infections and provides general treatment recommendations based on the consensus outcomes of an Expert Panel meeting on the topical treatment of superficial mycoses.

<p>Updates on Genital Dermatophytosis</p>

“…Inappropriate use of such combinations are associated with adverse effects, e.g., cutaneous atrophy, tinea incognito, Majocchi’s granuloma including suppression of the hypothalamus-pituitary-adrenal axis, especially when potent corticosteroid combinations are prescribed. 86 …”

S1 guidelines: Tinea capitis

“…Some authors believe that the significant inflammatory component of some TC variants (kerion) is in part due to a strong (delayed-type) immune response to the causative organism; this is also reflected by the common occurrence of dermatophytids [39,40]. Given this view, it has been recommended to use oral or intralesional corticosteroids to speed up the healing process and to minimize the risk of persistent alopecia [111,112]. The randomized trials conducted to date (Hussain et al 1999 [113]: griseofulvin 10 mg/kg plus systemic prednisolone 1-2 mg/kg for 2-4 weeks; Ginsburg et al 1987 [114]: griseofulvin 15 mg/kg plus a single dose [2.5 mg] of intralesional triamcinolone acetonide) showed no difference in terms of disease course and clinical response.…”

“…In inflammatory TC variants, strong immune responses and pruritus caused by highly potent antifungal monotherapy and rapid fungal degradation may be countered with topical combination therapy consisting of corticosteroids and antifungals, initially for a period of approximately seven days [111,112]. In inflammatory TC variants, strong immune responses and pruritus caused by highly potent antifungal monotherapy and rapid fungal degradation may be countered with topical combination therapy consisting of corticosteroids and antifungals, initially for a period of approximately seven days [111,112].…”

S1‐Leitlinie Tinea capitis

“…Die Studie von Proudfoot zeigt anhand von Fallbeobachtungen, dass mit dem topischen Einsatz potenter Glukokortikoide ein schnellerer Rückgang der Entzündung und der subjektiven Beschwerden sowie ein rascheres Haarwachstum zu beobachten waren. Einer Verstärkung der Immunreaktion beziehungsweise des Juckreizes durch eine hochpotente antimykotische Monotherapie und raschen Erregerzerfall bei inflammatorischen Tinea‐capitis‐Formen kann mit einer topischen Kombinationstherapie aus Glukokortikosteroiden und Antimykotika initial für einen begrenzten Zeitraum von etwa sieben Tagen begegnet werden .…”