TERAPEUTICS OF

DERMATOPHYTOSIS
CREATED BY :
CLAUDIA S.P KOTA SIKU 13 17 777 14 219
NOVIA PUTRI RAHMAN 13 17 777 14 222
USBAHUDDIN ALIMIN 13 17 777 14 239

Supervisor:
dr. Sukma Anjayani, M.Kes, Sp.KK
Palu, 21/01/2019
 DEFINITION OF
DERMATOPHYTOSIS
Dermatophytosis is superfisial fungal infection that
affects skin, hair and nails which cause by Dermatophytoses
epidermophyton, Micosporum and Trichiphyton.

Schieke S.M, Garg A,. Dermatology in General Medicine. Ed 8. United States of America: McGraw
Hill; 2012.
 CLASSIFICATION
A Tinea capitis describes dermatophyte
infection of hair and scalp

B Tinea favosa is a chronic dermatophyte

infection of the scalp rarely involving
glabrous skin, and/or nails

C
Tinea barbae affects the face unilaterally
and involves the beard area moore often
than the moustache or upper lip.

Verma S, Heffernan M.P.,Superficial Fungal Infections ; Dermatophytosis,Onychomycosis, Tinea Nigra, Piedra, In: Fitzpatrick's
T. Dermatology in General Medicine. Ed 7. United States of America: McGraw Hill; 2008. p:1807-20.
Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of
America: McGraw Hill; 2012. p:2277-96.
 Tinea corporis refers to any
D
dermatophytosis of glabrous skin except
palms, soles, and the groin.

E Tinea cruris is a dermatophytosis of the

groin, genitalia, pubic area, and perineal
and perianal skin

Tinea pedis denotes dermatophytosis of the

F
feet, whereas tinea manuum involves the
palmar and interdigital areas of the hands.

Verma S, Heffernan M.P.,Superficial Fungal Infections ; Dermatophytosis,Onychomycosis, Tinea Nigra, Piedra, In: Fitzpatrick's T.
Dermatology in General Medicine. Ed 7. United States of America: McGraw Hill; 2008. p:1807-20.
Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of
America: McGraw Hill; 2012. p:2277-96.
 G
Onychomycosis describes fungal infection
of the nail caused by dermatophytes,
nondermatophyte molds, or yeasts. .

H
Tinea nigra is a superficial dermatomycosis
caused by dermatiaceous, darkly
pigmented.

Verma S, Heffernan M.P.,Superficial Fungal Infections ; Dermatophytosis,Onychomycosis, Tinea Nigra, Piedra, In: Fitzpatrick's T.
Dermatology in General Medicine. Ed 7. United States of America: McGraw Hill; 2008. p:1807-20.
Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of
America: McGraw Hill; 2012. p:2277-96.
 PATHOGENESIS
Dermatophytes can survive solely on outer cornified layers of
the skin. The ability of certain fungi to adhere to particular host arises
from numerous mechanisms and host factors, including the ability to
adapt to the human body. Natural infection is acquired by the
deposition of viable arthrospores or hyphae on the surface of the
susceptible individual. After the inoculation in the host skin, suitable
conditions favor the infection to progress through the stages of
adherence and penetration.

Development of host response is mostly by a T-cell mediated

response of delayed-type hypersensitivity. Antibody formation does
not seem to be protective. Natural defenses against dermatophytes
depend on both immunological and nonimmunological mechanisms.
Tainwala R, Sharma Y. Pathogenesis Of Dermatophytoses. Indian J Dermatol. India. 2011; Vol.56(3)p.259–61.
 DIAGNOSTIC
1. Anamnesis
2. Physical Examination
3. KOH (Kalium Hydroxide)
4. Culture
5. Polymerase chain reaction (PCR)

Marie-Pierre Hayette, Sacheli R., Dermatophytosis, Trends in Epidemiology and Diagnostic Approach. National Reference Center
for Mycosis article. Department of Clinical Microbiology, University Hospital of Liège, Belgium. 2015.
Rudramurthy S.M, Shaw D., Overview and update on the laboratory diagnosis of dermatophytosis. Clinical Dermatology
Review.Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 2017;
Vol 1(3)p:1-3
 METABOLISM OF
ERGOSTEROL IN FUNGI

Ergosterol an important component of the fungal cell

membran, is not only essensial for fungal growth and
development , but also play a major role in the composition of the
cell membran, which can regulate cell membran fluidity and
permeability.

Biosynthesis of ergosterol can be divided in to three

modules : mevalonate, farnesyl pyrophosphat (farnesyl-PP) and
ergosterol Biosynthesis

Zhihong H, Recent advances in Ergosterol Biosynthesis and Regulation mecanisms in Sacchormyces

cerevisiae. Indian journal of microbiology. Assosciation of Microbilogy of India. 2017
Zhihong H, Recent advances in Ergosterol Biosynthesis and Regulation mecanisms in Sacchormyces
cerevisiae. Indian journal of microbiology. Assosciation of Microbilogy of India. 2017
 TREATMENT OF
DERMATPHYTOSIS
Treatment of dermatophytosis consist of oral and topical

antifungal drugs or combination of both, depending on the extent

and severity, site of infection, and causative organism.

Beside pharmacotherapy, there are many important

considerations while managing a case of dermatophytic infection

improving hygine of the skin, nails and hair.

•Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of America:
McGraw Hill; 2012. p:2277-96.
•Hay R.J, Ashbee H.R.,Mycology. Rook’s Book. Text Book of Dermatology. Ed 8.Garsington, Oxford, Untited State of America: Wiley-
Balck Well. 2010. Chapter 36.36-36.48
•SinghS,Sahni K, Dogra S.,Newer Topical Treatments in Skin and Nail Dermatophyte Infections. Indian Dermatol Online J. Candigarh,
India. 2018; 9(3)p.149–58.
 TOPICAL
1. Azole 2. Allylamin
a. Econazole a. Naftivine
b. Miconazole b. Gutenavine
c. Ketoconazole c. Terbinavine
d. Silconazole 3. Morpholine
e. Oxiconazole a. Amorolphyne
f. Lanoconazole 4. Echinocandins
g. Tiyoconazole a. Caspofungin
h. Sertaconazole b. Micafungin
•Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of America:
McGraw Hill; 2012. p:2277-96.
•Hay R.J, Ashbee H.R.,Mycology. Rook’s Book. Text Book of Dermatology. Ed 8.Garsington, Oxford, Untited State of America: Wiley-
Balck Well. 2010. Chapter 36.36-36.48
•SinghS,Sahni K, Dogra S.,Newer Topical Treatments in Skin and Nail Dermatophyte Infections. Indian Dermatol Online J. Candigarh,
India. 2018; 9(3)p.149–58.
 AZOLES
Act blocking the lanosterol 14-α-demethylase, an enzyme necessary for the
biosynthesis of ergosterol.

1. Sertaconazole

Dosage : 2% sertaconazole cream is applied once or twice daily for a period of 4 weeks.

Indicated : T. pedis caused by T. rubrum, T. Interdigitale and epidermophyton.

Preparation : Cream, lotion, shampoo and powder.

2. Ketokonazole

Dosage : 2% ketokonazole cream is applied once daily for a period of 2-4 weeks, 2%
ketokonazole shampoo recommendid 2-4 times weekly for 2-4 weeks.

Indicated : Dermatophytosis, Pityriasis versikolor, C. Kutaneus and D. Seboroik.

Preparation : Cream, shampoo, lotion, shoap and powder.

3. Miconazole

Dosage : 2% miconazole cream is applied twice daily for a period of 2-4

weeks.

Indicated : Dermatohytosis, Pityriasis versikolor, C. Mucokutanous, C.

Vaginalis and C. orale.

Preparation : Cream, lotion, Powder and shampoo.

4. Econazole

Dosage : 1% econazole cream is applied twice daily for a period of 2-4 weeks.

Indicated : Dermatophytosis, Pityriasis versikolor, C. Kutaneus and D.

Seboroik.

Preparation : Cream, powder, lotion dan shampoo.

5. Lanoconazole

Dosage : 1% lanoconazole cream is applied once daily for a period of 2-4

weeks.

Indicated :T. pedis, T. corporis and C. cutanous.

Preparation : Cream, solution and ointment.

6. Oxiconazole

Dosage : 2% oxiconazole cream is applied once or twice daily for a period

of 2-4 weeks, for T. pedis cream is applied once or twice daily for a period
of 4 weeks.

Indicated : Dermatophytosis and C. cutanous.

Preparation : Cream and lotion.

7. Tioconazol

Dosage : 1% tioconazol cream is applied twice daily for a period of 2 -4

weeks.

Indicated : Dermatophytosis.

Preparation : Cream.

8. Sulconazole

Dosage : 1% sulconazole cream is applied twice daily for a period of 4

weeks.

Indicated : Dermatophytosis.

Preparation : Cream, lotion, solution, shoap, and powder.

 ALLYLAMINES
Allylamines interfere with ergosterol synthesis similar to azole but
act at an earlier stage by inhibiting the formation of squalene epoxidase,
which is a precurso of lanosterol and involved in the formation of cell
membrane.

1. Naftifine

Dosage : 2% naftivine cream and gel is applied once daily for a period of 2
weeks.

Indicated : Dermatophytosis, Candidas and Aspergyllus species.

Preparation : Cream and Gel.

2. Butenafine

Dosage : 1% butenafine cream is applied once daily for a period of 1

weeks, for T. Cruris gutenavine 1% mix with terbinavine 1% is applied
once daily for a period of 4 weeks.

Indicated : Dermatophytosis.

Preparation : Cream.

3. Terbinafine

Dosage : 1% terbinafine cream is applied once daily for a period of 1-2

weeks.

Indicated : Dermatophytosis.

Preparation : Cream, gel, and spray solution.

 MORPHOLINE
Morpholine inhibit two enzymes C-14 sterol reductase and C-8
sterol isomerase, in the ergosterol synthesis pathway.

1. Amorolphyne

Dosage : 1% Amorolphyne cream is applied once daily for a period of 2-3

weeks, for onycomichosis 5% nail lacquer is applied once or twice weekly
for a period of 6 month.

Indicated : Dermatophytosis and onycomichosis.

Preparation : Cream and lacquer.

 HYDROXYPIRIDONE
Hydroxypiridone are weak acids and show broad-spectrum
antimicrobial activity. They act by chelating trivalent metal cations
inhibition of metal-dependent enzymes leading to less degradation of
cytoplasmic peroxides, increased sensitivity of cells to oxidative
stress, and decreased level of iron permeases or transpoters.

1. Siclopirox Olamine

Dosage : For T. corporis and T. Cruris 1% Siclopirox Olamine cream is

applied twice daily for a period of 2-4 weeks, for onycomichosis 8% nail
lacquer is applied once daily for a period of 48 weeks.

Indicated : Dermatophytosis and onycomichosis.

Preparation : Cream, lotion, shampoo, solution and lacquer.

 SYSTEMIC
1. Griseovulfin
2. Ketoconazole
3. Itraconazole
4. Fluconazole
5. Vericonazole
6. Terbinafine

•Schieke S.M, Garg A.,Superficial Fungal Infections, In: Fitzpatrick's T. Dermatology in General Medicine. Ed 8. United States of America:
McGraw Hill; 2012. p:2277-96.
•Hay R.J, Ashbee H.R.,Mycology. Rook’s Book. Text Book of Dermatology. Ed 8.Garsington, Oxford, Untited State of America: Wiley-
Balck Well. 2010. Chapter 36.36-36.48
•Setiabudy R, Gunawan SG, Nafrialdi, Instiaty. Obat Jamur. Farmakologi dan Terapi. Badan Penerbit Fakultas Kedokteran Universitas
Indonesia. Ed 6. Jakarta. 2016. p.5
GRISEOVULFIN
This is a metabolic product derived from species of
Penicillium. Its activity, which is fungistatic, is largerly
restricted to dermatophyte infections. The mode of actio
appears to be in part through inhibition of the formation of
intracelullar microtubules.
• Dossage

Adults
Children
 Tinea capitis : 20 - 25 mg/kg/day to 6 – 8
• Tinea corporis/cruris :
weeks
10 - 20mg/kg/day to 2- 4
 Tinea barbae : 1gr/kg/day to 6 weeks
weeks
 Tinea corporis/cruris : 500mg/day to 2 – 4
weeks

• Side effects : common side effects include photosensitivity, headache,

and gastrointestinal upset (vomite and nausea).

• Contraindicated : griseovulfin cant use with fenobarbital and warfarin.

KETOCONALOZE
Act blocking the lanosterol 14-α-demethylase, an enzyme necessary for
the biosynthesis of ergosterol.

• Dossage :

Adults Children
200 – 400mg/day, for tinea corporis and • Tinea corporis/cruris :
cruris can use for 2 – 4 weeks 10 - 20mg/kg/day to 2- 4
Cant recommended for tinea capitis and weeks
onychomycosis

Side effects : common side effects include anorexia, vomite, and nausea.

Contraindicated : Ketoconazole cant use with antasida, terfenadin, astemizol,

and cisaprid.
ITRACONAZOLE
Act blocking the lanosterol 14-α-demethylase, an enzyme
necessary for the biosynthesis of ergosterol.
• Dossage
Children
Adults
 Tinea corporis/cruris :
 Tinea capitis : 5 mg/kg/day to 2 – 4 weeks
5mg/kg/day to 1 weeks
 Tinea barbae : 200mg/day to 2 – 4 weeks
 Tinea pedis : 5mg/kg/day
 Tinea corporis/cruris : 100mg/day to 2 – 4
to 1 weeks
weeks
 Onychomycosis :
 Tinea Pedis : 200mg twice daily to 1 week
5mg/kg/day to 2 – 3
 Onychomycosis : 200mg/day to 2 – 3
months
months

• Side effects : common side effects include abdominal pain, vomite,

and constipation.
• Contraindicated : -
FLUCONAZOLE
Act blocking the lanosterol 14-α-demethylase, an enzyme
necessary for the biosynthesis of ergosterol.

• Dossage :

Adults
 Tinea capitis : 6 mg/kg/day to 3 weeks
Children
 Tinea barbae : 200mg/day to 4 – 6 weeks
• Onychomycosis :
 Tinea corporis/cruris : 150 – 300mg/day to
6mg/kg/week to 3 – 6
4 – 6 weeks
months
 Tinea Pedis : 150mg/week to 3 – 4 weeks
 Onychomycosis : 150 – 300mg/week to 3 –
12 months

• Side effects : common side effects include headache, abdominal

pain, diareae, vomite, and vomiting.
• Contraindicated : -
VORICONAZOLE
Act blocking the lanosterol 14-α-demethylase, an enzyme
necessary for the biosynthesis of ergosterol.

• Dossage :

Body weight <40kg : 100mg/12 hours

Body weight >40kg : 200mg/12 hours

• Contraindicated : Voriconazole cant use with rimfapicin,

karbamazepin, and Kuinicin.
TERBINAFINE
Terbinafine is a member of allylamine anti fungals, which act
by the inhibition of squalene epoxidase in the formation of
the fungal cell membrane. So, drug inhibits cell growth and
that a which the fungal cell is killed (the drug is fungicidal
rather than fungistatic)

• Side effects : common side effects include diareae,

dyspepsia, and abdominal pain.

• Contraindicated : terbinafine cant use pregnant.

• Dossage

Adults
 Tinea capitis : 250mg/day to 2 – 8 weeks
 Tinea barbae : 250mg/day to 2 – 4 weeks
 Tinea corporis/cruris : 250mg/day to 2 – 4 weeks
 Tinea Pedis : 250mg/week to 2 weeks
 Onychomycosis : 250mg/week to 6 – 12 weeks

Children
 Tinea capitis : 3 – 6mg/kg/day to 2 – 8 weeks
 Tinea corporis/cruris : 3 – 6mg/kg/day to 2 weeks
 Tinea pedis : 3 – 6mg/kg/day to 2 weeks
 Onychomycosis : 3 – 6mg/kg/day to 6 – 12 weeks
THANKYOU