Frequently Asked Questions About Antifungal Medications

Fungal infections or as they are alternatively called, mycoses, are infections induced by parasitic fungi. There are a lot of kinds of mycotic infections that differ by the pathogen that induced it and by the impacted body part:
– Ringworm is a skin disease induced by Trichophyton and Microsporum.
– Candidiasis is caused by Candida. It affects mucosa, internal organs, skin, and genitalia.
– Onychomycosis is a fungal infection of the toenails and fingernails. It can be induced by Trichophyton rubrum, Trichophyton interdigitale, Trichophyton tonsurans, less frequently by Epidermophyton floccosum, and Microsporum canis.
– The variegated (multicolored) lichen versicolor is distinguished by the formation of scales, caused by Malassezia furfur.
– Black lichen - on the palms and soles forms brown or black spots is caused by Exophiala werneckii.
– Piedraia hortae is a fungus colonizing hair.
– The white piedraia is a mycosis of the hair. It is induced by Trichosporon beigelii.
– Sporotrichosis is mycosis induced Sporotrichium.
– Black tongue is manifested in black raid formations on the tongue; the cause is not known exactly, but there is an assumption that the disease is induced by fungi.
– Seborrhea is a skin disease induced by the yeast-like fungus Pityrosporum ovale.
– Aspergillosis is a group of illnesses induced by mold fungi Aspergillus.

– It’s believed that the most frequent places to get the fungal infection are pools, saunas, shared showers, and so on. And it’s true. According to numerous studies, most of the fungi that cause feet and toenail mycoses are found on the floors of the places of shared use with a high level of moisture. Other potentially dangerous places are floors in the dressing rooms of gyms, fitness centers, and other places where many people change and walk barefoot. But this is not the only way of infection. You can get infected in the manicure/pedicure salon, or at a beach.
– If some of your family members or guests who comes to visit you have feet or toenail fungal infection, there is a high chance of getting infected if they walk barefoot or if you share shoes including slippers with them.
– The typical kind of infection which most of the women encounter once or several times throughout their lifetime is vaginal candidiasis. It can develop as a result of lowered immunity, injuries of the genitalia (including small cracks), or, due to the most common reason – use of antibiotics. Bacterial antibiotic medications can also cause oral candidiasis. To avoid it, it is advised to use antifungal medications with them as prophylaxis.

There are also some professions that make the risk of getting a fungal infection higher, they include:
– Professional athletes;
– Military personnel and generally serving as a militarized organization with uniform shoes (boots and heavy boots);
– Sailors;
– Steelworkers, miners, industrial workers, power plant personnel, and others.

Other risk groups include people with different health conditions:
– People with lowered immunity due to HIV, AIDS;
– Cancer patients undergoing chemotherapy;
– Individuals with endocrine diseases;
– Individuals with lowered local immunity usually of the mucosa.

Risk groups not related to diseases include:
– Individuals with bad hygiene, people who use other’s clothes, shoes, towels, combs, brushes, etc.
– Teenagers are more prone to getting a mycotic infection because when they are hitting puberty that is accompanied by hormonal changes and dysfunction of the sebaceous glands there are favorable conditions for fungus development created.
– Elderly patients are more prone to fungus because of the other health conditions that they have or the medications they use.

To avoid infestation, you can first minimize the risk factors by not going to the places where shared showers are used and people walk barefoot, or always put on flip-flops in such places, use only your individual shoes and hygiene products including combs, towels, slippers, and so on.  You can use antimycotic agents for prophylactic purposes. Thirdly, even if the infection has already begun, you can stop it in time and save your nails from the fungus development. To avoid traumatizing your feet and nail beds thus making them susceptible to fungus, make sure to wear comfortable and “breathing” shoes from quality materials.
If you have already got a mycotic infection on your feet, you should start treating it immediately as otherwise it will be transferred into the toenails they are much harder to treat. If you started to notice changes in the feet that are characteristic for fungal disease (peeling, itching, and cracks in the interdigital folds), immediately use antimycotic formulations. This can be done without first visiting a healthcare specialist – you can get any suitable over-the-counter spray or powder and use them as indicated on the label. But if there are already changes in the nails, consult a specialist dermatologist. If you neglect a fungal skin disease, then it will inevitably go on to the nails.

Contingent on the place of the mycotic infection onset the symptoms that occur can be differently located. However, there are some common ones:
– Itching;
– Peeling of the skin (dandruff).
In the case of nail fungus, the usual first sign is the yellowing of the nail and its fragility.

Mycotic infections usually can be diagnosed without any special tests by the visual inspection of a dermatologist. In case they have any doubts, analysis of the affected skin are made using the peeled skin parts.
In the case of vaginal or oral candidiasis, analysis of the discharges (vaginal or saliva) are made.

Contingent on the localization of an infection and it severity it can be treated either by topical medications, i.e. sprays, ointments, gels, or internally used medications. Most commonly, pills are used and they can be conveniently taken at home. The length of the therapy and the dose of the formulation are chosen by a doctor but you can read the instruction that comes with the pills and find out what dosages and courses durations are recommended for different mycoses.

Antifungal formulations also called antimycotic drugs are medicinal products that have fungicidal (killing fungi) or fungistatic (stopping fungi replication) effect and are used for the prophylaxis and elimination of mycoses.
For the elimination of mycotic infections various medications are used – they can be natural or synthetic, different by the range and principle of action, have a fungicidal or fungistatic action; they differ by the use for localized and systemic infections.
There are a number of ranging of the antimycotic formulations that are by the structure, principle of action, a range of action, tolerance, etc.

In medical practice, mycotic medicines are split into three main groups:
1. Formulations for the therapy of generalized mycotic infections. They include antibiotics (amphotericin); Imidazole derivatives (miconazole, ketoconazole); triazole derivatives (fluconazole).
2. Formulations for the treatment of skin, nail, and hair mycoses. They include: antibiotics (Griseofulvin); derivatives of methylnaphthalene (terbinafine); nitrophenol derivatives; iodine formulations.
3. Formulations for the elimination of candidiasis. They include antifungal antibiotics; Imidazole derivatives; triazole derivatives.

As we have already pointed out, different medications of different strengths are used for the elimination of fungal infections based on their severity, spread, and type. However, we can name the most frequently prescribed medications:
– Diflucan (Fluconazole);
– Griseofulvin (Fulvicin, Grisactin - Grisovin FP by GlaxoSmithKline);
– Lamisil (Terbinafine);
– Nizoral (Ketoconazole);
– Sporanox (Itraconazole 100 mg).

We have already mentioned that the dosages and course duration are greatly contingent on the type of the mycotic infection, its spread and severity. Here you can find approximate treatment lengths for different types of mycotic infections by the most popular medications.
1. Diflucan (Fluconazole):
– Acute vaginal candidiasis is treated with 150 mg taken once;
– Skin fungal infections are treated with 150 mg once a week or 50 mg once a day. The duration of treatment is 2-4 weeks. Treatment of mycosis of the feet can last up to 6 weeks.
– Nail mycosis is treated with a dose of 150 mg one time per week. Treatment should be continued until the healthy nail grows at the site of the infected nail. It usually takes 3-6 months for fingernails and 6-12 months to grow healthy toenails.
2. Fulvicin (Griseofulvin) dosages depend on the body weight and the type of infection. The average course durations are: skin infections – 2-4 weeks, scalp – 4-6 weeks, feet mycosis – 4-8 weeks, fingernails – more than 4 months, toenails – from six months and more. The treatment must be continued till the results of tests for fungus come back negative.
3. Lamisil (Terbinafine) is used for the mycosis of feet for 2-6 weeks, for other skin for 4 weeks, perineum mycosis for 2-4 weeks, and for nails the course is up to three months. When treating nails with this medication, you should keep in mind that the complete elimination of the symptoms can occur several weeks after the tests for fungal infection are negative because of the growth of the nail.
4. Nizoral (Ketoconazole) is used by one 200 mg capsule once a day during a meal. If the effect is insufficient, the dosage can be raised to 400 mg taken once a day. The therapy length for ringworm is 4 weeks, for pityriasis or lichen - 10 days, in Onychomycosis (nail fungus) - 6-12 months, for candidiasis of the mouth and skin - 2-3 weeks, for systemic mycoses - 1-2 months. In vaginal candidiasis, the daily dose is 400 mg, the length of the course is 5 days.
5. Sporanox (Itraconazole 100 mg) is taken in different dosages for different fungal infections. Vaginal candidiasis is treated with the formulation for one day or three days; chronic candidiasis is treated for 6-7 days and then on the first day of period once for 3-6 months; pityriasis is treated with the medication for 7 days; ringworm is treated for 15 days; oral candidiasis is treated for 15 days; fungal keratitis is treated for 21 day; fingernail fungus is treated with the daily use of the set dosage for three months or a pulse therapy of one week of use and three weeks of break repeated two times; toenail mycosis is treated with a pulse-therapy – one week of daily use, three weeks break, the cycle is repeated three times; systemic aspergillosis is treated for 5 months.