Superficial fungal infections: Clinical practices and management in Asia

Abstract

Fungal infections affecting the epidermis, mucosa, hair and nail are encompassed in superficial fungal infections. These include dermatophytosis (tinea), Malassezia-related skin disorders (pityriasis versicolor, seborrheic dermatitis or folliculitis) and fungal keratitis (FK). Several unique challenges related to their diagnosis and management persist in Asian countries including availability of multiple ineffective fixed dose combination, unauthorized cosmetics and self-treatment/non-compliance of patients. The most common antifungals used for the treatment of superficial infections include azoles (fluconazole, voriconazole, itraconazole, ketoconazole, sertaconazole, luliconazole, clotrimazole, miconazole); allylamines (terbinafine, naftifine); morpholine (amorolfine); oxaboroles/hydroxamic acid (ciclopirox olamine), natamycin, chlorhexidine and antibiotic (griseofulvin). Topical and/or systemic antifungals are used depending on the severity of infection and the site involved. A rising awareness regarding the diagnosis of superficial skin infections and the gradual improvement in generation of clinical data regarding treatment response is promising. We discuss here the current practices of management of superficial fungal infections in Asia with majority of data from India.