Management of mycoses in daily practice

The guideline recommendations, albeit founded on thorough reviews of clinically relevant literature data, are often not immediately adaptable to everyday life. Considering the marked heterogeneity of superficial mycoses, each of them requires specific management in a real life context; in all cases diagnostic confirmation is required with microscopic and culture examination. In tinea capitis oral therapy is necessary (minimum six weeks) and should be continued until clinical and, above all, mycological healing. In cases of tinea corporis, cruris or pedis, it may be necessary to associate oral therapy to topical treatment. The main oral antifungals are fluconazole, itraconazole and terbinafine. Fluconazole has favorable pharmacokinetic and pharmacodynamic characteristics, and is effective in most superficial mycoses, for example in cases of diffuse or recurrent pityriasis versicolor in which oral therapy with an azole derivative is useful. Topical treatment, lasting 6-12 months, is indicated in onychomycosis that is confined to one nail. In frequent cases of onychomycosis involving multiple nails or recurrence, oral therapy is necessary. Pharmacological history is important, given the possible interactions of some systemic drugs. In chronic or recurrent relapsing vulvovaginitis, first-choice therapy is oral fluconazole with a therapeutic regimen that respects the mycotic biorhythm (200 mg on days 1, 4, 11, 26, and subsequently 200 mg/week for 3 months).