Oral antifungal agents

1. Oral therapy is often chosen because of its shorter duration and greater compliance. However, oral agents must be used for disease that is extensive, that affects hair and nails, or that does not respond to topical agents.

2. Terbinafine (Sporanox) has fewer drug interactions because it minimally affects the cytochrome P450 enzyme system. Itraconazole, fluconazole and ketoconazole significantly inhibit this system.

3. Side effects of fluconazole (Diflucan) include rash, headache, gastrointestinal disorders and elevated liver function levels. Erythema multiforme may rarely occur.

4. Side effects of terbinafine (Lamisil) include skin rashes and gastrointestinal upset. It has also been associated with Stevens-Johnson syndrome, blood dyscrasias, hepatotoxicity and ocular disturbances, as well as elevated liver enzyme levels in 0.5%. Some patients have noted losing their sense of taste for up to six weeks.

5. Topical corticosteroids are beneficial in the initial stages of treatment because they suppress the inflammatory response and provide symptomatic relief. Because of the possibility of fungal proliferation, topical corticosteroids should not be used alone in the treatment of tinea infections.

References: See page 195.

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