Management of fungal skin infections with 15 days itraconazole treatment: a worldwide review.

Initial dose-finding and placebo-controlled studies in skin dermatophytoses demonstrated that itraconazole was more effective than placebo and that short-term treatment with itraconazole 100 mg daily gave better results than 50 mg daily. Subsequently, an approach has been followed which is quite different from the classical attitude in treating fungal infections. Indeed, it is usual policy to continue antifungal therapy for some days after complete disappearance of clinical signs and symptoms. With itraconazole, the opposite approach has been followed. Kinetic studies have shown that (a) tissue levels are higher (up to ten times in skin areas with a high density of sebaceous glands) than corresponding plasma levels, and (b) therapeutic concentrations of itraconazole remain present in the epidermis for up to four weeks after discontinuation of therapy, plasma levels being undetectable after one week. These findings confirm the exceptional affinity of itraconazole for the epidermis without re-uptake into the blood circulation. Based on these findings, fixed treatment schedules were initiated with a 15-day treatment course of 100 mg itraconazole once daily in patients with tinea cruris, tinea corporis or tinea pedis, with a 30-day treatment of 100 mg itraconazole once daily in patients with palmoplantar infections. With these short and fixed treatment regimens it became evident that an 80% mycological cure and a 90% clinical response could be obtained 3-4 weeks after discontinuation of therapy in tinea corporis/cruris infections when itraconazole was given at a daily dose of 100 mg for 15 days.(ABSTRACT TRUNCATED AT 250 WORDS)