Nenoff Pietro, Klonowski Esther, Uhrlaß Silke, Schaller Martin, Paasch Uwe, Mayser Peter
Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
Universitäts-Hautklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Deutschland.
Dermatologie (Heidelb). 2024 Aug;75(8):655-673. doi: 10.1007/s00105-024-05359-y. Epub 2024 Jun 14.
Topical antifungals with activity against dermatophytes include amorolfine, allylamines, azoles, ciclopiroxolamine, and tolnaftate. Polyene antimycotics, such as amphotericin B and nystatin, alternatively, miconazole are suitable for yeast infections of the skin and mucous membranes. For severe yeast infections of the skin and mucous membranes, oral triazole antimycotics, such as fluconazole and itraconazole, are used. Pityriasis versicolor is treated topically with antimycotics, and in severe forms also orally with itraconazole, alternatively fluconazole. Terbinafine, itraconazole and fluconazole are currently available for the systemic treatment of severe dermatophytoses, tinea capitis and onychomycosis. In addition to proven therapeutic regimens, unapproved (off-label use) intermittent low-dose therapies are increasingly being used, particularly in onychomycosis. Oral antimycotics for the treatment of tinea capitis and onychomycosis in children and adolescents can only be used off-label in Germany. In general, any oral antifungal treatment should always be combined with topical antifungal therapy. In tinea corporis and tinea cruris caused by Trichophyton (T.) mentagrophytes ITS (internal transcribed spacer) genotype VIII (T. indotineae), there is usually terbinafine resistance. Identification of the species and genotype of the dermatophyte and resistance testing are required. The drug of choice for T. mentagrophytes ITS genotype VIII dermatophytoses is itraconazole. In individual cases, treatment-refractory onychomycosis may be due to terbinafine resistance of T. rubrum. Here too, resistance testing and alternative treatment with itraconazole should be considered. Therapy monitoring should be carried out culturally and, if possible, using molecular methods (polymerase chain reaction). Alternative treatment options include laser application, and photodynamic therapy (PDT).
对皮肤癣菌有活性的外用抗真菌药包括阿莫罗芬、烯丙胺类、唑类、环吡酮胺和托萘酯。多烯类抗真菌药，如两性霉素B和制霉菌素，另外，咪康唑适用于皮肤和黏膜的酵母菌感染。对于严重的皮肤和黏膜酵母菌感染，可使用口服三唑类抗真菌药，如氟康唑和伊曲康唑。花斑癣采用抗真菌药局部治疗，严重时也可口服伊曲康唑，也可用氟康唑。特比萘芬、伊曲康唑和氟康唑目前可用于严重皮肤癣菌病、头癣和甲癣的全身治疗。除了已证实的治疗方案外，未经批准（标签外使用）的间歇性低剂量疗法越来越多地被使用，尤其是在甲癣治疗中。在德国，用于治疗儿童和青少年头癣和甲癣的口服抗真菌药只能标签外使用。一般来说，任何口服抗真菌治疗都应始终与外用抗真菌治疗联合使用。由须癣毛癣菌ITS（内转录间隔区）基因型VIII（印地毛癣菌）引起的体癣和股癣通常对特比萘芬耐药。需要鉴定皮肤癣菌的种类和基因型并进行耐药性检测。须癣毛癣菌ITS基因型VIII皮肤癣菌病的首选药物是伊曲康唑。在个别情况下，治疗难治性甲癣可能是由于红色毛癣菌对特比萘芬耐药。同样，也应考虑进行耐药性检测并用伊曲康唑进行替代治疗。应通过培养进行治疗监测，如有可能，使用分子方法（聚合酶链反应）。替代治疗方案包括激光治疗和光动力疗法（PDT）。
