Antifungal therapy of yeast infections.

Candida infections of the skin and mucous membranes are common in both healthy and immunocompromised patients. Management with topical azole or polyene therapy is generally straightforward except in immunocompromised patients with oropharyngeal infections and in Candida onychomycosis. Oral candidosis in patients with AIDS generally requires oral therapy with fluconazole, itraconazole, or ketoconazole. Continuous suppressive therapy carries the risk of the development of clinical tolerance or secondary drug resistance. In nail disease, oral antifungal therapy is appropriate except in paronychia, for which topical azole antifungals appear to be equally effective. In any case it is important to determine whether Candida isolated from nail material is a true nail pathogen or merely colonizing the nail plate. Distal erosion of the nail plate, the presence of underlying host abnormalities such as Raynaud's disease, and hyphae in the nail plate are clues that organism is invading the nail plate.