The Susceptibility of Dermatophytes to Photodynamic Treatment with Special Focus on Trichophyton rubrum

Owing to the accessibility of skin to light, many applications of photodynamic treatment (PDT) have been developed within dermatology. The recent increase of dermatological antimicrobial PDT investigations is related to the growing problem of bacterial and fungal resistance to antibiotics. This review focuses on the susceptibility of dermatophytic fungi, in particular Trichophyton rubrum, to PDT and shows its potential usefulness in treatment of clinical dermatophytoses. There are no data indicating significant differences in PDT susceptibility between various dermatophytes and it is unlikely that treatment problems of especially T. rubrum with current antimycotics would occur in case of PDT. Red light 5-aminolevulinic acid-mediated PDT is after repeated sessions successful in in vivo treatment of onychomycosis (fungal nail infection) caused by various dermatophytes. Regarding skin dermatophytoses, UVA-1 PDT with cationic porphyrins appears to be safe and efficient. Most effective toward T. rubrum ex vivo is 5,10,15-tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride (Sylsens B) when combined with UVA-1 radiation or red light; this creates the possibility of efficiently treating nail infections and remaining spores in hair follicles. If the promising in vitro and ex vivo results could be transferred to clinical practice, then PDT has a good prospect to become a worthy alternative to established antifungal drugs.