The use of systemic antimycotics in dermatotherapy

Fungal infections of the skin as well as of the nails and hair due to dermatophytes or due to yeasts or moulds still form a major portion of skin diseases overall. Effective therapy of mycoses is not always simple to achieve. In less severe cases topical therapy can be sufficient, but in extensive cutaneous infections, previous resistance to treatment and especially hyperkeratotic tinea and onychomycosis, systemic therapy can be mandatory. For systemic therapy, in particular azoles, i.e. itraconazole and fluconazole as well as the allylamine terbinafine are worth considering. The older antimycotics, i.e. griseofulvin and also ketoconazole are more and more replaced by other, newer drugs. For optimal treatment of a given mycosis, therapy can and should correspond to the individual situation. This applies both to the type of drug and its mode of application. The treatment of choice is the one with the best benefit to risk ratio and the best benefit to cost ratio. Unfortunately, as yet, a cure cannot be expected in every single case.