Tinea corporis in human immunodeficiency virus-positive patients: case report and assessment of oral therapy.
Dermatophytosis in immunocompromised hosts is more varied and often more severe than in immunocompetent hosts. Early recognition and treatment with systemic therapy are important in human immunodeficiency virus (HIV)-positive patients in order to prevent severe infection. Potential drug resistance can occur due to chronic usage of systemic azole therapy in such patients, or the existence of atypical fungi. Although warnings have been made of possible drug interactions between certain antifungals and antiretroviral medications, only one combination has shown a clinically significant interaction. A case treated aggressively with oral terbinafine at the onset is presented.


BACKGROUND
Dermatophytosis in immunocompromised hosts is more varied and often more severe than in immunocompetent hosts. Early recognition and treatment with systemic therapy are important in human immunodeficiency virus (HIV)-positive patients in order to prevent severe infection.


OBJECTIVE
To analyze potential therapies for dermatophyte infections in immunocompromised patients and risk of drug resistance and interactions with antiretroviral medications.


METHODS
Literature search based on MEDLINE (1966-March 2003) and additional references obtained from cross-referencing retrieved articles. All information deemed relevant by the reviewers was included. A case study was employed to exemplify the usage of this information in patient care.


RESULTS
Although warnings have been made of possible drug interactions between certain antifungals and antiretroviral medications, only one combination has shown a clinically significant interaction.


CONCLUSIONS
When considering drug interactions and side-effects, there are no clinically significant reasons to avoid any oral antifungal for dermatophytosis in the HIV-positive patient.
Burkhart
Craig N
CN
Department of Microbiology and Immunology, Medical College of Ohio, Toledo, Ohio 43623, USA. cburkhart@mco.edu
Chang
Howard
H
Gottwald
Lorie
L
D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009281:Naphthalenes / Q000627:therapeutic use*; D000077291:Terbinafine; D014005:Tinea / Q000150:complications* / Q000188:drug therapy*
D000935:Antifungal Agents; D009281:Naphthalenes; D000077291:Terbinafine