Systemic Therapies: Antifungals

Terbinafine, fluconazole, itraconazole and ketoconazole are all oral antifungals that can be used in treatments of cutaneous fungal infections such as tinea capitis and onychomycosis. Fungal infection that invovles hair, nail, or large body surface areas should be treated with systemic therapy as creams are ineffective. Terbinafine is the most commonly used and is given for 4-12 weeks depending on the clinical situation. Screening of liver function prior to therapy was previously standard, but recent studies have demonstrated limited utility. Oral ketoconazole is not often used as other medications have better side effect profiles and fewer drug-drug interactions.