Practical aspects of treatment of superficial mycoses of the skin and cutaneous appendage

In recent years, the Russian Federation has seen an increase in the incidence of superficial mycoses of the skin, a change in the nature of the disease course and spectrum of its pathogens. At the same time, the imperfection of the nosological classification and nomenclature of pathogens is noted. Besides there is a deficit of modern methods for diagnosing and treating mycoses of the skin and cutaneous appendage. These facts determine the current need to update clinical guidelines and create guidelines for onychomycosis, scalp mycoses and skin mycoses.

The main methods of diagnosing superficial mycoses of the skin and its appendages in most countries are the KOH test and culture, with luminescence, histological examination and nail dermatoscopy as auxiliary methods. In some diagnostic laboratories, molecular genetic methods with high sensitivity and specificity have become much more widely used. The greatest difficulty is the diagnosis of onychomycosis. The accumulated experience of clinical practice and research data confirm atypical clinical manifestations of modern mycoses and difficulties in their diagnosis.

Currently, one of the most important problems in the treatment of skin mycoses is the development of resistance to antimycotics. In this regard, it is necessary to use drugs that reduce the risk of resistance. Amorolfine, as a morpholine, acts on two different enzymes (sterol Δ14 reductase and sterol Δ7-Δ8 isomerase) and is a possible therapeutic option for overcoming antifungal resistance. It has a favorable safety profile and efficacy similar to other classes of antifungal agents. There is now a significant evidence base for the fungistatic and fungicidal activity of the amorolfine molecule, its efficacy and safety. In this regard, it seems appropriate to include amorolfine in cream form 0,25% in national clinical guidelines for the treatment of superficial cutaneous mycosis.