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Ciclopirox

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81. Seborrheic Dermatitis (Overview)

-term use and at risk for tachyphylaxis when used as monotherapy) For skin involvement, ketoconazole, naftifine, or ciclopirox creams and gels [ , , ] ; alternatively, calcineurin inhibitors (ie, pimecrolimus, tacrolimus), [ , , ] sulfur or sulfonamide combinations, or propylene glycol [ , , , , ] For acute flares, class IV or lower corticosteroid creams, lotions, or solutions For severe or unresponsive lesions, systemic fluconazole [ ] Treatment of dandruff may involve the following: More frequent (...) shampooing or longer lathering Discontinuance of hair spray or hair pomades Use of shampoos containing salicylic acid, tar, selenium, sulfur, or zinc [ , ] ; selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs [ , , ] ; an alternative to a shampoo with zinc is a conditioner rinse with zinc, 0.01% fluocinolone, and acetonide topical oil Overnight application of tar, bath oil, or Baker’s P&S solution; Derma-Smoothe F/S oil is especially

2014 eMedicine.com

82. Candidiasis (Overview)

- Most localized cutaneous candidiasis infections can be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin) Chronic mucocutaneous candidiasis - This condition is generally treated with oral azoles Oropharyngeal candidiasis - This can be treated with either topical antifungal agents or systemic oral azoles Esophageal candidiasis - Treatment requires systemic therapy with fluconazole VVC - Topical antifungal agents or oral

2014 eMedicine.com

83. Candidiasis (Treatment)

treatments. Ketoconazole tablets were also withdrawn from the market in the European Union in July 2013. [ , ] The therapeutic options available for the management of invasive candidiasis and candidemia have continued to increase with the addition of newer echinocandins [ , ] and triazoles. Cutaneous candidiasis Most localized cutaneous candidiasis infections may be treated with any number of topical antifungal agents (eg, clotrimazole, econazole, ciclopirox, miconazole, ketoconazole, nystatin

2014 eMedicine.com

84. Erythropoietic Porphyria (Treatment)

-overview Diseases & Conditions Diseases & Conditions 2010 loprox-penlac-ciclopirox-topical-343484 Drugs Drugs Need a Curbside Consult? Share cases and questions with Physicians on Medscape consult.

2014 eMedicine.com

85. Paronychia (Treatment)

anesthesia. Medscape Drugs & Diseases. Available at . July 7, 2015; Accessed: November 30, 2015. Daniel CR 3rd, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis . 2004 Jan. 73(1):81-5. . Media Gallery Classic presentation of paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed. In this case of paronychia, no pus

2014 eMedicine.com

86. Pityrosporum Folliculitis (Treatment)

continued after successful initial treatment with oral medication. Other topicals that are used to treat Pityrosporum folliculitis are ciclopirox olamine cream, econazole cream, alcohol and salicylic acid solution (with or without benzoic acid 5%), propylene glycol 50% in water, and selenium sulfide shampoo. [ ] Other topical treatments with some reported success include tea tree oil, honey, tacrolimus, and cinnamic acid. [ ] In cases associated with antibiotic use, discontinuing the antibiotic may

2014 eMedicine.com

87. Piedra (Treatment)

17, 2018 Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Piedra Treatment Medical Care Shaving or cutting the hair is the treatment of choice. Antifungal agents and terbinafine also are used in the treatment of piedra. Black piedra is treated by using oral terbinafine. White piedra can be treated by using topical antifungals, including imidazoles, ciclopirox olamine, 2% selenium sulfide, 6% precipitated sulfur in petroleum

2014 eMedicine.com

88. Onychomycosis (Treatment)

agents should be limited to cases involving less than half of the distal nail plate or for patients unable to tolerate systemic treatment. Agents available in the United States include ciclopirox olamine 8% and efinaconazole 10% nail solutions. Amorolfine and bifonazole/urea are available outside of the United States. Topical treatments alone are generally unable to cure onychomycosis because of insufficient nail plate penetration. Ciclopirox and amorolfine solutions have been reported to penetrate (...) through all nail layers but have low efficacy when used as monotherapy. [ ] They may be useful as adjunctive therapy in combination with oral therapy or as prophylaxis to prevent recurrence in patients cured with systemic agents. Daily application and a long duration of treatment (48 wk) are required for efinaconazole and ciclopirox. Efinaconazole is indicated for toenail onychomycosis. [ ] Its approval was based on 2 phase III multicenter, randomized trials (N = 1655). Complete cure was seen in 17.8

2014 eMedicine.com

89. Paronychia (Overview)

. Daniel CR 3rd, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis . 2004 Jan. 73(1):81-5. . Media Gallery Classic presentation of paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed. In this case of paronychia, no pus or fluctuance is involved in the nail bed itself. Typical appearance of paronychia. Depicted

2014 eMedicine.com

90. Seborrheic Dermatitis (Treatment)

been associated with the development of telangiectasias and thinning of the skin. [ ] Although the levels of Malassezia yeast does not correlate with the severity of seborrheic dermatitis, antifungal therapies are first-line therapies. [ ] Ketoconazole, naftifine, or ciclopirox creams and gels are effective therapies. [ , , ] Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), [ , , ] sulfur or sulfonamide combinations, or propylene glycol. [ , , , , , ] Class IV or lower (...) in an alternating schedule. [ , ] An alternative to a shampoo with zinc is a conditioner rinse with zinc, 0.01% fluocinolone, and acetonide topical oil. Overnight occlusion of tar, bath oil, or Baker's P&S solution may help to soften thick scalp plaques. Derma-Smoothe F/S oil is especially helpful when widespread scalp plaques are present. Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs. [ , , ] Shampoos may be used on truncal lesions

2014 eMedicine.com

91. Tinea Versicolor (Treatment)

initiated. Recurrence is common, and prophylactic therapy may help reduce the high rate of recurrence. Tinea versicolor can be successfully treated with various agents. [ ] Effective topical agents include selenium sulfide, zinc-pyrithione, sodium sulfacetamide, ciclopirox olamine, [ ] , tacrolimus, [ ] as well as azole and allylamine antifungals. [ , , , , ] Even if a small area of skin is involved, treating with topicals from the neck to the knees may make treatment more successful. [ ] Various (...) of Pityriasis versicolor. Mycopathologia . 1997. 139(2):71-4. . Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother . 2014 Aug. 15(12):1707-13. . Gupta AK, Skinner AR. Ciclopirox for the treatment of superficial fungal infections: a review. Int J Dermatol . 2003 Sep. 42 Suppl 1:3-9. . Sepaskhah M, Sadat MS, Pakshir K, Bagheri Z. Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor

2014 eMedicine.com

92. Tinea Faciei (Treatment)

ciclopirox and terbinafine possess additional anti-inflammatory effects, which are especially important in the therapy for infections caused by zoophilic dermatophytes in which inflammatory reactions are usually prominent. Topical azoles are effective. Isoconazole nitrate and diflucortolone valerate combination therapy has been used successfully. [ ] Although rare, chronic and/or multiple lesions may require systemic therapy. Next: Prevention The isolation and treatment of infected pets is of great

2014 eMedicine.com

93. Tinea Corporis (Treatment)

of this enzyme causes squalene, a substance toxic to fungal cells, to accumulate intracellularly and leads to rapid cell death. Allylamines bind effectively to the stratum corneum because of their lipophilic nature. They also penetrate deeply into hair follicles. [ ] Ciclopirox olamine is a topical fungicidal agent. It causes membrane instability by accumulating inside fungal cells and interfering with amino acid transport across the fungal cell membrane. A low-to-medium potency topical corticosteroid can

2014 eMedicine.com

94. Onychomycosis (Overview)

of topical and systemic treatment increases the cure rate. Adjunctive surgical measures may also be used. Topical therapy for onychomycosis is as follows: Ciclopirox olamine 8% nail lacquer solution Amorolfine or bifonazole/urea (available outside the United States) Efinaconazole 10% topical solution (the first FDA-approved topical triazole for toenail onychomycosis) Tavaborole 0.5% topical solution, an oxaborole solution (boron-containing compound) Can be used in WSO and DLSO limited to the distal nail (...) as and . Previous References Andre J, Achten G. Onychomycosis. Int J Dermatol . 1987 Oct. 26(8):481-90. . Baran R, Hay RJ, Tosti A, Haneke E. A new classification of onychomycosis. Br J Dermatol . 1998 Oct. 139(4):567-71. . Bohn M, Kraemer K. The dermatopharmacologic profile of ciclopirox 8% nail lacquer. J Am Podiatr Med Assoc . 2000 Nov-Dec. 90(10):491-4. . Leverone AP, Guimarães DA, Bernardes-Engemann AR, Orofino-Costa R. Laser treatment of onychomycosis due to Neoscytalidium dimidiatum: An open prospective

2014 eMedicine.com

95. Onychomycosis (Follow-up)

agents should be limited to cases involving less than half of the distal nail plate or for patients unable to tolerate systemic treatment. Agents available in the United States include ciclopirox olamine 8% and efinaconazole 10% nail solutions. Amorolfine and bifonazole/urea are available outside of the United States. Topical treatments alone are generally unable to cure onychomycosis because of insufficient nail plate penetration. Ciclopirox and amorolfine solutions have been reported to penetrate (...) through all nail layers but have low efficacy when used as monotherapy. [ ] They may be useful as adjunctive therapy in combination with oral therapy or as prophylaxis to prevent recurrence in patients cured with systemic agents. Daily application and a long duration of treatment (48 wk) are required for efinaconazole and ciclopirox. Efinaconazole is indicated for toenail onychomycosis. [ ] Its approval was based on 2 phase III multicenter, randomized trials (N = 1655). Complete cure was seen in 17.8

2014 eMedicine.com

96. Paronychia (Follow-up)

anesthesia. Medscape Drugs & Diseases. Available at . July 7, 2015; Accessed: November 30, 2015. Daniel CR 3rd, Daniel MP, Daniel J, Sullivan S, Bell FE. Managing simple chronic paronychia and onycholysis with ciclopirox 0.77% and an irritant-avoidance regimen. Cutis . 2004 Jan. 73(1):81-5. . Media Gallery Classic presentation of paronychia, with erythema and pus surrounding the nail bed. In this case, the paronychia was due to infection after a hangnail was removed. In this case of paronychia, no pus

2014 eMedicine.com

97. Piedra (Follow-up)

17, 2018 Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD Share Email Print Feedback Close Sections Sections Piedra Treatment Medical Care Shaving or cutting the hair is the treatment of choice. Antifungal agents and terbinafine also are used in the treatment of piedra. Black piedra is treated by using oral terbinafine. White piedra can be treated by using topical antifungals, including imidazoles, ciclopirox olamine, 2% selenium sulfide, 6% precipitated sulfur in petroleum

2014 eMedicine.com

98. Pityrosporum Folliculitis (Follow-up)

continued after successful initial treatment with oral medication. Other topicals that are used to treat Pityrosporum folliculitis are ciclopirox olamine cream, econazole cream, alcohol and salicylic acid solution (with or without benzoic acid 5%), propylene glycol 50% in water, and selenium sulfide shampoo. [ ] Other topical treatments with some reported success include tea tree oil, honey, tacrolimus, and cinnamic acid. [ ] In cases associated with antibiotic use, discontinuing the antibiotic may

2014 eMedicine.com

99. Tinea (Treatment)

. Int J Dermatol . 2006 Mar. 45(3):215-9. . Avner S, Nir N, Henri T. Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis. J Dermatolog Treat . 2005. 16(5-6):327-30. . Bahamdan K, Mahfouz AA, Tallab T, et al. Skin diseases among adolescent boys in Abha, Saudi Arabia. Int J Dermatol . 1996 Jun. 35(6):405-7. . Brodell RT, Elewski BE. Clinical pearl: systemic antifungal drugs and drug interactions. J Am Acad Dermatol . 1995 Aug. 33(2 Pt

2014 eMedicine Emergency Medicine

100. Seborrheic Dermatitis (Follow-up)

been associated with the development of telangiectasias and thinning of the skin. [ ] Although the levels of Malassezia yeast does not correlate with the severity of seborrheic dermatitis, antifungal therapies are first-line therapies. [ ] Ketoconazole, naftifine, or ciclopirox creams and gels are effective therapies. [ , , ] Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), [ , , ] sulfur or sulfonamide combinations, or propylene glycol. [ , , , , , ] Class IV or lower (...) in an alternating schedule. [ , ] An alternative to a shampoo with zinc is a conditioner rinse with zinc, 0.01% fluocinolone, and acetonide topical oil. Overnight occlusion of tar, bath oil, or Baker's P&S solution may help to soften thick scalp plaques. Derma-Smoothe F/S oil is especially helpful when widespread scalp plaques are present. Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs. [ , , ] Shampoos may be used on truncal lesions

2014 eMedicine.com

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