We have reviewed six new antimycotic agents which have potential applications for human cutaneous and mucosal diseases. Information on these six drugs was obtained via an English language search of PubMed through the US National Library of Medicine. The antimycotic agents reviewed include
rilopirox,
lanoconazole,
NND-502,
butenafine,
eberconazole and
voriconazole.
Rilopirox is a synthetic pyridone derivative, related to
ciclopirox, with a fungicidal action.
Rilopirox is a hydrophobic, topical agent with potential application in mucosal
candida infections,
tinea versicolor and
seborrheic dermatitis.
Lanoconazole, an
imidazole, is a topical agent with potential application in
tinea infections and
cutaneous candidiasis. The
drug has been available for clinical use in Japan since 1994 and once-daily application to affected areas is recommended. In addition to its antifungal effect, animal data suggest that application of
lanoconazole 0.5 or 1% cream is associated with accelerated wound healing.
NND-502, a stereoselective analog of
lanoconazole, is a topical agent with potential application in
tinea pedis infection.
NND-502 appears to be more effective in inhibiting
ergosterol biosynthesis than
lanoconazole or
bifonazole and clinical trials comparing these agents are awaited.
Butenafine is the first member of a new class of antifungals, the
benzylamine derivatives, and has been approved for topical use in Japan (since 1992) and the US.
Butenafine has a potent fungicidal action and the
drug has been shown to be effective in multiple clinical trials in patients with
tinea pedis,
tinea corporis and
tinea cruris.
Butenafine has also been reported to exert an anti-inflammatory action after topical application and this may offer potential benefit over other topical
antifungal agents.
Eberconazole, an
imidazole derivative, is a topical
antifungal agent that has been shown to be effective in clinical trials in patients with
tinea infections. Preliminary data indicate that the
eberconazole is effective against some
triazole-resistant yeasts such as Candida krusei and Candida glabrata.
Voriconazole is an
azole antifungal derivative of
fluconazole. The
drug is available in both oral and parenteral formulations. Oral
voriconazole 200mg twice daily has been effective in treating oropharyngeal
candidiasis and apergillosis in immunocompromised patients. After 12 weeks' treatment, a similar dosage of the
drug elicited a positive response in 69% of nonimmunocompromised patients with invasive
aspergillosis.