Superficial Dermatophytosis across the World's Populations: Potential Benefits from Nanocarrier-Based Therapies and Rising Challenges

Abstract

The most prevalent infection in the world is dermatophytosis, which is a major issue with high recurrence and can affect the entire body including the skin, hair, and nails. The major goal of this Review is to acquire knowledge about cutting-edge approaches for treating dermatophytosis efficiently by adding antifungals to formulations based on nanocarriers in order to overcome the shortcomings of standard treatment methods. Updates on nanosystems and research developments on animal and clinical investigations are also presented. Along with the currently licensed formulations, the investigation also emphasizes novel therapies and existing therapeutic alternatives that can be used to control dermatophytosis. The Review also summarizes recent developments on the prevalence, management approaches, and disadvantages of standard dosage types. There are a number of therapeutic strategies for the treatment of dermatophytosis that have good clinical cure rates but also drawbacks such as antifungal drug resistance and unfavorable side effects. To improve therapeutic activity and get around the drawbacks of the traditional therapy approaches for dermatophytosis, efforts have been described in recent years to combine several antifungal drugs into new carriers. These formulations have been successful in providing improved antifungal activity, longer drug retention, improved effectiveness, higher skin penetration, and sustained drug release.

Figure 1

Dermatophytes epidemiology on a worldwide basis. A solid color denotes that the identified Trichophyton is responsible for more than 85% of the cases in that country. Colorless hatching denotes that the identified Microsporum is responsible for more than 90% of cases in that nation. Both Trichophyton and Microsporum are significant causes of fungal infection in that nation, as evidenced by the combination of color and hatch patterns.

Figure 2

Specific form of dermatophytosis in humans along with the anatomic location of infection (the organs or tissues) that is targeted by the infection.

Figure 3

Mechanism of action of antifungal agents, including their respective target sites as follows: (1) Polyenes bind to ergosterol: Instead of stopping an enzyme from working, it binds to ergosterol, the main sterol in fungus membranes, which disrupts membrane function enough to let cellular contents leak out (amphotericin B); (2) azole derivatives that inhibit the 14a lanosterol demethylase (ketoconazole, fluconazole, itraconazole, and voriconazole); (3) Inhibition of Squalene epoxidase: Terbinfine and Naftifine; (4) DNA and RNA synthesis inhibitors (flucytosine); and (5) 1,3-β-glucan synthase inhibitors: Echinocandins inhibits the activity of the enzyme 1,3-β-glucan synthase; (6) Inhibition of chitin synthase by Nikkomycin, Polyoxins; (7) Inhibition of Heat Shock Protein 90 (Hsp90); (8) Inhibition of microtubules assembly (Griseofulvin); (9) Inhibition of C-14 sterol reductase and C-11 sterol Isomerase by morpholines class; (10) ROS, RNS leading to cell death: Amphotericin B, miconazole, and ciclopirox cause the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS), resulting in cell death.

Figure 4

Potential advantages of utilizing nanocarriers in drug delivery systems when compared to conventional treatments.

Figure 5

A wide range of nanoformulations incorporating azole antifungal medicines are being explored as potential treatments for dermatophytosis.