·        Extracts of his Opinion.

·        Fungus is saprophytic infection in the skin. Living on dead tissue.

·        Dermatophytes (a misnomer) live only on keratin.i.e skin, hair & nails.

·        Fungal infection is restricted to epidermis, all of which is not dead, as deeper layers contain some keratin for dermatophytes but these are still cellular. Invasion of dermis is not possible, as it can not grow in the living tissue.

·        Fungus of animal origin zoophilic, is very inflammatory. Needs longer duration of therapy.. From human origin anthrophilic is not much inflammed.and needs shorter duration of therapy. From earth, Geophilic is least inflammed and needs shortest period of therapy.

·        All fungal lesions should be examined with following criteria in the mind.
*How much is the inflammation
*How much is the hyperkeratosis
*Is there any mixed infection involving commensals or Oppurtunistic bacterias.

·        Differentiation of Different species is important only to decide the duration of treatment when using agents other than keratolytic agents.

·        Duration of therapy is usually longer than the recommended by the Commercial concerns.

·        Psoriasis is important in differential diagnosis of all types & in all areas. But Remember there is never super added fungal infection in Psoriasis, as psoriatic patches are immune to fungus due to increased turnover of keratin.

·        Laboratory Diagnosis
Direct Microscopy & Culture is not a routine in Pakistan Dr Riaz ud Din feels that Eye of Dermatologist should be trained enough &  usually it is , to pick up all important factors needed for successful treatment...
 ( Although Acadimic circles recommend at least in nails, to start treatment after lab identification)

·        Careful inspection of the lesion is fundamental in diagnosis. History is important in maltreated cases.

·        On Treatment Good personal hygiene plays very important role in preventing recurrances.

·        Lotions for wet lesions

·        Ointment for dry lesions.

·        Cream for in between lesions.

On Local  Applications

·        . All keratolytic agents are antifungal agents. These are more economical & more effective than all latest preparations. In lesions which are widespread & are going to consume lot of amount of drugs for local application ,cheaper agents are more preferable. Whitfield Ointment & Resorcin preparations are usually the preparations in use. Concentration of Benzoic Acid & salicylic acid vary in individual patients.

·        In affording patients use of Triazole group and latest compounds like Terbinafine should be added as these reduce the rate of recurrences.

·        If patient can maintain good hygiene then keratolytic agents alone can be good enough.

·        Nystatin is still drug of choice for Candidiasis.

·        Latest compounds like Ketoconazole & Terbinafine are good broad-spectrum compounds.

Systemic Therapy

·        Griseofulvin is cheaper but less effective. Still being used with some success.

·        Triazoles like ketokonazole, Itroconazole, or fluconazole & Terbinafine, are broadspectrum antifungal agents. These are quite effecitve.

·        About Triazoles he is very suspect about their side effects like hepatitis which can be idiosyncratic or dose related.

·        Terbinafine (Lamisil) has better tolerability.

·        Duration of Therapy.

·        It varies from patient to patient, type of lesion, its spread & immune system of the patient.

·        Criteria of duration.
Talk of Mycological cure & clinical cure is just acadimic.

·        When skin or affected area gives a perfect normal appearance & texture feels normal, then treatment should be stopped.

·        Systemic treatment is essential in Nail infection. But in scalp & skin other factors like affordability should be considered.

·        Compromised hepatic function only local therapy is indicated.

·        Steroids should be used where massive inflammation is present &especially where atrophy of skin or Allopecia is feared.