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The Overuse of Antifungal Creams: A Growing Health Concern

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Dr. Jessica Nelson
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The Overuse of Antifungal Creams: A Growing Health Concern

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In recent years, there has been a concerning rise in drug-resistant fungal skin infections, and according to a report by the Centers for Disease Control and Prevention (CDC), the improper prescribing or overuse of antifungal creams may be a significant contributing factor. In 2021 alone, a staggering 6.5 million topical antifungal prescriptions were issued to Medicare patients in the United States. This trend, alongside the common misdiagnosis of cutaneous fungal infections, has led to a situation that demands immediate attention.

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The Issue of Misdiagnosis and Overprescription

One of the significant issues highlighted in the CDC report is the frequent misdiagnosis of cutaneous fungal infections by visual inspection. This inaccurate method of diagnosis often leads to nonrecommended prescription of topical antifungals. In fact, the report suggests that such nonrecommended prescribing is likely commonplace due to incorrect diagnosis and lack of confirmatory testing.

Adding to the problem is the fact that antifungal cream prescribing rates were highest in the South and Northeastern parts of the U.S., suggesting regional discrepancies in prescribing patterns. The top 10 percent of antifungal prescribers were responsible for nearly half of the dispensed medications, indicating a need to identify and educate clinicians who prescribe a disproportionate volume of topical antifungals.

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The Rise of Superfungal Skin Infections

Notably, the CDC report also indicates that the overuse of antifungal creams and the use of combination treatments with corticosteroids are contributing to the rise and spread of severe skin, scalp, and nail fungal infections. Drug-resistant fungal skin infections have spread to at least 11 U.S. states and have also been detected in China, signifying a global health concern.

The large number of clotrimazole-betamethasone prescriptions, in particular, is seen as a potential driver of the emerging drug-resistant tinea, a type of superficial fungal infection. The issue of drug resistance is a serious one, as it can render standard treatments ineffective and compromise patient health.

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Addressing the Issue: The Need for Better Education and Diagnostic Testing

In light of these findings, the CDC report calls for better education and awareness among healthcare providers and patients to address this issue. Clinicians, in particular, are frequently incorrect in diagnosing skin conditions, and the researchers recommend the use of diagnostic testing to confirm suspected superficial fungal infections.

This would not only ensure accurate diagnosis but also promote the correct use of antifungal creams. By understanding prescribing patterns and identifying clinicians who prescribe a disproportionate volume of topical antifungals, it would be possible to curtail the overuse of these medications and prevent the further spread of drug-resistant fungal skin infections.

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