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New perspectives on the topical management of recurrent candidiasis

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Abstract

Candidiasis is a common opportunistic infection caused by fungi of the Candida genus that affects mainly mucocutaneous tissues (e.g., vaginal, oral, and mammary). This condition has been known for a long time; thus, innumerous topical and systemic treatments are already available on the market worldwide. Yet, recurrent superficial candidiasis (RSC) is an expected outcome, still lacking effective and convenient treatments. Although several individual conditions may contribute to disease recurrence, biofilms’ presence seems to be the main etiological factor contributing to antifungal resistance. More than proposing novel antifungal agents, current research seems to be focusing on improving the pharmaceutical technology aspects of formulations to address such a challenge. These include extending and improving intimate contact of drug delivery systems with the mucocutaneous tissues, increasing drug loading dose, and enhancing topical drug permeation. This review discusses the current understanding of the RSC and the use of pharmaceutical technology tools in obtaining better results. Even though several drawbacks of conventional formulations have been circumvented with the help of nano- or microencapsulation techniques and with the use of mucoadhesive formulation excipients, many challenges remain. In particular, the need to mask the unpalatable taste of formulations for the treatment of oral candidiasis, and the necessity of formulations with a “dryer” sensorial feeling and improved performances in providing higher bioavailability for the treatment of mammary and vaginal candidiasis.

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Acknowledgments

The authors would also like to thank Mr. Renato Fernandes Feitosa for his assistance with the figures’ design.

Funding

This research was funded by the University of Brasilia (Edital DPI/UnB 03/2020).

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  1. Ana Carolina S. Ré and Jayanaraian F. Martins contributed equally to this work.

Authors and Affiliations

  1. Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirao Preto, SP, 14040-903, Brazil

    Ana Carolina S. Ré & Carolina P. Aires

  2. Laboratory of Food, Drugs and Cosmetics (LTMAC), University of Brasilia, Brasilia, DF, 70910-900, Brazil

    Jayanaraian F. Martins, Marcílio Cunha‐Filho, Guilherme M. Gelfuso & Taís Gratieri

  3. Campus Universitário Darcy Ribeiro, Asa Norte, Brasilia, DF, 70910-900, Brazil

    Taís Gratieri

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A.C.S. Ré and J.F. Martins contributed equally to the writing of the work. M. Cunha‐Filho. G.M. Gelfuso, C.P. Aires, and T. Gratieri participated in the conceptualization, revision, and editing of the text.

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Ré, A.C.S., Martins, J.F., Cunha‐Filho, M. et al. New perspectives on the topical management of recurrent candidiasis. Drug Deliv. and Transl. Res. 11, 1568–1585 (2021). https://doi.org/10.1007/s13346-021-00901-0

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