Abstract
The management of dermatophytosis is challenging in India and there are reports of using systemic antifungals at higher doses. But there are multiple reports of increased treatment failures with terbinafine at standard dosage as well, hence we conducted this study to compare efficacy and safety of high dose of terbinafine with itraconazole at standard dose. Topical ciclopirox olamine was used in both arms.This was randomized, open label, comparative study where 80 patients with tinea corporis et cruris infection were included. Patients were either prescribed terbinafine 250mg twice a day or itraconazole 100mg twice a day for 4 weeks. Efficacy was assessed based on complete, clinical and mycological cure rate. Safety was assessed by evaluating adverse events and monitoring liver function of patients.Total 76 patients completed the study with 38 in each group. 81.5% patients achieved complete cure in terbinafine group compared to 76.31% patients in itraconazole group. At the end of six weeks, there was a statistically significant improvement (p value<0.05) in the total symptom score (erythema, scaling, and pruritus) in Group I as well as in Group II compared to baseline. None of the patients showed any significant side effect in both Itraconazole and Terbinafine groups. No changes in liver function were observed in both the groups. This study shows that the high dose of terbinafine in combination with topical ciclopirox is effective and safe in management of tinea corporis et cruris.
Highlights
The management of dermatophytosis is challenging in India and there are reports of using systemic antifungals at higher doses
Dermatophytosis caused by Trichophyton, Microsporum, and Epidermophyton is the most common fungal infection affecting 20%–25% population globally, with varying geographic distribution. 1,2 Due to India’s hot and humid climate, there has been a rampant increase in the cases of dermatophytosis and atypical presentation in recent years. 3,4 In addition, the recommended treatment of commonly prescribed antifungal agents no longer seems to be valid in the current scenario, resulting in treatment failures and relapses when given in conventional doses
5 the management of dermatophytosis is becoming more subjective in order to overcome these challenges. 6,7 the choice of therapy is further influenced by multiple factors like simultaneous involvement of extensive body area, hair follicles and a previous history of treatment failures, recurrences and relapses
Summary
The management of dermatophytosis is challenging in India and there are reports of using systemic antifungals at higher doses. Conclusion: This study shows that the high dose of terbinafine in combination with topical ciclopirox is effective and safe in management of tinea corporis et cruris. 13,14 it is advisable to use higher dose of terbinafine as seen in an article by Murlidhar et al 10 In a recent study, Terbinafine was reported to be efficacious and safe in the management of dermatophytosis at higher doses of 500 mg/day. Itraconazole is another antifungal drug which acts by inhibiting ergosterol synthesis It has shown good results in the treatment of dermatophytosis at doses of 100 mg once a day for two weeks and with 200 mg once a day for seven days. It differs in structure and mechanism of action from the other known antifungal agents. It acts through the chelation of polyvalent metal cations, such as ferric (Fe3+) and aluminium (Al3+), thereby causing inhibition of metal-dependent enzymes (cytochromes, catalase, and peroxidase) leading to the disruption of cellular activities such as mitochondrial electron transport processes, energy production, and nutrient intake across cell membrane. It alters membrane permeability causing blockage of intracellular transport of precursors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
