Systemic Terbinafine Research Articles

Majocchi’s granuloma

Majocchi’s granuloma is an uncommon deep fungal folliculitis primarily caused by Trichophyton rubrum. The most common predisposing factors are the use of topical steroids and immunosuppression. In this case report, the cases with similar clinical presentation, an exanthema with perifollicular nodules, pustules, and scaling especially in the periphery of the lesions was seen. The diagnosis is made from clinical, mycological, and histologic examination with the latter demonstrating a perifollicular granulomatous inflammation. Treatment is systemic terbinafine combined with topical antifungal therapy.

Trichophyton erinacei infection in humans: a case report and a literature review.

Trichophyton (T.) erinacei is a rare but emerging zoonotic dermatophyte that is rarely isolated as a human pathogen, with only a few cases extensively described in the literature. We conducted a systematic search to identify eligible articles reporting demographics, clinical characteristics, and the therapeutic approach regarding T.erinacei infection in humans. 168 patients affected by T.erinacei were reported in the international literature between inception and November 2023. Only 56 cases (32.1%) were fully described. The median age at diagnosis was 26years, the female/male ratio was around 2:1. The main source of the disease was the hedgehog. The infection presented with a combination of erythema, scaly plaques, pustules, papules, vesicles, oedema, and erosion; the most common locations were the hands and the head. The most frequently conducted examination was fungal culture, but gene sequencing and mass spectrometry improved both speed and precision in the most recent diagnostic course. Topical clotrimazole and systemic terbinafine were the most chosen treatment. Trichophytonerinacei should be considered in patients with erythematous scaly patches and recent contact with hedgehogs. Terbinafine should be considered as a first-line effective treatment, griseofulvin and azoles could be considered valid alternatives.

Prolonged treatment of dermatophytosis caused by Trichophyton indotinea with terbinafine or itraconazole impacts better outcomes irrespective of mutation in the squalene epoxidase gene.

Over the past decades, the increasing incidence of recurrent dermatophytosis associated with terbinafine-resistant Trichophyton has posed a serious challenge in management of dermatophytosis. Independent reports of failure of treatment and high minimum inhibitory concentrations (MIC) of antifungals are available, but data correlating MIC and clinical outcomes is still sparse. Therefore, the present study was conducted to evaluate the outcomes of systemic treatment of dermatophytosis and its correlation with MIC of the etiological agents isolated from such patients. Retrospective analysis of 587 consecutive patients with dermatophytosis was done from March 2017 to March 2019. Demographic and clinical details of the patients were noted, along with the results of direct microscopy and fungal culture. The isolates were identified by sequencing the internal transcribed spacer region of rDNA. Antifungal susceptibility testing was performed following the CLSI M38 protocol. Mutation in the squalene epoxidase (SE) gene was detected by DNA sequencing and ARMS-PCR. Based on the culture-positivity and prescribed systemic antifungal, patients were categorised into Group I culture-positive cases treated with systemic terbinafine and Group II culture-positive cases treated with systemic itraconazole, each for a total period of 12 weeks. In the present study, 477 (81.39%) were culture-positive; however, 12 weeks follow-up was available for 294 patients (Group I-157 and Group II-137) who were included for statistical analysis. In both groups [Group I-37/63 (51.4%) and Group II-14/54 (58.3%)], a better cure rate was observed if the initiation of therapy was performed within <6 months of illness. Treatment outcome revealed that if therapy was extended for 8-12 weeks, the odds of cure rate are significantly better (p < .001) with either itraconazole (Odd Ratio-15.5) or terbinafine (Odd Ratio-4.34). Higher MICs for terbinafine were noted in 41 cases (cured-18 and uncured-23) in Group I and 39 cases (cured-16 and uncured-23) in Group II. From cured (Group I-17/18; 94.4% and Group II-14/16; 87.5%) and uncured (Group I-20/23; 86.9% and Group II-21/23; 91.3%) cases had F397L mutation in the SE gene. No significant difference in cure rate was observed in patients with Trichophyton spp. having terbinafine MIC ≥ 1or <1 μg/mL (Group I-p = .712 and Group II-p = .69). This study revealed that prolonging terbinafine or itraconazole therapy for beyond 8 weeks rather than the standard 4 weeks significantly increases the cure rate. Moreover, no correlation has been observed between antifungal susceptibility and clinical outcomes. The MIC remains the primary parameter for defining antifungal activity and predicting the potency of antifungal agents against specific fungi. However, predicting therapeutic success based solely on the MIC of a fungal strain is not always reliable, as studies have shown a poor correlation between invitro data and invivo outcomes. To address this issue, further correlation of antifungal susceptibility testing (AFST) data with clinical outcomes and therapeutic drug monitoring is needed. It also highlights that initiation of the treatment within <6 months of illness increases cure rates and reduces recurrence. Extensive research is warranted to establish a better treatment regime for dermatophytosis.

The Addition of Systemic Terbinafine to Antifungal Combination Therapy in the Treatment of Disseminated Drug-Resistant Mold Infections in a National Cancer Institute Comprehensive Cancer Center: A Six-Year Study.

Introduction Combination antifungal regimens are frequently employed in the treatment of invasive fungal infections in patients who are immunocompromised, particularly for cancer and transplant patients. Terbinafine is a potential agent of interest for combination regimens. Methods We reviewed data over a six-year period examining patient outcomes in terms of bothmortality and distribution of pathogens. The total number of patients in our study was 64. The use of terbinafine versus no terbinafine in combination therapy was assessed. Of the 64 patients analyzed, only 14 received terbinafine. Mortality was calculated for both groups, and demographics were analyzed by descriptive statistics. Results There was no statistical difference in mortality outcomes in either group. The addition of terbinafine was well tolerated and did not appear to result in any undue toxicity concerns. Discussion We wish to draw greater attention to this potential agent within our armamentarium for invasive fungal infections. To our knowledge, the total number of patients in our study, while small, representsthe largestreported cohort in the literature to date. Sensitivities are crucial to be obtained for fungal pathogens as this likely undermined the utility of terbinafine in our study with larger than expected numbers of multidrug-resistant Fusarium. With limited patient numbers, a multicenter trial would be beneficial to further examine terbinafine in combination regimens.

Tinea capitis due to Trichophyton soudanense and Microsporum audouinii: A surprising finding

AbstractTinea capitis is a prevalent dermatophyte infection among German children, primarily caused by Microsporum canis, Trichophyton mentagrophytes and Trichophyton benhamiae. Other pathogens, such as T. soudanense and M. audouinii, have also been identified in Germany. This case report describes a 10‐year‐old Angolan girl with chronic osteomyelitis who was brought to Germany for treatment, which was organized by the Friedensdorf International (Peacevillage International). In addition to chronic osteomyelitis of the lower leg, the patient presented with alopecic areas of the scalp with adherent scales, which raised the suspicion of tinea capitis. Fungal cultivation and polymerase chain reaction (PCR) diagnostics revealed a coinfection of T. soudanense and M. audouinii, which, to the best of our knowledge, has not been previously reported in Europe. After 4 weeks of systemic terbinafine treatment and topical use of ciclopirox solution and clotrimazole cream, there was a marked improvement in the patient's condition. This was confirmed by a negative fungal culture and PCR; no adverse events were reported. This report highlights a rare dual dermatophyte infection caused by T. soudanense and M. audouinii in Europe, and the successful response to treatment with systemic terbinafine and topical ciclopirox solution as well as clotrimazole cream.

Combination of Photodynamic Therapy and Oral Antifungals for the Treatment of Onychomycosis

Onychomycosis accounts for 50% of nail disorders, making it one of the most prevalent fungal diseases and a therapeutic challenge. Photodynamic therapy (PDT) could constitute a therapeutic alternative, owing to its good adherence, the low probability of resistance, the lack of interaction with antimicrobials, and its favorable adverse effect profile. This retrospective observational study included all patients with a microbiological diagnosis of onychomycosis treated with PDT at Miguel Servet University Hospital, Zaragoza (Spain), between January 2013 and June 2021. The protocol consisted of pre-treatment with 40% urea for 7 days, followed by 16% methyl-aminolevulinate (MAL) for 3 h and subsequent irradiation with a red-light LED lamp (37 J/cm2), every 1 or 2 weeks. Combined treatment with oral and/or topical antifungals was recorded. Of the 20 patients included (mean age, 59 ± 17 years), 55% were men. The most frequently detected microorganism was Trichophyton rubrum (55%). The most commonly affected location was the feet (90%): 50% of these cases were associated with tinea pedis. The median (standard deviation) number of PDT sessions was 6 (2.8). PDT was combined with systemic terbinafine (250 mg/day) in 10 cases (in 8 cases, this was administered for only 1 month), and with topical terbinafine in 3 cases. A complete clinical response was achieved in 80% (16) of cases and microbiological cure in 60% (12). PDT is a therapeutic alternative for onychomycosis, and can be administered either in monotherapy or combined with antifungals, allowing for a reduction in the duration and possible adverse effects of antifungal treatment and achieving higher cure rates than those obtained with either treatment alone.

Successful Treatment of Nannizziopsis guarroi Infection Using Systemic Terbinafine in a Central Bearded Dragon (Pogona vitticeps)

Nannizziopsis guarroi infection in lizards presents therapeutic challenges, with reports of poor clinical outcomes, including antifungal toxicity, incomplete clearance of infection, and recrudescence of infection being common. The case presented here describes the successful treatment of an N. guarroi infection using systemic terbinafine and environmental disinfection in a captive-bred central bearded dragon (Pogona vitticeps). The lizard presented with darkly colored cutaneous lesions, and mycologic culture samples were identified as N. guarroi using matrix-assisted laser desorption/ionization–time of flight. Based upon the lack of clinical resolution of cutaneous lesions, weight loss, and reduced appetite, initial treatment with voriconazole was discontinued. Terbinafine was prescribed, and weekly environmental disinfection with sodium hypochlorite was initiated until cutaneous clearance of the fungus was confirmed by negative culture, histopathology, and N. guarroi quantitative polymerase chain reaction from cutaneous swab. Terbinafine treatment was discontinued after 80 days. There were no clinical signs of toxicity associated with the prolonged treatment, and the lizard has not developed any cutaneous lesions or illness in more than 2 yr of clinical follow-up. Although the ideal treatment of N. guarroi is still being investigated, this case demonstrates a promising and safe treatment option for an increasingly common and devastating disease.

Combination of systemic terbinafine (250 mg) twice daily and itraconazole (100 mg) twice in a pulse dose in resistant tinea infection

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The management of tinea is challenging in Bangladesh and there are reports of using systemic antifungals at higher doses. The aim of the study was to find out the effectiveness of systemic terbinafine (250 mg) twice daily and itraconazole (100 mg) twice in a pulse dose in resistant tinea infection.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; It was a prospective, observational study conducted in the department of dermatology and venereology, Dhaka Dermatology Institute, Dhaka, Bangladesh from November 2020 to October 2021. Clinically confirmed cases of tinea corporis et cruris were recruited by random sampling techniques for the study and followed up for 12 weeks, till the completion of their treatment. Patients who were pregnant, lactating, non-consensual, as well as those who had a history of anti-mycotic treatment within 2 weeks prior to baseline visit were excluded from the study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 30 patients were randomly assigned treatment and included in the study&lt;strong&gt;.&lt;/strong&gt; According to within 4 weeks 11 (36.33%) patients were significantly improved and 19 (63.33%) patients were non-significantly improved, &amp;gt;4 week to till 8 weeks 16 (84.21%) patients were improved significantly and 3 (15.79%) patients were improved non-significantly and &amp;gt;8 week to till 12 weeks 3 (100%) patients were improved properly. Mycological cure was achieved in 25 (82.89%) patients, clinical cure rate was achieved same in 24 (79%) patients and complete cure rate was achieved 30 (100%) patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The combination of systemic terbinafine (250 mg) twice daily and itraconazole (100 mg) twice in a pulse dose therapy may be an effective and safe therapeutic strategy in the management of registrant tinea infection.&lt;/p&gt;

Evaluation of Sense of Smell in Onychomycosis Patients Receiving Terbinafine Treatment

Aim: The most common side effects of terbinafine are gastrointestinal symptoms. Loss of taste and smell side effects are presented in a small number of case reports. We aimed to measure the effect of terbinafine on the sense of smell and the degree of change in the sense of smell in this study. Material and Methods: Odor identification test (OIT), odor threshold test (OTT), and odor discrimination test (ODT) were applied to the patients treated with terbinafine and the control group. It was applied with “Sniffin Sticks” test pens. Smell test was performed on the patient group just before the start of terbinafine treatment and at the end of 3 months of treatment. Results: There was no statistical difference between the patient and control groups in terms of age (p=0.991) and gender (p=0.811). There was no statistical difference when the initial odor tests of the patient group and the control group were compared. The OIT value of the patient group was 10.15±1.43 at the beginning and 10.10±1.15 at the end of the treatment (p=0.743). The OTT values were 6.23±1.08 at the beginning and 6.21±0.85 at the end of the treatment (p=0.811). The ODT values were 9.71±1.44 at the beginning and 9.69±1.34 at the end of the treatment (p=0.767). There was no statistical difference in the results of the tests performed at the beginning and end of the treatment. Conclusion: There was no adverse effect on the sense of smell associated with the use of systemic terbinafine treatment for 3 months.

Successful Treatment of Nannizziopsis guarroi Infection using Systemic Terbinafine in a Central Bearded Dragon (Pogona vitticeps)

Nannizziopsis guarroi infection in lizards presents therapeutic challenges as reports of poor clinical outcomes, including antifungal toxicity, incomplete clearance of infection and recrudescence of infection are common. The case presented here describes the successful treatment of a N. guarroi infection using systemic terbinafine and environmental disinfection in a captive-bred central bearded dragon (Pogona vitticeps). The lizard presented with darkly colored cutaneous lesions and mycologic culture samples were identified as N. guarroi using Matrix-Assisted Laser Desorption/Ionization – Time Of Flight (MALDI-TOF). Based upon the lack of clinical resolution of cutaneous lesions, weight loss, and reduced appetite, initial treatment with voriconazole was discontinued. Terbinafine was prescribed and weekly environmental disinfection with sodium hypochlorite was initiated until cutaneous clearance of the fungus was confirmed by negative culture, histopathology, and N. guarroi qPCR from cutaneous swab. Terbinafine treatment was discontinued after 80 days. There were no clinical signs of toxicity associated with the prolonged treatment and the lizard has not developed any cutaneous lesions or illness in more than two years of clinical follow up. While the most ideal treatment of N. guarroi is still being investigated, this case demonstrates a promising and safe treatment option for an increasingly common and devastating disease.

Systemic therapy of onychomycosis of the feet with terbinafine: dynamics of nail rehabilitation and quality of life

BACKGROUND: Systemic therapy with terbinafine (Exifin) forms the basis of any treatment programs for onychomycosis of the feet of dermatomycete etiology. At the same time, the available literature presents relatively little data on the efficacy and safety of systemic terbinafine drugs for individual age groups; and there are practically no such studies based on a large statistical sample with a simultaneous assessment of the dynamics of the quality of life indicator. AIMS: To study the use of the drug Exifin tablets in certain age groups of patients with mycosis and onychomycosis in clinical practice. MATERIALS AND METHODS: The study was a multicenter observational (non-interventional) study involving 1602 patients with varying degrees of severity of onychomycosis of the feet/hands. The patients were divided into 4 age groups, each of which was divided into subgroups according to the severity of onychomycosis, from very mild to extremely severe. The positive dynamics of regression of symptoms, improvement of the quality of life according to the survey scale, the presence or absence of significant adverse reactions were evaluated. RESULTS: In all 1602 patients, positive dynamics from the skin process was obtained in the form of regression of onychomycosis symptoms. The best results on the speed of nail sanitization were obtained in more young age groups with a mild degree of onychomycosis. The lowest rate of regrowth of a healthy nail plate was observed in the age groups 4560 years and over 60 years. In the same age groups, the greatest number of persistent onychodystrophy remained after the eradication of the fungus. In all age groups, there was a positive trend in the quality of life: at the end of treatment, 67% of patients rated the quality of life as excellent and good, and another 24.1% ― satisfactory. No adverse events were recorded in any clinical case. CONCLUSION: Systemic therapy with terbinafine in onychomycosis of the feet/hands is a highly effective component in the combination treatment, allowing to achieve eradication of the fungus in 8590% of cases.

Retrospective analysis of abnormal laboratory test results in pediatric patients prescribed terbinafine for superficial fungal infections

To the Editor: Superficial fungal infections in children are common, with significant impact on quality of life.1,2 Terbinafine is frequently prescribed for its antifungal coverage and high cure rates.3 It is well tolerated in adults, with low rates of abnormal laboratory test results and adverse events and few drug-drug interactions.4 There are no guidelines for laboratory monitoring in children prescribed systemic terbinafine.3 Our objectives were to investigate the prevalence of abnormal laboratory test results in children prescribed systemic terbinafine for superficial fungal infections.

Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow-up by image analysis.

Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied. This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR. We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis. We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus-based ART, respectively). Clinical and biological follow-up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open-source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up. The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.

Optimization of modern complex treatment of microsporia in athletes taking into account the clinical course of dermatosis

Objective — to optimize the modern complex treatment of patients with microsporia with regard to the clinical course of dermatosis by the use of systemic antifungals of griseofulvin in combination with the drug Antral and terbinafine depending on the localization of the pathological process, antifungal agent 2 % sertaconazole nitrate cream Zalain, probiotic-vitamin-mineral complexes Bion 3 Kid and Bion 3. Materials and methods. There were 55 patients under observation: 22 — with microsporia of the scalp, 14 — with microsporia of the scalp and smooth skin, 19 — with microsporia of the smooth skin. All patients were divided into two groups. Patients of group 1 were given griseofulvin in tablets in combination with Antral. Patients of group 2 were prescribed terbinafine depending on body weight. Systemic therapy was combined with external treatment with 2 % sertaconazole nitrate cream Zalain. Duration of treatment ranged from 1 to 5 weeks. 25 patients were prescribed the original probiotic-vitamin-mineral complexes Bion 3 Kid and Bion 3 depending on age. Duration of treatment ranged from 1 to 3 weeks.Results and discussion. As a result of treatment, clinical and etiological recovery was achieved in all 55 patients with microsporia. Duration of treatment ranged from 1 to 5 weeks. Introduction of the original probiotic-vitamin-mineral complexes Bion 3 Kid and Bion 3 to the complex treatment of microspore made it possible to increase the effectiveness and improve the results of treatment, reduce its duration by 1—2 weeks, prevent relapse of the disease and development of concomitant colds during and after treatment. Тhere was good tolerability of drugs without changes in indicators of general and biochemical blood and urine tests.Conclusions. Complex treatment with systemic antifungal drug griseofulvin in combination with Antral and 2 % sertaconazole nitrate cream Zalain is effective and safe in treating microsporia of the scalp and smooth skin. Complex treatment with systemic antifungal drug terbinafine and 2 % sertaconazole nitrate cream Zalain is effective and safe in children and adults with microsporia of smooth skin. The inclusion of probiotic-vitamin-mineral complexes Bion 3 Kid and Bion 3 in combination with systemic antimycotic agents griseofulvin and terbinafine as also antifungal agent 2 % cream sertaconazole nitrate Zalain in the complex of treatment of patients with microspore contributed to an increase in the effectiveness of treatment, acceleration of clinical and mycological recovery, prevention of recurrence of the disease and prophylaxis of acute respiratory viral infections.

Effect of Salicylic Acid 3% + Benzoic Acid 6% (Whitfield’s Ointment), Clotrimazole 1% Cream, and Systemic Terbinafine on Mild-to-Moderate Tinea Corporis: A Randomized Comparative Study

Abstract Introduction The various epidemiological studies conducted on dermatophytic infection in different parts of India have concluded that there is a rising prevalence of dermatophytosis, with change in clinical presentation of infection. Although most of the therapeutic interventions show sufficient effect, there is a need for objective high-quality randomized comparative study to evaluate the effects of intervention, which can provide reliable evidence for clinical practice. Therefore, keeping this need in mind, we undertook this research work. To date, to the best of our knowledge, the inclusion of body surface area (BSA) as a tool for the evaluation of clinical improvement in dermatophytosis infection has not been considered. Objective The aim of this study was to assess the effect of topical antifungal as a monotherapy in naive and in combination with systemic antifungal drug in relapse cases of mild-to-moderate tinea corporis, to study and compare the efficacy of Clotrimazole 1% and Whitfield’s ointment as a monotherapy in mild-to-moderate cases of tinea corporis, and to study and compare the efficacy of combination of systemic terbinafine with Whitfield’s ointment and with clotrimazole 1% in mild-to-moderate relapsed cases of tinea corporis. Materials and Methods A total of 102 patients with mild-to-moderate tinea corporis who fulfilled the inclusion and exclusion criteria were enrolled. The naive patients for monotherapy and relapsed cases for a combination of systemic and topical antifungal drugs were randomly distributed. Results Predominance of males than females and the duration of disease for more than 6 weeks were observed. There was a significant reduction of infection in all the groups after 4 weeks, but early response was observed with clotrimazole as a monotherapy and in combination of clotrimazole with systemic drug. Conclusion Topical drugs as a monotherapy in naive and in combination of topical and systemic antifungal drug in relapsed cases were effective, but to achieve zero BSA, treatment for more than 4 weeks is required.

Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis

Background: There has been an alarming increase in recalcitrant dermatophytosis in recent years. The standard treatment guidelines no longer seem effective in achieving clearance and results in high failure rates.Objective: To evaluate the efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis.Methods: Clinically diagnosed and KOH positive patients of tinea corporis/cruris/faciei were randomly divided into three groups and given terbinafine 250 mg, itraconazole 200 mg and a combination of both once daily taken on the same day respectively for 3 weeks. Partial responders at the end of the therapy were given same treatment for additional 3 weeks. Clinical parameters namely itching, erythema, and scaling were evaluated at baseline, 3, 6, and 9 weeks. Adverse effects were noted at the end of therapy.Results: Maximum clinical and mycological cure was achieved in group III (receiving combination therapy) (90%) followed by group II (receiving itraconazole) (50%) and group I (receiving terbinafine) (35%). The combination therapy of oral terbinafine and itraconazole was found to be as safe as monotherapy without any significant adverse effects.Conclusions: The combination of systemic terbinafine and itraconazole therapy may be an effective and safe therapeutic strategy in the management of dermatophytosis

Modern view on treatment of microsporia of children, taking into account the etiology, pathogenesis and features of clinical course of dermatosis

Objective — to analyze publications and summarize literature data on the optimization of the treatment of microsporia of children, taking into account the etiology, pathogenesis and features of the clinical course of dermatosis. Materials and methods. Based on a retrospective analysis of scientific sources and the results of our own research, information on the treatment of microsporia in children is systematized, taking into account the etiology, pathogenesis and features of the clinical course of dermatosis. Results and discussion. Mycotic skin lesions occupy one of the leading places in the structure of dermatovenerological diseases. The high prevalence of fungal infections shows that 20—25 % of the world’s population has skin mycoses, making them one of the most common forms of infection. An important role in the pathogenesis of microsporia is played by various changes in the immune status, the expression of which determine the clinical course of mycosis, its prediction and the choice of rational therapy. Conclusions. At present, complex treatment with the use of systemic antimycotic terbinafine and 2 % sertaconazole nitrate cream is considered effective and safe for microsporia of smooth skin with predominant lesion of vellus hair. Systemic antimycotic grisofulvin combined with the original drug antral proved to be effective and safe in the treatment of microsporia of the scalp in children and adults. Introduction of the probiotic-vitamin-mineral complex Bion 3 Kid in combination with systemic antimycotics griseofulvin, terbinafine and 2 % sertaconazole nitrate cream into the complex of treatment of microsporia contributed to increasing effectiveness of treatment, accelerating clinical and mycological recovery, preventing recurrence of the disease and the occurrence of concurrent cold-related diseases.

Recurrent terbinafine resistant Trichophyton rubrum infection in a child with congenital ichthyosis

Dermatophytosis in children caused by Trichophyton rubrum is preferably treated with topical or systemic terbinafine. We report the first case of terbinafine resistance in a child with recurrent T. rubrum dermatophytosis and congenital ichthyosiform erythroderma.

Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis

Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial.

Norway spruce (Picea abies) produces resin to protect against decomposition by microbial pathogens. In vitro tests have shown that spruce resin has antifungal properties against dermatophytes known to cause nearly 90% of onychomycosis in humans. To confirm previous in vivo observations that a topical resin lacquer provides mycological and clinical efficacy, and to compare this lacquer with topical amorolfine hydrochloride lacquer and systemic terbinafine for treating dermatophyte toenail onychomycosis. In this prospective, randomized, controlled, investigator-blinded study, 73 patients with onychomycosis were randomized to receive topical 30% resin lacquer once daily for 9 months, topical 5% amorolfine lacquer once weekly for 9 months, or 250 mg oral terbinafine once daily for 3 months. The primary outcome measure was complete mycological cure at 10 months. Secondary outcomes were clinical efficacy, cost-effectiveness and patient compliance. At 10 months, complete mycological cure rates with the resin, amorolfine and terbinafine treatments were 13% [95% confidence interval (CI) 0-28], 8% (95% CI 0-19) and 56% (95% CI 35-77), respectively (P ≤ 0·002). At 10 months, clinical responses were complete in four patients (16%) treated with terbinafine, and partial in seven (30%), seven (28%) and nine (36%) patients treated with resin, amorolfine and terbinafine, respectively (P < 0·05). Resin, amorolfine and terbinafine treatments cost €41·6, €56·3 and €52·1, respectively, per patient (P < 0·001). Topical 30% resin lacquer and topical 5% amorolfine lacquer provided similar efficacy for treating dermatophyte toenail onychomycosis. However, orally administered terbinafine was significantly more effective in terms of mycological cure and clinical outcome than either topical therapy at the 10-month follow-up.