Treatment Of Dermatophyte Infections Research Articles

A PROSPECTIVE RANDOMIZED OPEN-LABELED PARALLEL GROUP STUDY TO COMPARE THE EFFICACY OF ORAL TERBINAFINE VERSUS ORAL TERBINAFINE PLUS ORAL FLUCONAZOLE IN DERMATOPHYTE INFECTIONS

Objectives: The objectives of this study were to assess the efficacy of oral monotherapy (Terbinafine) as compared to combination of oral drugs (Terbinafine and fluconazole) in treatment of dermatophyte infections. Methods: Patients of clinically diagnosed, potassium hydroxide (KOH) confirmed dermatophyte infections (n=235), were recruited as per inclusion criteria and randomized into Group A (Tab. Terbinafine 6 mg/kg body weight daily) and Group B (Tab. Terbinafine 6 mg/kg daily+Tab Fluconazole 3 mg/kg twice per week) treatment for 2 weeks. Assessment was done in beginning, after week 1 and after week 2 using visual analog scale (VAS) and global physician assessment (GPA). At the end of 4 weeks, they were again called back to assess the residual disease activity. Results: VAS scoring at week 1 and week 2 showed a significant reduction of scores in both the groups as compared to basal score of 0 week. Inter-group comparison showed decrease in mean-VAS itch scores in Group B as compared to Group A. Week 1 reduction in the Group B was statistically significant (p<0.001). GPA reflected a gradual but significant improvement in GPA scores end of week 1 and week 2 in both groups. The improvement seemed robust in Group B reflecting the stronger clinical response. The inter-group comparison showed statistically significant improvement in Group B over Group A in both 1stweek (p<0.001) and 2nd week (p=0.021). Conclusion: Dermatophyte infections treated with either terbinafine alone or terbinafine and fluconazole combination is clinically effective. Combination therapy is better than single drug therapy in terms of treatment response.

Insights into Changing Dermatophyte Spectrum in India Through Analysis of Cumulative 161,245 Cases Between 1939 and 2021

Dermatophytosis is one of the most common superficial infections of the skin affecting nearly one-fifth of the world population at any given time. With nearly 30% of worldwide terbinafine-resistance cases in Trichophyton mentagrophytes/Trichophyton interdigitale and Trichophyton rubrum reported from India in recent years, there is a significant burden of the emerging drug resistance epidemic on India. Here, we carry out a comprehensive retrospective analysis of dermatophytosis in India using 1038 research articles pertaining to 161,245 cases reported from 1939 to 2021. We find that dermatophytosis is prevalent in all parts of the country despite variable climatic conditions in different regions. Our results show T. rubrum as the most prevalent until 2015, with a sudden change in dermatophyte spectrum towards T. mentagrophytes/T. interdigitale complex since then. We also carried out an 18S rRNA-based phylogenetics and an average nucleotide identity-and single nucleotide polymorphism-based analysis of available whole genomes and find very high relatedness among the prevalent dermatophytes, suggesting geographic specificity. The comprehensive epidemiological and phylogenomics analysis of dermatophytosis in India over the last 80 years, presented here, would help in region-specific prevention, control and treatment of dermatophyte infections, especially considering the large number of emerging resistance cases.

In vitro antifungal activity of heterocyclic organoboron compounds against Trichophyton mentagrophytes and Microsporum canis obtained from clinical isolates.

The aim of this study was to investigate the in vitro activity of thirty-eight heterocyclic organoboron compounds (1a-o, 2a-j, 3a-m) against clinically isolated dermatophytes Trichophyton mentagrophytes and Microsporum canis. Minimum inhibitory concentrations (MICs) of compounds (1a-o, 2a-j, 3a-m) were determined according to published protocol Clinical and Laboratory Standards Institute (CLSI) M38-A2 broth microdilution method. The minimum fungicidal concentrations (MFCs) for both T. mentagrophytes and M. canis were found by subculturing each fungal suspension on potato dextrose agar. According to the results, heterocyclic organoboron compounds (1a-o, 2a-j, 3a-m) were found to be more effective against dermatophyte M. canis (MIC = 3.12-25µg/ml) than T. mentagrophytes (MIC = 12.5-100µg/ml). Our findings showed that 7-membered heterocyclic organoboron compounds (3a-m) (MIC = 12.5-50µg/ml) have stronger in vitro antifungal activity against T. mentagrophytes than 5-membered heterocyclic organoboron compounds (1a-o, 2a-j) (MIC = 25-100µg/ml). The MFC values for all compounds ranged from 6.25 to 200µg/ml. The limited number of systemic antifungal agents used in the treatment of dermatophyte infections and the presence of side effects have led to the search for new treatment resources in recent years. Therefore, investigation of the effect of heterocyclic organoboron compounds against dermatophytes will be promising for the discovery of new antifungal compounds that have gained great importance today.

Efficacy of Oral Voriconazole in the Treatment of Dermatophyte Infections (Tinea Corporis and Cruris)

Objective: To determine the efficacy of oral voriconazole in the treatment of dermatophyte infections (tinea corporis and cruris) Methodology: A total of 200 patients of both sex with age group 18-60 year having dermatophyte infection of body and groin were enrolled in this study. Each patient was given oral voriconazole 200 mg twice a day (tablet vorif 200 mg) for two weeks. Follow up was done at end of 2nd, 4th and 12 weeks. Efficacy was assessed clinically in the form of complete healing of lesion leaving behind post inflammatory pigmentation or normal skin. Study duration was 3 months. Patients were assessed for any possible side effects at each appointment. All of the patients were truly monitored and checked for their compliance to drug. The data was recorded on preformed Proforma for each patient. Results: Out of 200 cases, 133 were new, 42 were relapsing and 25 were resistant cases. Total efficacy was noted in 164 patients (82%) of all study cases. Male and female showed efficacy in 81% and 82% of cases respectively (Table 1). Patients belonging to age group 18-40 year showed 86 % efficacy and patients belonging to age group 41-60 year showed 76% efficacy (Table 2). From all new, relapsing and resistant study cases, 90 %, 71% and 58% showed efficacy to treatment respectively (Table 3). Conclusion: In our population oral voriconazole is efficacious in the treatment of tinea corporis and cruris. Keywords: Dermatophytes, Efficacy, Voriconazole

Major challenges and perspectives in the diagnostics and treatment of dermatophyte infections.

Dermatophytes are the aetiological factors of a majority of superficial fungal infections. What distinguishes them from other pathogenic filamentous fungi is their unique ability to degrade keratin. The remarkable ability of this group of fungi to survive in different ecosystems results from their morphological and ecological diversity as well as high adaptability to changing environmental conditions. Paradoxically, despite the progress in medicine, the prevalence of dermatophyte infections is increasing from year to year. At the beginning of the third millennium, practical diagnostic and therapeutic options are still very limited. This review focuses on understanding the major problems in this aspect of dermatophyte infections and indicates future strategies and perspectives for novel approaches to identification and drugs for elimination of dermatophytes. Particular importance is placed on development of a strategy for a diagnostic pathway and implementation of rapid and reliable diagnostics methods designed by international teams. Furthermore, among compounds that currently arouse great interest, representatives of terpenoids, alkaloids, saponins, flavonoids and essential oils deserve attention. Many of these compounds are undergoing clinical trials as potential antifungal agents, and future research should focus on attempts at determination of the applicability of tested substances. Finally, the advantages and disadvantages in implementation of new diagnostic paths and medicinal substances for routine use are indicated.

Efficacy of daily oral terbinafine versus pulse fluconazole therapy in the treatment of tinea corporis, tinea cruris, and tinea faciei: A comparative study

Introduction: Both terbinafine and fluconazole are effective systemic drugs for dermatophytosis. They can be used intermittently as pulse doses or as daily doses for the treatment of the same. Aim: The aim of this study was to assess the efficacy and safety of 1 week twice a day therapy of terbinafine and to compare it with that of a daily 2-week course of terbinafine and weekly pulse fluconazole therapy. The adverse effects and relapse rates after the completion of therapy were assessed. Materials and Methods: A study was conducted with 90 patients divided into three Groups A, B, and C. Patients were assessed at 2 and 4 weeks of starting treatment and 6 weeks following the completion of treatment. Adverse effects if any were noted. Clinical scores were calculated, and skin scraping for potassium hydroxide (KOH) examination was done. Clinical improvement was assessed. A mycological cure is defined as a negative KOH examination. Results: There was a significant decrease in clinical scores before treatment and at 2 and 4 weeks of visits. The highest clinical cure rates were attained in Group A (80%), followed by Group B (73.33%) and Group C (63.3%). Mycological cure rate at 4 weeks was highest in Group A (93.3%), followed by Group B (86.7%) and Group C (83.3%). This difference in clinical and mycological cure rates in the three groups was not found to be statistically significant. Of the patients who had responded to treatment at 4 weeks, the clinical and mycological cure was maintained in 96.4% individuals in Group A, 96.1% in Group B, and 88% in Group C at 6 weeks. Thus, the highest number of recurrences was seen in Group C, followed by Group B and Group A. All the three treatment regimens were well tolerated. Side effects were seen in 17 patients. They were mild and predominantly gastrointestinal. Conclusion: All three drugs in different regimens were found to be equally efficacious in the treatment of dermatophytic infections in our center.

Terbinafine: Safety profile and monitoring in treatment of dermatophyte infections

Terbinafine: Safety profile and monitoring in treatment of dermatophyte infections

Comparative Antiseptic Effects of Some Locally Used Plant Products on Isolated Skin Microorganisms

This research was undertaken to test the efficacy of three locally used plant products (shear butter, palm kernel oil and black soap) and their synergistic combinations against selected skin microbes. One hundred and twenty (120) swab sticks were used to collect skin associated organisms from body parts (leg, knee, head, chest, face, back, armpit and areas affected by heat rashes) among volunteers with Makurdi metropolis, Nigeria. Microbial culture, identification and sensitivity tests followed standard microbiological practices. Identified genera were: Pseudomonas, Staphylococcus, Bacillus, Escherichia, Mucor, Aspergillus, Penicillium, Saccharomyces, Candida and Epidermophyton conidia. Inhibitory effect of the locally used products was compared with known orthodox medicated soaps (OMS) as control. As a result, most of the microbes resisted shear butter (SB only) except Candida and Saccharomyces. Palm kernel oil (PKO only) was effective against all microbes except Bacillus. All isolates were sensitive to Black soap (BS only). SB+PKO were 80% effective whereas SB+BS were 90% effective while BS+PKO were 100% effective against all microbes. Only one of the three OMS was 100% effective on skin isolates. Black soap has proven more effective than the two popularly used medicated soaps against skin microflora. Palm kernel oil was also highly effective but 100% efficacy was observed when it mixed with black soap. It was due to their synergistic effect. Shear butter was the least effective but its antiseptic action may be enhanced when mixed with black soap. The information provided is useful in the discovery of cheap and effective natural products in the prevention and treatment of dermatophytic infections in Nigeria.

In vitro and in vivo antidermatophytic activities of some Iranian medicinal plants.

In the last decades, the number of people suffering from dermatophytoses has seriously increased, which may be due to the development of resistant strains to a range of antifungal drugs. The present study was aimed to evaluate the antidermatophytic properties of eight extracts from the selected spices and herbs, which were ethno-medicinally used in Iran against Trichophyton mentagrophytes, Trichophyton interdigitale, Microsporum canis, and Microsporum gypseum (10 strain of each). The in vitro antifungal activities of the extracts from four spices and four plants were evaluated by the broth macro dilution method against four dermatophyte strains. In addition, the in vivo therapeutic effects of Myrtus communis L. and Cinnamomum zeylanicum Blume extracts (the most active extracts) on dermatophytosis induced by M. canis and T. mentagrophytes in guinea pigs were evaluated. Results of in vitro antifungal assay revealed that all the tested extracts demonstrated both fungistatic and fungicidal activities with the geometric mean (GM) MIC ranging from 0.058 to 3.73 mg/ml and GM (MFC) ranging from 0.058 to 7.46 mg/ml, respectively. Two extracts (M. communis and C. zeylanicum) significantly inhibited the growth of all the tested dermatophytes, while other extracts demonstrated weak (MICs of >0.625 mg/ml) to moderate (MICs ranging from 100 to 0.625 mg/ml) activities. In vivo antidermatophytic assay demonstrated that clotrimazole cured T. mentagrophytes and M. canis infection on days 21 and 17, respectively, whereas M. communis and C. zeylanicum extracts significantly (p < 0.05) cured T. mentagrophytes and M. canis infection on days 9 and 13 as well as 9, 11, respectively. Phytochemical screening showed the presence of flavonoids, tannins, phenols, and alkaloids in M. communis and alkaloids, flavonoids, and tannins in C. zeylanicum. Findings of the present study also provided the scientific evidence that natural plants could be used in traditional medicine for the prevention and treatment of dermatophytic infections.

Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy.

Treatment of dermatophyte infections is based on the clinical picture and mycological detection of the causative pathogen. Based on the appropriate indication, onychomycosis can be treated topically using an antimycotic nail lacquer. Atraumatic nail abrasion with 40 % urea ointment has a beneficial effect on healing. Continuous treatment of onychomycosis with terbinafine represents the most effective systemic therapy. Terbinafine or itraconazole are the safest and most effective antimycotic agents for the treatment of onychomycosis in children. For laser therapy of onychomycosis, only a few studies on clinical efficacy are available. Regarding tinea capitis, targeted species-specific therapy of dermatophytosis of the scalp is currently recommended. Terbinafine, yet also itraconazole and fluconazole, are effective in tinea capitis caused by Trichophyton species. Microsporum infections of the scalp are preferably treated with griseofulvin, alternatively with itraconazole or fluconazole. Terbinafine is less effective. Candidal intertrigo are topically treated with nystatin, but azoles or ciclopirox olamine are also suitable candidates. Systemically, fluconazole or itraconazole are used. Topical and systemic antimycotics are equivalent forms of therapy in acute vulvovaginal mycosis. Fluconazole is the drug of choice in chronic recurrent vulvovaginal mycosis caused by Candida albicans. Ketoconazole shows very good efficacy in tinea versicolor. With respect to systemic treatment of severe and widespread tinea versicolor, itraconazole is the drug of choice.

Clinico-Mycological Evaluation of Dermatophytes and Other Fungal Agents Isolated from Various Clinical Samples

Background : Human pathogenic dermatophytes are keratinophilic molds that infect human skin, nails and hairs. Three genera (Trichophyton, Micosporum and Epidermophyton) of these organisms exist: however, their preferred sites for infections vary. Current management often consists of the topical and systemic administration of antifungal agents or a combination of both. However, these approaches may not be successful in every case due to such factors as difficulty with long term application of topical medications. Despite the successful use of systemic medications side effects and drug resistance remains a major obstacle. The treatment of dermatophyte infections represents a significant cost burden. Aims and Objectives : To study the epidemiology, clinical types and mycological features of dermatophytes from various clinical samples from dermatology department, Santosh Hospital. Material and Method : A total of 100 samples were collected including infected skin, hair and nail samples for a period of six months. Before collecting the samples, 70% alcohol was applied to the infected area and ensured that it was totally dried. Skin samples were collected by scraping, nail sample by clipping and hair samples collected by using sterile forcep or scalpel. Identification was done by KOH mount, culture on SDA, pigment production, lactophenol cotton blue staining and biochemical tests and slide culture techniques. Results : Dermatophytosis was manifested clinically more in the age group 21 - 30 years age. Tinea corporis was the predominant clinical presentation followed by Tinea cruris. Tinea capitis was the predominant clinical presentation in children and Tinea manuum was the commonest clinical type found in female patients. In the present study the male to female ratio was found 1.5 : 1. Majority of patients were belonged to the low socio-economic status. Trichophyton rubrum was the predominant pathogen followed by the Trichophyton mentagrophytes. Conclusion : Tinea corporis was found the most common clinical type of dermatophytosis and Trichophyton rubrum was found the most common fungal isolate in this part of Uttar Pradesh.

Contact-Free Inactivation of Trichophyton Rubrum and Microsporum Canis by Cold Atmospheric Plasma Treatment

Cold atmospheric plasma (CAP) has already proven efficient at disinfection of microorganisms including biofilms. The objective of the present study is to assess the efficacy of CAP against the dermatophytes Trichophyton rubrum and Microsporum canis in vitro. T. rubrum and M. canis were exposed to CAP for different treatment times and time intervals in vitro. Treatment with ciclopirox olamine or UVC radiation (0.120 J/cm(2)) served as controls. CAP was generated by the surface microdischarge technology. Fungal colony growth was measured upon CAP treatment. Repeated daily CAP treatments of 10 min demonstrated an inhibition of growth during the treatment period of 9 days. Single CAP treatment sessions for 5, 8 and 10 min, as well as treatments for 5 or 8 min daily, resulted in less fungal growth inhibition. UVC radiation treatment failed, but not ciclopirox olamine. CAP shows promising potential for future application in the treatment of dermatophyte infections.

Additive and inhibitory effect of antifungal activity of Curcuma longa (Turmeric) and Zingiber officinale (Ginger) essential oils against Pityriasis versicolor infections

The antifungal potential of Curcuma longa (turmeric) and Zingiber officinale (ginger) essential oils alone and in combinations, against common causes of Pityriasis versicolor infections in humans was investigated via in vitro investigations, in order to determine a suitable dosage for use in clinical trials. The antifungal activity of oils was screened against Malassezia furfurby using disc diffusion method and microdilution method. Turmeric oil showed strong antifungal activity (55 mm, MIC 0.1 µl/ml) while ginger oil had good antifungal activity (37.5 mm, 0.03 µl/ml) and their mixture showed excellent antifungal activity (65 mm, MIC 0.02 µl/ml) against M. furfur. The inhibition zone of mixture of oils (turmeric and ginger) is higher than single oils and reference antibiotics. Gentamycin and Streptomycin showed inhibition zone of 16.5 and 17 mm against M. furfur. From our findings, the results provide a scientific validation for the use of these essential oils in the treatment of dermatophytic infections and could be used in future for the development of anti-skin disease agents. Key words: Pityriasis versicolor, Curcuma longa and Zingiber officinale oils.

Recent updates in oral terbinafine: its use in onychomycosis and tinea capitis in the US

Onychomycosis and tinea capitis are prevalent fungal diseases that are difficult to cure and usually require systemic treatment. Onychomycosis has high recurrence rates and can significantly affect a patient's quality of life. Oral terbinafine has been approved for onychomycosis for 20 years in Europe and 15 years in the United States. Over these past 20 years, numerous studies show that oral terbinafine is a safe and efficacious treatment for onychomycosis. More recently, oral terbinafine also has been approved for tinea capitis. Once difficult to treat, terbinafine has revolutionised treatment of these fungal diseases. It has minimal side effects and its limited drug interactions make it an excellent treatment option for patients with co-morbidities. This review discusses oral terbinafine and new insights into the treatment of onychomycosis and tinea capitis. Recent publications have enhanced our knowledge of the mechanisms of oral terbinafine and its efficacy in treating onychomycosis. Oral terbinafine vs. other antifungal therapeutic options are reviewed. Overall, terbinafine remains a superior treatment for dermatophyte infections because of its safety, fungicidal profile, once daily dosing, and its ability to penetrate the stratum corneum.

Synergistic Antifungal Activity of Curcuma longa (Turmeric) and Zingiber officinale (Ginger) Essential Oils Against Dermatophyte Infections

The antifungal potential of Curcuma longa (turmeric) and Zingiber officinale (ginger) essential oils alone and in combinations, against common causes of tinea infections in humans was investigated via in vitro investigations, in order to determine a suitable dosage for use in clinical trials. Turmeric oil showed good antifungal activity (68 mm, MIC 1.6 μl/ml against Trichophyton rubrum and 5 6mm, MIC 1.4 μl/ml against Microsporum gypseum) while ginger oil had strong antifungal activity (72 mm, 0.05 μl/ml against T. rubrum and 69 mm, MIC 0.06 μl/ml against M. gypseum) and their mixture showed excellent antifungal activity (82 mm, MIC 0.02 μl/ml against T. rubrum and 79 mm, MIC 0.04 μl/ml against M. gypseum).The antifungal activity of oils was screened against T. rubrum and M. gypseum by using disc diffusion method and microdilution method. The inhibition zone of mixture of oils (turmeric and ginger) is higher than single oils and reference antibiotics i.e Clotrimazole (36 mm against T. rubrum, 41 mm against M. gypseum) and Ketoconazole (60 mm against T. rubrum, 26 mm against M. gypseum). From our findings, the results provide a scientific validation for the use of these essential oils in the treatment of dermatophytic infections and could be used in future for the development of anti-skin disease agents.

In vitroandin vivoantifungal activity of essential oils ofCymbopogon martiniandChenopodium ambrosioidesand their synergism against dermatophytes

The present study was carried out to evaluate the antifungal efficacy of essential oils (EO) of Cymbopogon martini, Chenopodium ambrosioides and of their combination against dermatophytes and some filamentous fungi in vitro as well as in vivo using a guinea pig model. The minimum inhibitory concentrations of EOs and of their combination were found between 150 and 500 ppm, while those of known antifungal drugs ranged from 1000 to 5500 ppm. EO ointments were prepared and applied against induced ringworm in guinea pig model and disease removal was observed in 7-21 days, and the hair samples showed negative results for fungal culture in a time-dependent manner after the application of EO ointments. Chemical constituents of EOs were determined by GC-MS. Both the EOs and their combination displayed strong antifungal effects. The results provide a scientific validation for the use of these EOs in the treatment of dermatophyte infections and may be recommended as an alternative to synthetic drug for topical application.

An open study of tinea capitis in 50 children treated with a 2-week course of oral terbinafine

Background: Terbinafine is used in the treatment of dermatophyte infections. There have been several studies suggesting a good response to terbinafine in treating tinea capitis, specifically with dermatophytes of the Trichophyton species. Methods: We enrolled 50 consecutive children with a clinical diagnosis of tinea capitis into an open study using terbinafine for 2 weeks. Results: Clinical and mycologic cure occurred in more than 86% of patients with no side effects and good compliance. Conclusion: In this study terbinafine was a safe and effective treatment of tinea capitis in children, particularly when caused by the Trichophyton species. (J Am Acad Dermatol 1999;41:60-3.)

Terbinafine and Drug Interactions

General wisdom has it that terbinafine, a commonly used oral treatment for dermatophyte infections, has no effect on P450 cytochromes. This study examined terbinafine's effect on CYP2D6, an important cytochrome P450 that metabolizes more than 35 drugs. CYP2D6 activity was tested in nine subjects who received 250 mg …

Treatment of dermatophyte infection

Treatment of dermatophyte infection

The Development of Green Vision in Association With Terbinafine Therapy

Terbinafine is one of a new generation of antifungal drugs that is effective in the treatment of dermatophyte infections. It is an allylamine that inhibits the enzyme squalene epoxidase in fungal cell membranes. Adverse events have been reported in 10.4% of the patients receiving this drug.¹We report the development of dyschromatopsia, pruritus, and urticarial le