Treatment Of Dermatophyte Infections Research Articles

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

Intermittent Itraconazole Therapy

Itraconazole is a triazole antifungal that has recently become available in the United States for treatment of dermatophyte infections of toenails. The

Oral itraconazole versus topical bifonazole treatment in experimental dermatophytosis.

Guinea pigs, infected with either Trichophyton mentagrophytes or Microsporum canis, were treated orally or topically with azole antifungals daily for two weeks. Fungi located in the stratum corneum were affected similarly by both treatment schedules, showing typical cell wall changes after azole exposure and necrosis of internal organelles. Fungi located in the hair sheaths were affected only by the oral treatment, which not only prevented invasion of the inner hair structures and inflammatory responses but also led to a complete clearance of the infection within 7 days. Topically applied azole treatment was not able to injure fungi in the hair sheaths and did not suppress invasion into the hair shafts. These observations are in favour of oral antifungal medication with azoles for the treatment of dermatophyte infections involving hairy skin.

Correction: terbinafine for dermatophytes in skin and nail (8 June, page 47)

We states that terbinafine was effective in the treatment of dermatophyte infections of thick keratin (such as the sole of the foot) but not been compared with griseofulvin at the recommended does (1g daily). We overlooked a small double-blind trial (31 patients).1 Terbinafine 250mg daily for 6 weeks achieved 100% mycological cure – much better than griseofulvin 1g daily (45%). The result does not alter our recommendations on use of terbinafine.

▾ Terbinafine for dermatophytes in skin and nail

Most common fungal infections of the skin respond to topical treatment but dermatophytosis (ringworm; tinea) is sometimes an exception; ringworm of the body or groin usually clears (e.g. with a topical azole) but dermatophyte infections of the nails, the hair and scalp, or of the soles and palms, generally need systemic therapy. This has traditionally been with griseofulvin but length of treatment, low rates of lasting cure and unwanted effects are drawbacks. Terbinafine (Lamisil – Sandoz) is a new systemic antifungal intended for the treatment of dermatophyte infections in adults. The manufacturer claims it achieves a high cure rate and low rate of relapse with only brief treatment periods. How useful is it?

Pharmacology of the allylamines

The allylamines are a new class of antifungal drugs that inhibit ergosterol synthesis at the level of squalene epoxidase. These agents are highly selective for the fungal enzyme and have a minimal effect on mammalian cholesterol synthesis. Naftifine, the original member of the allylamine series, possesses only topical activity, whereas the naftifine analog terbinafine is active both topically and orally. In vitro, terbinafine is exceptionally active against dermatophytes, molds, and dimorphic fungi in which it exerts a fungicidal action. This in vitro profile is reflected by the clinical effectiveness of this allylamine in the treatment of dermatophyte infections. When given orally, terbinafine is well absorbed and rapidly and extensively distributed to the skin and sebum in concentrations that exceed the minimum inhibitory concentrations of these organisms by several orders of magnitude.

Dermatophyte infections in hereditary palmo-plantar keratoderma. Frequency and therapy.

The frequency of dermatophyte infections in hereditary palmo-plantar keratoderma ( HPPK ) of the Unna - Thost variety was investigated in 280 patients admitted to the Department of Dermatology, Central Hospital, Boden , during 1977-1981, and was found to be 35.0%. The distribution of fungi did not differ from that found for the total number of dermatophytes. An almost complete therapeutical resistance was found especially in Trichophyton rubrum infections, when patients were treated with micronized griseofulvin and topical econazole cream. Treatment of dermatophyte infections in HPPK with 50% propylene glycol in distilled water gave poor results but when 1% econazole nitrate was added negative cultures were found in 86.4% of the patients treated for 3 weeks.

Ketoconazole (R 41 400) in the treatment of dermatophyte infections: a clinical, mycological, and morphological study.

Ketoconazole (100 mg, orally, once daily) was investigated in nine patients with extensive dermatophyte infections. After treatment ranging between one week and three months, clinical cures (healing of lesions and negative cultures) were observed in all cases. In vitro growth of Trichophyton rubrum, T. mentagrophytes, and T. verrucosum isolated from infected skin scales were completely inhibited by concentrations of ketoconazole of 10 microgram/ml and above. No evidence for the development of drug resistance was obtained from regular in vitro sensitivity tests.

Studies on the treatment of dermatophytic infections of glabrous skin by topical treatment alone or with combination of griseofulvin for comparison

This study is based on 254 dermatophytic infections of glabrous skin with their 130 pieces of clothing materials which yielded positive findings both in KOH preparations and on culture media. A 50 days period of time is found to be sufficient. In order to prevent reinfections it is found necessary to disinfect all clothing materials in the time of treatment and to continue this process for 6 months after the treatment ceased.

Biochemical Studies on the Metabolism of Griseofulvin

Introduction Since the discovery of and the subsequent use of griseofulvin in the systemic treatment of dermatophyte infection, many observations have been made concerning this antibiotic's effect on both the host and the infectious organism. It seems clear that orally administered griseofulvin inhibits the growth of dematophytes in vivo without inducing significant adverse effects an either man or experimental animals. 2-6 When this antifungal antibiotic is injected intravenously in rats at approximately ten times (100-200 mg/kg.) the oral therapeutic dosage, arrest of mitosis is observed in metaphase. 7 In this respect griseofulvin resembles colchicine. Similar effects by griseofulvin have been reported in plant cells. 7 This paper presents data on the blood and serum levels of mice following a single oral dose of griseofulvin, chromatographic and spectrophotometric assay techniques for this antibiotic, and the partial reversal of griseofulvin activity by purines, pyrimidines, and their nucleotides. Methods Assays Utilizing Tritium-Labeled Griseofulvin.—