“Tineariasis” (or plaque-psoriasis induced by Terbinafine)

Terbinafine is an anti fungal drug used worldwide to treat dermatophytosis. Although generally is well tolerated, several cutaneous side effects have been described. One of them is the induction or exacerbation of psoriasis, especially the pustular type. We describe a case of plaque-psoriasis induced by terbinafine in a young patient. Skin biopsy was performed to confirm the diagnosis and the suspected drug was discontinued. Biopsy showed regular epidermal hyperplasia with parakeratoses and neutrophils in the corneal layer. No fungal elements were observed. Improvement was observed after discontinuation of terbinafine. We present a new case of the induction of plaque-psoriasis after the use of oral terbinafine and conclude that this drug should be used with caution in predisposed patients. Keywords: psoriasis; pustular posriasis; plaque-psoriasis; terbinafine

A Comparative Study of Safety and Efficacy of Oral Terbinafine and Itraconazole in Patients of Tinea Corporis/ Tinea Cruris Infection, A Randomized Open Label Parallel Group Study

Introduction: Superficial dermatophytosis is a common public health problem in India, due to its tropical climate with heat and humidity. Today, the triazoles, mainly Itraconazole and the allylamines, chiefly Terbinafine, are the main ammunitions against dermatophytes. This study is undertaken to compare the safety and efficacy of both the drugs. Materials and Methods: This study was conducted to find the efficacy of Oral Terbinafine and Oral Itraconazole in Tinea Corporis/Tinea Cruris infection. The primary efficacy parameter was change in composite score (pruritus, erythema, pigmentations) from baseline to end of the treatment period. And to compare the safety of Oral Terbinafine and Oral Itraconazole by comparing the following parameters, Liver enzymes - SGOT/SGPT before and after treatment with the study drugs. Drug Dosage: Group 1: Drug –Tab. Terbinafine: Dose 500 mg per day once daily at bedtime for 2 weeks. Group 2: Drug –Tab. Itraconazole: Dose 200 mg per day, once daily at bedtime for 2 weeks. Results: The study participants show significant reduction in itching at the second follow up (after 2 weeks of drug completion) in both groups. Pruritis was reduced in 92% subjects in group 1 and 97.5% subjects in group 2. There was 87% reduction in erythema in group 1 and 93% reduction in group 2. Pigmentations were seen in 2% subjects in both groups indicating relapse of infection. Conclusion: The significant outcome of the study was that oral Itraconazole 200mg/day for 14 days(2 weeks) can be the better antifungal.

COMPARATIVE STUDY OF EFFICACY OF ORAL TERBINAFINE ALONE AND ORAL TERBINAFINE WITH TOPICAL 8% CICLOPIROX OLAMINE IN ONYCHOMYCOSIS

Onychomycosis is a common fungal infection of nail plate caused by dermatophytes, non dermatophyte molds & yeasts. Tinea unguium on the other hand refers specifically to infection caused by dermatophytes. Onychomycosis represents 50% of all nail disorders and 30% of all mycotic infections of skin.1 It is distributed worldwide with prevalence of 3% to 9%. It is generally considered as a disease of middle aged and elderly affecting a large and significant number of people. There has been a recent increase in the incidence as well as a spectrum of causative pathogens associated with onychomycosis. 50 patients of onychomycosis who attended our outpatient department were randomly selected. These 50 patients were equally divided into two groups A and B. Patients in group A (25) were given only oral terbinafine 250mg/once daily for 12 weeks. Patients in group B (25) were given oral terbinafine 250mg/once daily for 12 weeks along with 8% Ciclopirox Olamine nail lacquer which is applied topically once daily at night. In our present study combination therapy give high mycological cure rates than oral terbinafine monotherapy. Combination therapy (oral terbinafine 250mg daily dose with 8% ciclopirox olamine nail lacquer) showed 70 % clinical cure rate and 60 % mycological cure.

Efficacy and safety of different terbinafine regimens in patients of recurrent tinea corporis and cruris

Background: Tinea corporis and cruris is said to be recurrent when there is relapse of sign and symptoms after 6 weeks of cure. Recently, there has been increase in cases of recurrent tinea corporis and cruris, with atypical lesions. This study was done to establish efficacy and safety of different terbinafine regimens against recurrent tinea corporis and cruris.Methods: Sixty patients with clinically and mycologically diagnosed recurrent tinea corporis and cruris were enrolled and divided into three groups. Group A was administered oral terbinafine 500 mg once daily for 2 weeks, group B was given terbinafine 250 mg once daily for double duration i.e., 4 weeks, and group C was given standard treatment which is 250 mg once daily for 2 weeks. Physician assessment four-point scale (PA4PS) and KOH wet mount were assessed for clinical and mycological efficacy. Biochemical laboratory parameters (liver function tests and kidney function tests) and adverse drug reactions were assessed for safety.Results: At the end of 6 weeks, reduction in PA4PS from baseline was 46.5%, 95.8%, and 20.4% in groups with double dose, double duration and standard therapy respectively with statistically significant (p<0.05) improvement in group with double duration. Mycological cure at the end of 4 weeks was 80%, 100% and 50%. There was no safety concern in any of the groups.Conclusions: Double duration of terbinafine was found to be more efficacious and safer.

Onychomatricoma with Onychomycosis: A Case Report and Review of the Literature

Onychomatricoma is a primary benign neoplasm of the nail matrix. Currently, a limited number of cases have been reported, so it is still considered a rare neoplasia. However, it is debatable if this condition is underdiagnosed and underreported. Onychomycosis is an important differential diagnosis of onychomatricoma, and sometimes, both these conditions may even coexist in the same nail. As the tumor grows, tissue microenvironment is more vulnerable to dermatophytes. Probably, the altered keratin appears to be susceptible to fungal invasion. Careful clinical assessment and dermoscopic evaluation help nailing the diagnosis. Usually, total nail avulsion is the preferred therapeutic approach when they coexist. Herein, we present a case of a middle-aged woman with onychomycosis and onychomatricoma affecting a single fingernail. The proposed therapy was oral terbinafine for 6 months followed by a conservative surgery. There were dramatic changes in dermoscopic features after fungal treatment, which, to our knowledge, have not been previously reported.

Terbinafine used safely in autoimmune hepatitis for treatment of tinea corporis

Terbinafine is often considered contraindicated in those with liver disease, as one of the known side effects is hepatotoxicity. We report the first case documenting the safe use of oral terbinafine in a 77-year-old woman with stable autoimmune hepatitis presenting with extensive tinea corporis. Precautions were carried out to minimise the risk of worsening hepatotoxicity, including consultation with the patient’s hepatologist, limiting terbinafine exposure to less than 6 weeks, monitoring of liver function tests, and patient education. The patient’s fungal infection cleared without any signs or symptoms of worsening liver disease. The rash had not recurred 6 months after treatment. When terbinafine must be used in a patient with pre-existing liver disease, we recommend considering a short course of oral terbinafine after consultation with their hepatologist, obtaining baseline liver function tests with consideration of further monitoring during treatment course, and patient education on the signs and symptoms of liver injury.

A Comparative Study of Efficacy of Oral Terbinafine and Oralitraconazole in Tinea Corporis / Tinea Cruris Infection

Dermatophytoses which are superficial fungal infections of the skin, hair, and nail are among the most common infective dermatoses seen in dermatology outpatient clinics. Today, we are facing an onslaught of chronic and recurrent dermatophytosis in volumes never encountered previously. Itraconazole was found to be the better antifungal in terms of clinical cure,mycological clearance and less need for extension of treatment than Terbinafine. Overall, oral Itraconazole 200 mg/day for 2 weeks proved to be a better agent with excellent and significantly better cure rates than oral Terbinafine 500mg/day for 2 weeks. With Itraconazole, the contra-indications, drug interactions must be kept in mind to prevent loss of efficacy/ potentially hazardous interactions. Both drugs had a good safety profile and few minor adverse events. The reasons for extension of treatment comprise chronicity, previous treatment with OTC steroid preparations, and misuse of systemic antifungal drugs, diabetes, and obesity. Poor personal practices and hygiene also havetheir contribution. Significant associations were also noted between diabetes and chronicity.