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Onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Dimitris Rigopoulos, Robert Baran
Terbinafine is a member of the allylamine antifungal drug group. Terbinafine is active against a wide range of pathogenic fungi in vitro, but in vivo is only useful for dermatophytosis 250 mg daily. Significant recovery rates of toenail infections at 3 months and fingernails at 6 weeks. It is considered the gold standard for onychomycosis, with high mycologic (46%–82%) and clinical cure rates (53%–70%) and lower relapse rates compared to other agents. Numerous off-label pulse therapies with terbinafine have been described with efficacy similar to continuous dosing.
Therapy For Skin, Hair and Nail Fungal Infections
Published in Raimo E Suhonen, Rodney P R Dawber, David H Ellis, Fungal Infections of the Skin, Hair and Nails, 2020
Raimo E Suhonen, Rodney P R Dawber, David H Ellis
Topical therapy may be sufficient for dermatophytosis other than nail and scalp infections—for example, terbinafine topical formulations, tolnaftate, imidazole, amorolfine, cyclopiroxolamine, clotrimazole, miconazole, econazole, ketoconazole, bifonazole and tioconazole. Terbinafine, which has the shortest treatment time of topical antifungals, takes about one week to kill the fungus but the skin will take about 2–4 weeks to return to normal.
Novel Perspectives in Treatment of Fungal Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
Bhavana Sharma, Payal Gupta, Prashant Borde, Arjun Ravi, R.B. Vajpayee
Recent studies have provided better understanding of pathogenesis of mycotic keratitis. However, there still remains an increasing need for more effective and better means to treat mycotic keratitis, so as to prevent complications and improve visual outcomes. Terbinafine used in fungal skin diseases has shown to inhibit the growth of fungi in cornea. Topical terbinafine was effective in successful management of filamentous keratomycosis (Bourguet et al. 2015). Immunosuppresive agent Tacrolimus (FK506) has been reported to inhibit inflammation caused by fungi in addition to all-trans retinoic acids (ATRA) which possesses anti-inflammatory and immunoregulatory effects (Zhou et al. 2015). Furthermore cryotherapy has been found to be effective in treating mycotic corneal ulcers. Immunotherapeutic modalities like vitamin D receptors and cathelicidin have been reported to play an important role in innate immunity of corneal epithelial cells for treatment of mycotic keratitis (Cong et al. 2015, Zhong et al. 2016).
Antifungal resistance in superficial mycoses
Published in Journal of Dermatological Treatment, 2022
Aditya K. Gupta, Maanasa Venkataraman
Terbinafine is widely used to treat dermatophyte infections such as onychomycosis due to its high efficacy (39). Terbinafine resistance has been predominately attributed to point mutations in the squalene epoxidase (SQLE) gene whose product is the drug target for terbinafine (29). A unique mechanism of resistance exhibited by T. rubrum and T. interdigitale was documented, where elevated expression of salicylate 1-monooxygenase (salA) gene increased terbinafine resistance (40). Furthermore, molds such as Aspergillus fumigatus, may also exhibit terbinafine resistance due to the extra-plasmidial copies of the SQLE gene (40). Molecular biology techniques such as real-time polymerase chain reaction (RT-PCR), mutation, and gene expression analysis, could provide insight into the novel mechanisms of the fungal pathogens against terbinafine (29,40).
Terbinafine-loaded branched PLGA-based cationic nanoparticles with modifiable properties
Published in Pharmaceutical Development and Technology, 2019
Juraj Martiska, Eva Snejdrova, Martin Drastik, Ludmila Matysova, Milan Dittrich, Jan Loskot, Petr Jilek
Although the systemic administration of terbinafine is quite well tolerated, topical treatment of the local infections is preferred more often (Sun et al. 2007; Gianni 2010). The efficiency of the local treatment depends on delivery of the drug to the target site of action at the effective concentrations. Here the deliberate choice of excipients and technology, that is, formulation of dosage form, plays a crucial role. Terbinafine is commercially available as tablets, granules, sprays, creams, gels, and lotions. New formulation strategies in topical antifungal therapy represent the polymeric nanoparticles (PNPs) (Güngör et al. 2013). Thanks to the size, charge and hydrophobic nature, they are expected to ensure close contact with either stratum corneum or mucin membrane, may enhance tissue penetration of drug, controlled release of drug, and thus the improved therapeutic effect.
Utility of boron in dermatology
Published in Journal of Dermatological Treatment, 2020
David G. Jackson, Leah A. Cardwell, Elias Oussedik, Steven R. Feldman
Terbinafine is commonly used in onychomycosis management, but it causes acute liver damage as a rare and dangerous side effect (41). Terbinafine inhibits CYP450 enzymes, thereby affecting the pharmacokinetics of other CYP450-metabolized drugs and increasing the likelihood of drug-drug interactions (42,43). Since terbinafine is metabolized by liver enzymes, it is not ideal for patients with onychomycosis and comorbid liver disease. Tavaborole may be a better option for these individuals (27,28,30). The biochemistry of boron-based medications such as tavaborole and crisaborole has taught us that diversifying the targets of dermatologic therapies is beneficial in expanding our treatment options.