Therapy For Skin, Hair and Nail Fungal Infections
Raimo E Suhonen, Rodney P R Dawber, David H Ellis in Fungal Infections of the Skin, Hair and Nails, 2020
Most of the fungi that affect the skin, hair and nails only proliferate under the ideal conditions of warmth, moisture and humidity. 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. It has been available for over 30 years and is still valuable for dermatophytic skin infection, in particular tinea capitis. Oral therapy using griseofulvin has been used extensively for the treatment of dermatophytosis. The duration of therapy varies from patient to patient and on the site and severity of the infection, with up to 12 weeks being required for skin and hair infections and approximately 12 months for nails. Oral ketoconazole has a high affinity for keratin and it has been used for dermatophytes, although the risk of hepatitis, albeit rare, makes this a secondary choice for therapy, especially now newer agents such as fluconazole, itraconazole and terbinafine are available.
An Overview and Assessment of the Use of the Antifungal Agents Itraconazole, Terbinafine, and Fluconazole in Dermatology
Hans C. Korting, M. Schafer-Korting in The Benefit/Risk Ratio, 1999
In 1958, griseofulvin became the first significant oral antifungal agent available to treat cutaneous fungal infections.1•3 Anderson1 found that about 50% to 60% of patients with tinea corporis, tinea manuum, and tinea pedis were clinically cured with griseofulvin. With pedal onychomycosis however, cure rates were much lower, typical values being 3% to 38%.2 High relapse rates of 40% to 60% have been reported. c.s Ketoconazole, introduced in the late 1970s was the next important antifungal agent.6-8 This imidazole was an effective treatment for chronic superficial candidiasis and chronic dermatophytosis.9 A few years after the introduction of ketoconazole several cases of symptomatic hepatitis were reported, estimated to be from 1 in 10,000 to 1 in 15,000 in frequency and occasionally fatal. 10•11 The reactions were felt to be an idiosyncratic drug-induced hepatitis, not necessarily associated with high doses of ketoconazole or duration of therapy. 12 As a consequence of these results the benefit/risk ratio of oral antifungal agents The new generation of antifungal agents available for the treatment of dermatomycoses are itraconazole, fluconazole, and terbinafine. In this chapter we will present an overview of these agents, and examine their efficacy and adverse-effect profile.
Scaling of the Scalp with Occipital Lymphadenopathy in a Child
Rachael Morris-Jones, Ann-Marie Powell, Emma Benton in 100 CASES in Dermatology, 2011
This chapter presents the case study of a 4-year-old boy. A 4-year-old boy is referred from the accident and emergency department to the paediatric dermatology clinic, owing to a 1-year history of scaling and crusting of his scalp associated with hair loss. The patient is accompanied by his parents and older sibling. There are obvious patches of alopecia over the vertex of his scalp associated with scaling and crusting. The whole family had scalp brushings taken for mycological culture. This boy presents with a very common scalp complaint of children seen in most urban areas. He is suffering from tinea capitis which is a dermatophyte fungal infection. The fungal hyphae of T. tonsurans penetrate into the hair shaft rendering topical therapy ineffective. Therefore, systemic treatment is required to clear the scalp infection. Oral terbinafine is therefore the treatment of choice in many paediatric dermatology clinics, as it is highly effective and well tolerated.
Acute generalized exanthematous pustulosis associated with terbinafine: a case report
Published in Cutaneous and Ocular Toxicology, 2013
Hakan Turan, Ersoy Acer, Havva Erdem, Esma Uslu, Cihangir Aliagaoglu
A 27-year-old male patient who has used oral terbinafine for two weeks was admitted to our outpatient clinic for non-follicular millimetric pustules on erythematous and edematous different-sized plaques on his trunk and flexural areas. He was diagnosed with acute generalized exanthematous pustulosis (AGEP) because of terbinafine use in the light of history, clinical and histopathological findings. An AGEP is a rare and severe pustular reaction usually triggered by systemic drug intake. Approximately, 2.3% of the patients having oral terbinafine have been reported to develop cutaneous adverse effects. Although terbinafine is a commonly used medicine, it must be considered that it may cause severe adverse reactions.
A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole
Published in Journal of Dermatological Treatment, 2012
ZhiQiang Yin, JiaLi Xu, Dan Luo
As the most frequently used systemic antifungal agents for onychomycosis, terbinafine and itraconazole have both proved to have the conditions of recurrence in various degrees during follow-up period after end of therapy; very little is known about their comparative recurrences after long-term follow-up. We conducted a meta-analysis of available trials to compare the long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. Meta-analysis was performed by the Review Manager version 5.0.25. Risk ratio and 95% confidence intervals were calculated by the fixed effect model. Five trials and total 251 eligible patients were included in this meta-analysis. The combined risk ratio of the meta-analysis comparing terbinafine with itraconazole for mycological recurrence rate was 0.44 (95% CI 0.29–0.66), which suggests that itraconazole therapy is more likely to produce mycological recurrence compared with terbinafine therapy.
Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis
Published in Journal of Dermatological Treatment, 2005
Shemer Avner, Nathansohn Nir, Trau Henri
Background: Treatment of onychomycosis has recently been enhanced by the introduction of combination therapies. Objective: To evaluate the efficacy of a combination therapy of ciclopirox nail lacquer and oral terbinafine compared to oral terbinafine monotherapy for the treatment of onychomycosis caused by dermatophytes. Patients and methods: Eighty patients with onychomycosis were randomly assigned to receive either oral terbinafine 250 mg/day for 16 weeks or a combination of oral terbinafine 250 mg/day for 16 weeks and topical ciclopirox nail lacquer once daily for 9 months. Both groups were followed up for 9 months from start of treatment. Results: After 9 months of treatment, the mycological cure rates were 22/34 (64.7%) for the terbinafine‐only group and 30/34 (88.2%) for the combination therapy group (p
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