Oral terbinafine: a new antifungal agent

Determination of terbinafine (Lamisil) in human hair by microbore liquid chromatography/tandem mass spectrometry

An analytical method for the determination of terbinafine (Lamisil(R)) in human hair was developed and validated. Human hair (10 mg) was hydrolyzed in 0.50 mL of 5.0 N sodium hydroxide for 1.5 h. The aqueous layer was extracted with 1.5 mL of n-hexane. The organic layer was separated and re-extracted with 0.20 mL of formic acid (12.5%)/2-propanol (85:15, v/v). The aqueous layer was separated and 0.010 mL of the aqueous extract was injected onto a reversed-phase microbore (50 x 1.0 mm i.d.) column for analysis by liquid chromatography/tandem mass spectrometry (LC/MS/MS). The instrument was equipped with an electrospray ionization (ESI) interface and operated in the positive ion mode of detection. Interday and intraday accuracy and precision were assessed from the relative recoveries of spiked samples analyzed on three different days. The method showed excellent specificity and ruggedness with a lower limit of quantitation of 10 ng/g (i.e., 10 ppb) using 10 mg of human hair.

Oral terbinafine (Lamisil) in the short-term treatment of fungal infections of the skin: results of a post-marketing surveillance study

Oral terbinafine (Lamisil, Novartis Pharma AG, Basel, Switzerland) is an effective therapy for fungal infections of the skin and nails. A post-marketing surveillance study was undertaken to evaluate the clinical efficacy and safety of oral terbinafine. A total of 454 patients with clinically and mycologically confirmed superficial fungal infections of the skin were enrolled from 79 dermatology clinics. Patients received oral terbinafine (250 mg day-1) for 2 weeks. Specific signs and symptoms were assessed by standard questionnaire before, immediately after, and 4 weeks after treatment. Observed improvements in patients after 2 weeks treatment were: erythema 81%, blistering 33%, exudation 50%, scaling 89%, pruritus 83%. After 4 weeks treatment, erythema was absent in 85% of patients, blistering and exudation in 99.7%, scaling in 82%, and pruritus in 94%. Overall clinical efficacy was assessed as good to excellent in 97% of patients. Adverse effects--mainly gastrointestinal and minor skin rashes--were reported in 5.3% of patients. The results of this study confirm that oral terbinafine is safe and highly effective for the short-term treatment of fungal skin infections.

New drugs in veterinary dermatology

This article discusses several different new drugs currently being used in dermatology. Most of the drugs discussed showed some promise as being a useful therapy in veterinary medicine, but a few have questionable efficacy (nonsedating antihistamines). The majority of these drugs have not had any pharmacokinetic or clinical trials conducted on them in small animals. Hopefully, in the future, more studies are funded so that we can determine the clinical therapeutical efficacy and appropriate doses for these drugs.

Immunohistochemical study of type I collagen turn-over and of matrix metalloproteinases in chromoblastomycosis before and after treatment by terbinafine

The distribution of type I collagen, the major component of human dermis, was characterized by immunohistochemistry in skin lesions of chromoblastomycosis, a chronic cutaneous mycosis, before and after a specific antifungal treatment with terbinafine to study the changes induced in the lesions by the treatment. Newly synthesized type I collagen was studied with an antibody directed against the aminoterminal propeptide of the molecule (PINP), whereas mature, cross-linked type I collagen was detected with an antibody against the carboxyterminal telopeptide of type I collagen (ICTP). The isopeptide N epsilon gamma-glutamyl lysine (N epsilon gamma GL), synthesized by transglutaminase and able to cross-link several components of the extracellular matrix, has also been investigated with two monoclonal antibodies to determine if it is involved in the stabilisation of the fibrotic cutaneous lesions. The degradative process involved in the remodelling has also been assessed by immunohistochemistry with anti-metalloproteinase (MMP-1 and MMP-9) and anti-tissue inhibitor (TIMP-1) antibodies. All tissue macrophages stained for CD68 and MMP-9, but not for MMP-1, while the polymorphonuclear neutrophils had an elastase and a weak MMP-9 phenotype. The fibroblasts of fibrotic areas stained constantly for N epsilon gamma GL and PINP. The immunostaining of extracellular matrix for ICTP and N epsilon gamma GL, and the number of PINP-positive fibroblasts, decreased significantly after one year of antifungal treatment. Terbinafine treatment decreases the synthesis of type I collagen and leads to a partial reversal of the cutaneous fibrotic lesions, independently of the cure of the fungal infection.

Current issues in onychomycosis

OBJECTIVE

To review the epidemiology, mycology, clinical features and diagnosis, current pharmacotherapy, and pharmacoeconomics of onychomycosis.

DATA SOURCES

We conducted a MEDLINE search from 1966 to May 1997. References from these articles, manufacturers of the discussed antimycotics, and relevant abstracts from recent dermatology conferences were used to collect pertinent data.

DATA EXTRACTION

Data were obtained from published controlled studies and case reports. In the pharmacotherapy section, the most weight was placed on fully reported, randomized, controlled comparative trials, but abstracts and case series were included when well-controlled studies were unavailable.

DATA SYNTHESIS

Onychomycosis is a common nail disorder that has a substantial impact on patients' quality of life. It is most commonly caused by dermatophytes, but yeasts and molds can also be involved. Diagnosis is made through clinical presentation, potassium hydroxide preparations, and culture of tissue/nail samples. Griseofulvin was the drug of choice for many years, but its low cure rates and the development of newer, more effective drugs made it fall out of favor. Current therapeutic alternatives include fluconazole, itraconazole, and terbinafine. Data on the use of fluconazole are limited to case series and reports. Continuous dosing of itraconazole and terbinafine are well-proven therapies. New data are becoming available on the use of pulse itraconazole dosing, which has recently been approved by the Food and Drug Administration for fingernail infections. These drugs are well tolerated, but attention to drug interactions is necessary with the azoles.

CONCLUSIONS

Currently, continuous terbinafine appears to be the most cost-effective drug for dermatophyte onychomycosis.