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Haghani I, Babaie M, Hoseinnejad A, Rezaei-Matehkolaei A, Mofarrah R, Yahyazadeh Z, Kermani F, Javidnia J, Shokohi T, Azish M, Kamyab Hesari K, Saeedi M, Ghasemi Z, Khojasteh S, Hajheydari Z, Mosayebi E, Valadan R, Seyedmousavi S, Abastabar M, Hedayati MT. High Prevalence of Terbinafine Resistance Among Trichophyton mentagrophytes/T. interdigitale Species Complex, a Cross-Sectional Study from 2021 to 2022 in Northern Parts of Iran. Mycopathologia 2024; 189:52. [PMID: 38864945 DOI: 10.1007/s11046-024-00855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/18/2024] [Indexed: 06/13/2024]
Abstract
Treatment-resistant dermatophytosis caused by the members of the Trichophyton mentagrophytes/Trichophyton interdigitale species group (TMTISG) is increasing worldwide. We aimed to determine the prevalence of TMTISG in patients with dermatophytosis in two centers from north of Iran and detect the possible mutations in the squalene epoxidase (SQLE) gene in relevant terbinafine (TRB) resistant pathogenic isolates. From November 2021 to December 2022, 1960 patients suspected to dermatophytosis and referred to two mycology referral laboratories in the north of Iran were included in the study. Identification of all dermatophyte isolates was confirmed by RFLP of rDNA internal transcribed spacer (ITS) regions. Antifungal susceptibility testing against five common antifungals using the CLSI-M38-A3 protocol was performed. The TMTISG isolates resistant to TRB, were further analyzed to determine the possible mutations in the SQLE gene. Totally, 647 cases (33%) were positive for dermatophytosis of which 280 cases (43.3%) were identified as members of TMTISG. These were more frequently isolated from tinea corporis 131 (44.56%) and tinea cruris 116 (39.46%). Of 280 TMTISG isolates, 40 (14.3%) were resistant to TRB (MIC ≥ 4 µg/mL), all found to be T. indotineae in ITS sequencing. In SQLE sequencing 34 (85%) of TRB-resistant isolates had coincident mutations of Phe397Leu and Ala448Thr whereas four and two isolates had single mutations of Phe397Leu and Leu393Ser, respectively. Overall, the resistance of Iranian TMTISG isolates to TRB greatly occurred by a mutation of Phe397Leu in the SQLE gene as alone or in combination with Ala448Thr. Nevertheless, for the occurrence of in vitro resistance, only the presence of Phe397Leu mutation seems to be decisive.
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Affiliation(s)
- Iman Haghani
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Babaie
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hoseinnejad
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Rezaei-Matehkolaei
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ramin Mofarrah
- Department of Dermatology, Faculty of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Zahra Yahyazadeh
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Firoozeh Kermani
- Department of Parasitology and Mycology, Infectious Diseases and Tropical Medicine Research Center, Health Research Center, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Javad Javidnia
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Shokohi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Maryam Azish
- Department of Parasitology and Medical Mycology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Kambiz Kamyab Hesari
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Ghasemi
- Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Khojasteh
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, 7916613885, Iran
| | - Zohreh Hajheydari
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Mosayebi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Valadan
- Molecular and Cell Biology Research Center (MCBRC), Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyedmojtaba Seyedmousavi
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Mahdi Abastabar
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
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Towe AE, Hardman RH, Cox S, Sheley WC, DeMarchi JA, Carter ED, Miller DL. PILOT STUDY OF INTRACOELOMIC TERBINAFINE IMPLANTS IN GREATER SIRENS ( SIREN LACERTINA). J Zoo Wildl Med 2024; 55:453-461. [PMID: 38875202 DOI: 10.1638/2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 06/16/2024] Open
Abstract
Chytridiomycosis caused by Batrachochytrium dendrobatidis (Bd) has been documented in greater sirens (Siren lacertina) in the wild and in the pet trade. This study evaluated the use of terbinafine-impregnated implants for chytridiomycosis prophylaxis in greater sirens exposed to Bd. Implants were placed intracoelomically in both control (blank implant, n = 4) and treatment (24.5 mg of terbinafine implant, n = 4) groups. Sirens were exposed to Bd zoospores via 24-h immersion bath at 1 and 2 mon postimplant placement. Blood was collected monthly for plasma terbinafine levels, and skin swabs were collected weekly for Bd quantitative PCR. Animals with terbinafine implants had detectable concentrations of plasma terbinafine ranging from 17 to 102 ng/ml. Only one terbinafine-implanted animal had a peak concentration above the published minimum inhibitory concentration for terbinafine against Bd zoospores (63 ng/ml); however, it is unknown how plasma terbinafine concentrations relate to concentrations in the skin. There was no difference between the two treatment groups in clinical signs or Bd clearance rate, and no adverse effects from implants were observed. These findings indicate using intracoelomic drug implants for drug delivery in amphibians is safe; however, terbinafine efficacy in preventing Bd chytridiomycosis in sirens remains unclear. Further investigation of the use of intracoelomic implants and identification of effective drugs and doses in other amphibian species against Bd and other infectious diseases is warranted, as this may provide a practical method for long-term drug delivery in wildlife.
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Affiliation(s)
- Anastasia E Towe
- Department of Comparative and Experimental Medicine, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- University of Tennessee One Health Initiative, Knoxville, TN 37996, USA,
| | - Rebecca H Hardman
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
- University of Tennessee One Health Initiative, Knoxville, TN 37996, USA
| | - Sherry Cox
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
| | - Wesley C Sheley
- Department of Comparative and Experimental Medicine, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- University of Tennessee One Health Initiative, Knoxville, TN 37996, USA
| | - Joseph A DeMarchi
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
| | - E Davis Carter
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
- University of Tennessee One Health Initiative, Knoxville, TN 37996, USA
| | - Debra L Miller
- Department of Comparative and Experimental Medicine, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- Center for Wildlife Health, Department of Forestry, Wildlife, and Fisheries, University of Tennessee, Institute of Agriculture, Knoxville, TN 37996, USA
- Department of Biomedical and Diagnostic Sciences, University of Tennessee, College of Veterinary Medicine, Knoxville, TN 37996, USA
- University of Tennessee One Health Initiative, Knoxville, TN 37996, USA
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Rana DK, Shah TS, Rohit MH, Patel NH, Khadela AD, Oza YP, Padhiyar JK. Evaluation of the benefit of the addition of 1% topical luliconazole versus topical bland emollient to the systemic itraconazole therapy for the management of disseminated dermatophytosis: A randomised control trial. Mycoses 2024; 67:e13681. [PMID: 38214352 DOI: 10.1111/myc.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The present epidemic of dermatophytosis in India is marked by an increase in chronic, recurrent and disseminated cases. A combination of oral itraconazole and topical luliconazole is being increasingly utilised by dermatologists in India. The superiority of this combination is not supported by robust clinical trial data. OBJECTIVE We conducted this randomised, open-label, two arms, parallel assignment intervention trial between November 2022 and May 2023 to determine the superiority of topical 1% Luliconazole over bland emollient as adjuvant to systemic Itraconazole therapy in the management of dermatophytosis. METHOD In this study, 135 patients of either sex were randomised to two study cohorts. Major exclusions being concomitant medical illness, use of concomitant medication and substance abuse. Participants were randomly assigned to receive topical bland emollient, (Cohort I, n = 67) or topical luliconazole, (Cohort II, n = 68). Both cohorts received oral itraconazole 200 mg/day (100 mg BID) and levocetirizine 5 mg twice a day as a systemic regime. Clinical and mycological cure at the end of 6 weeks and clinical relapse among cure patients during 10-week follow-up were observed. RESULTS The cure rates for Cohorts I and II at 6 weeks were 50 (74.62%) and 56 (82.35%), (p = .46), respectively. During the 4-week follow-up period, clinical relapses were observed in 16 (32%) of the 50 patients in Cohort I and 12 (21.43%) of the 56 patients in Cohort II (p = .18). Luliconazole cohort shows a significantly higher medical cost (p < .05). CONCLUSION Our study shows a similar cure rate and relapse rate for patients receiving topical Luliconazole versus topical bland emollient as an adjuvant to the systemic itraconazole regime.
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Affiliation(s)
- Deval K Rana
- Department of Pharmacology, L.M. College of Pharmacy, Ahmedabad, Gujarat, India
| | - Tithi S Shah
- Department of Pharmacology, L.M. College of Pharmacy, Ahmedabad, Gujarat, India
| | - Mansi H Rohit
- Department of Pharmacology, L.M. College of Pharmacy, Ahmedabad, Gujarat, India
| | - Nayankumar H Patel
- GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Avinash D Khadela
- Department of Pharmacology, L.M. College of Pharmacy, Ahmedabad, Gujarat, India
| | - Yaksh P Oza
- GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
| | - Jigna K Padhiyar
- GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India
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Mijaljica D, Spada F, Harrison IP. Emerging Trends in the Use of Topical Antifungal-Corticosteroid Combinations. J Fungi (Basel) 2022; 8:812. [PMID: 36012800 PMCID: PMC9409645 DOI: 10.3390/jof8080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
A broad range of topical antifungal formulations containing miconazole or terbinafine as actives are commonly used as efficacious choices for combating fungal skin infections. Their many benefits, owing to their specific mechanism of action, include their ability to target the site of infection, enhance treatment efficacy and reduce the risk of systemic side effects. Their proven efficacy, and positioning in the treatment of fungal skin infections, is enhanced by high patient compliance, especially when appropriate vehicles such as creams, ointments and gels are used. However, inflammation as a result of fungal infection can often impede treatment, especially when combined with pruritus (itch), an unpleasant sensation that elicits an urge to scratch. The scratching that occurs in response to pruritus frequently accelerates skin damage, ultimately aggravating and spreading the fungal infection. To help overcome this issue, a topical antifungal-corticosteroid combination consisting of miconazole or terbinafine and corticosteroids of varying potencies should be used. Due to their inherent benefits, these topical antifungal-corticosteroid combinations can concomitantly and competently attenuate inflammation, relieve pruritus and treat fungal infection.
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Affiliation(s)
| | | | - Ian P. Harrison
- Department of Scientific Affairs, Ego Pharmaceuticals Pty Ltd., 21–31 Malcolm Road, Braeside, VIC 3195, Australia; (D.M.); (F.S.)
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Verma SB, Panda S, Nenoff P, Singal A, Rudramurthy SM, Uhrlass S, Das A, Bisherwal K, Shaw D, Vasani R. The unprecedented epidemic-like scenario of dermatophytosis in India: III. Antifungal resistance and treatment options. Indian J Dermatol Venereol Leprol 2021; 87:468-482. [PMID: 34219433 DOI: 10.25259/ijdvl_303_20] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/01/2020] [Indexed: 02/03/2023]
Abstract
One of the canonical features of the current outbreak of dermatophytosis in India is its unresponsiveness to treatment in majority of cases. Though there appears to be discordance between in vivo and in vitro resistance, demonstration of in vitro resistance of dermatophytes to antifungals by antifungal susceptibility testing is essential as it may help in appropriate management. The practical problem in the interpretation of antifungal susceptibility testing is the absence of clinical breakpoints and epidemiologic cutoff values. In their absence, evaluation of the upper limit of a minimal inhibitory concentration of wild type isolates may be beneficial for managing dermatophytosis and monitoring the emergence of isolates with reduced susceptibility. In the current scenario, most of the cases are unresponsive to standard dosages and duration of treatment recommended until now. This has resulted in many ex-cathedra modalities of treatment that are being pursued without any evidence. There is an urgent need to carry out methodical research to develop an evidence base to formulate a rational management approach in the current scenario.
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Affiliation(s)
| | - Saumya Panda
- Department of Dermatology, Belle Vue Clinic, Kolkata, West Bengal, India, India
| | - Pietro Nenoff
- Department of Dermatology and Laboratory Medicine, Laboratory for Medical Microbiology, Moelbis, Germany
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Shivprakash M Rudramurthy
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Silke Uhrlass
- Department of Dermatology and Laboratory Medicine, Laboratory for Medical Microbiology, Moelbis, Germany
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Kavita Bisherwal
- Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College and SSK Hospital, Delhi
| | - Dipika Shaw
- Department of Medical Microbiology, PGI, Chandigarh, India
| | - Resham Vasani
- Department of Dermatology, Bhojani Clinic, Mumbai, Maharashtra, India
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Kaur N, Bains A, Kaushik R, Dhull SB, Melinda F, Chawla P. A Review on Antifungal Efficiency of Plant Extracts Entrenched Polysaccharide-Based Nanohydrogels. Nutrients 2021; 13:2055. [PMID: 34203999 PMCID: PMC8232670 DOI: 10.3390/nu13062055] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/08/2023] Open
Abstract
Human skin acts as a physical barrier; however, sometimes the skin gets infected by fungi, which becomes more severe if the infection occurs on the third layer of the skin. Azole derivative-based antifungal creams, liquids, or sprays are available to treat fungal infections; however, these formulations show various side effects on the application site. Over the past few years, herbal extracts and various essential oils have shown effective antifungal activity. Additionally, autoxidation and epimerization are significant problems with the direct use of herbal extracts. Hence, to overcome these obstacles, polysaccharide-based nanohydrogels embedded with natural plant extracts and oils have become the primary choice of pharmaceutical scientists. These gels protect plant-based bioactive compounds and are effective delivery agents because they release multiple bioactive compounds in the targeted area. Nanohydrogels can be applied to infected areas, and due to their contagious nature and penetration power, they get directly absorbed through the skin, quickly reaching the skin's third layer and effectively reducing the fungal infection. In this review, we explain various skin fungal infections, possible treatments, and the effective utilization of plant extract and oil-embedded polysaccharide-based nanohydrogels.
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Affiliation(s)
- Navkiranjeet Kaur
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
| | - Aarti Bains
- Department of Biotechnology, Chandigarh Group of Colleges Landran, Mohali 140307, Punjab, India;
| | - Ravinder Kaushik
- School of Health Sciences, University of Petroleum and Energy Studies, Dehradun 248007, Uttrakhand, India;
| | - Sanju B. Dhull
- Department of Food Science and Technology, Chaudhary Devi Lal University, Sirsa 125055, Haryana, India;
| | - Fogarasi Melinda
- Department of Food Engineering, University of Agricultural Sciences and Veterinary Medicine of Cluj-Napoca, Calea Mănăstur 3–5, 400372 Cluj-Napoca, Romania
| | - Prince Chawla
- Department of Food Technology and Nutrition, Lovely Professional University, Phagwara 144411, Punjab, India;
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EFFICACY OF SUBCUTANEOUS IMPLANTS TO PROVIDE CONTINUOUS PLASMA TERBINAFINE IN HELLBENDERS ( CRYPTOBRANCHUS ALLEGANIENSI) FOR FUTURE PROPHYLACTIC USE AGAINST CHYTRIDIOMYCOSIS. J Zoo Wildl Med 2021; 52:300-305. [PMID: 33827189 DOI: 10.1638/2020-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/21/2022] Open
Abstract
Batrachochytrium dendrobatidis (Bd) is an important fungal pathogen present in wild hellbender (Cryptobranchus alleganiensis) populations that appears to cause disease during novel exposure and acute stress. Hellbender repatriation efforts are ongoing to combat declining populations, but mortality by chytridiomycosis (disease from Bd) after release has been reported. The goal was to determine whether a safe antifungal agent could be administered and provide prolonged plasma concentrations without repeated handling. A subcutaneous implant impregnated with 24.5 mg of terbinafine was tested in three juvenile eastern hellbenders (C. a. alleganiensis) raised in human care, and plasma terbinafine concentrations were recorded from weekly to biweekly for 141 days. Plasma concentrations were variable, with peak plasma concentrations of 1,610, 112, and 66 ng/ml between 28 and 56 days postimplant. Although all hellbenders achieved plasma concentrations above the published minimum inhibitory concentration for terbinafine against Bd zoospores (63 ng/ml) at several time points, only one individual remained above this threshold for more than two consecutive time intervals. Results show the potential for these implants as a prophylaxis for chytridiomycosis in captive-to-wild hellbender releases. However, further investigation will be needed to determine the plasma concentrations required to achieve prophylaxis in vivo and implant reliability.
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Gnat S, Dyląg M, Łagowski D, Zielinski J. Therapeutic efficacy of topically used luliconazole vs. terbinafine 1% creams. Mycoses 2021; 64:967-975. [PMID: 33884673 DOI: 10.1111/myc.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Dermatomycoses of zoophilic origin, especially those caused by Trichophyton mentagrophytes, often pose considerable therapeutic problems. This is reflected in the growing number of strains of this species with resistance to terbinafine caused by a mutation in the squalene epoxidase (SQLE) gene. Therefore, it is reasonable to look for alternative therapies to the commonly used terbinafine. The aim of the present study was to assess the in vivo effectiveness of topical therapy with luliconazole or terbinafine 1% cream. METHODS Therapeutic efficacy was assessed using direct examination in KOH with DMSO, qPCR analysis with pan-dermatophyte primers and culturing. Moreover, in vitro susceptibility tests for luliconazole and terbinafine were performed. RESULTS The results demonstrated significantly higher antifungal activity of luliconazole than terbinafine against dermatomycoses caused by T. mentagrophytes. The geometric mean of the MIC value for luliconazole against all T. mentagrophytes strains was 0.002 μg/ml, while this value for terbinafine was 0.004 μg/ml. In all studied cases, 28-day local therapy with luliconazole contributed to complete eradication of the aetiological agent of infection. CONCLUSIONS Given the increasingly frequent reports of difficult-to-treat dermatophytoses caused by zoophilic terbinafine-resistant strains, the 1% luliconazole cream can be alternative solution in topical therapy.
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Affiliation(s)
- Sebastian Gnat
- Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, Lublin, 20-033, Poland
| | - Mariusz Dyląg
- Department of Mycology and Genetics, Institute of Genetics and Microbiology, Faculty of Biological Sciences, University of Wroclaw, Wroclaw, Poland
| | - Dominik Łagowski
- Department of Veterinary Microbiology, Institute of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, Akademicka 12, Lublin, 20-033, Poland
| | - Jessica Zielinski
- Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston, SC, USA
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The Growing Problem of Antifungal Resistance in Onychomycosis and Other Superficial Mycoses. Am J Clin Dermatol 2021; 22:149-157. [PMID: 33354740 DOI: 10.1007/s40257-020-00580-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/06/2023]
Abstract
Superficial mycoses are becoming increasingly resistant to current antifungal medications. As alternative therapeutic options are limited, the increasing frequency of reports of antifungal resistance is alarming. This epidemic parallels the rise of antibiotic resistance; however, the significance of this problem has yet to gain global attention. Here, we discuss the reports of antifungal resistance from around the world, present our own experience with treatment-resistant infections, and examine alternative treatment strategies. The majority of reports of recalcitrant infections indicate terbinafine resistance as the causative factor. Single-point mutations in the squalene oxidase gene is the most reported mechanism of resistance to terbinafine. Mixed infections of dermatophytes with non-dermatophyte molds and/or yeasts are becoming more prevalent and contributing to the resistant nature of these infections. The key to selecting an effective antifungal therapy for a recalcitrant infection is identification of the infectious organisms(s) and testing susceptibility of the organism(s) to antifungal drugs. Combination and sequential therapy regimens are options, but both require active monitoring for hepatic and renal function, drug interactions, and other adverse effects. Selected topical antifungals with a wide spectrum of activity may also be considerations in some clinical presentations. Innovative treatment regimens and novel therapeutics are needed to overcome the rising epidemic of antifungal resistance.
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Bhatia A, Kanish B, Badyal DK, Kate P, Choudhary S. Efficacy of oral terbinafine versus itraconazole in treatment of dermatophytic infection of skin - A prospective, randomized comparative study. Indian J Pharmacol 2019; 51:116-119. [PMID: 31142947 PMCID: PMC6533924 DOI: 10.4103/ijp.ijp_578_17] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES: Dermatophytic infections are the common fungal infections aggravated by hot and humid climate. Terbinafine and itraconazole are commonly used oral antifungal agents for the same. However, resistance to these drugs is being seen increasingly when used in the conventional doses and duration. Therefore, this study was designed to compare the efficacy of terbinafine and itraconazole in increased dosages and duration in the treatment of tinea corporis and tinea cruris. MATERIALS AND METHODS: In this randomized comparative study, patients of tinea cruris and tinea corporis were randomly divided into two groups of 160 each and were given oral terbinafine (Group I) and oral itraconazole (Group II) for 4 weeks. The scores and percentage change in scores of pruritus, scaling, and erythema were evaluated at 2 and 4 weeks. RESULTS: At the end of week 4, mycological cure was seen in 91.8% after 4 weeks in the itraconazole group as compared to 74.3% of patients in the terbinafine group. There was a significant improvement in percentage change in pruritus, scaling, and erythema in both the groups from 0 to 4 weeks. On comparing groups, the percentage change was significantly different in scaling from 0 to 2 weeks (5.4 vs. −4.8) and 2–4 weeks (16.7 vs. 29.6) between Group I and Group II, respectively. Clinical global improvement was better with itraconazole. Mild adverse effects such as gastrointestinal upset, headache, and taste disturbances were observed which were comparable in both the groups. CONCLUSIONS: Itraconazole and terbinafine seem to be equally effective and safe in the treatment of tinea cruris and tinea corporis.
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Affiliation(s)
- Anuradha Bhatia
- Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Bimal Kanish
- Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Dinesh Kumar Badyal
- Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Prajakta Kate
- Department of Dermatology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Swati Choudhary
- Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Petrucelli MF, Matsuda JB, Peroni K, Sanches PR, Silva WA, Beleboni RO, Martinez-Rossi NM, Marins M, Fachin AL. The Transcriptional Profile of Trichophyton rubrum Co-Cultured with Human Keratinocytes Shows New Insights about Gene Modulation by Terbinafine. Pathogens 2019; 8:pathogens8040274. [PMID: 31795354 PMCID: PMC6963840 DOI: 10.3390/pathogens8040274] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022] Open
Abstract
The dermatophyte Trichophyton rubrum is the main causative agent of dermatophytoses worldwide. Although a superficial mycosis, its incidence has been increasing especially among diabetic and immunocompromised patients. Terbinafine is commonly used for the treatment of infections caused by dermatophytes. However, cases of resistance of T. rubrum to this allylamine were reported even with the efficacy of this drug. The present study is the first to evaluate the effect of terbinafine using a co-culture model of T. rubrum and human keratinocytes, mimicking a fungus-host interaction, in conjunction with RNA-seq technique. Our data showed the repression of several genes involved in the ergosterol biosynthesis cascade and the induction of genes encoding major facilitator superfamily (MFS)- and ATP-binding cassette superfamily (ABC)-type membrane transporter which may be involved in T. rubrum mechanisms of resistance to this drug. We observed that some genes reported in the scientific literature as candidates of new antifungal targets were also modulated. In addition, we found the modulation of several genes that are hypothetical in T. rubrum but that possess known orthologs in other dermatophytes. Taken together, the results indicate that terbinafine can act on various targets related to the physiology of T. rubrum other than its main target of ergosterol biosynthetic pathway.
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Affiliation(s)
- Monise Fazolin Petrucelli
- Biotechnology Unit, University of Ribeirão Preto-UNAERP, Av. Costábile Romano 2201, Ribeirão Preto 14960-900, SP, Brazil; (M.F.P.); (J.B.M.); (R.O.B.); (M.M.)
| | - Josie Budag Matsuda
- Biotechnology Unit, University of Ribeirão Preto-UNAERP, Av. Costábile Romano 2201, Ribeirão Preto 14960-900, SP, Brazil; (M.F.P.); (J.B.M.); (R.O.B.); (M.M.)
| | - Kamila Peroni
- National Institute of Science and Technology in Stem Cell and Cell Therapy, Center for Cell-Based Therapy, Ribeirão Preto 14051-140, SP, Brazil; (K.P.)
| | - Pablo Rodrigo Sanches
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (P.R.S.); (N.M.M.-R.)
| | - Wilson Araújo Silva
- National Institute of Science and Technology in Stem Cell and Cell Therapy, Center for Cell-Based Therapy, Ribeirão Preto 14051-140, SP, Brazil; (K.P.)
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (P.R.S.); (N.M.M.-R.)
- Center for Integrative System Biology-CISBi-NAP/USP, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil
- Center for Medical Genomics, University Hospital of the Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14015-010, SP, Brazil
| | - Rene Oliveira Beleboni
- Biotechnology Unit, University of Ribeirão Preto-UNAERP, Av. Costábile Romano 2201, Ribeirão Preto 14960-900, SP, Brazil; (M.F.P.); (J.B.M.); (R.O.B.); (M.M.)
| | - Nilce Maria Martinez-Rossi
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14049-900, SP, Brazil; (P.R.S.); (N.M.M.-R.)
| | - Mozart Marins
- Biotechnology Unit, University of Ribeirão Preto-UNAERP, Av. Costábile Romano 2201, Ribeirão Preto 14960-900, SP, Brazil; (M.F.P.); (J.B.M.); (R.O.B.); (M.M.)
| | - Ana Lúcia Fachin
- Biotechnology Unit, University of Ribeirão Preto-UNAERP, Av. Costábile Romano 2201, Ribeirão Preto 14960-900, SP, Brazil; (M.F.P.); (J.B.M.); (R.O.B.); (M.M.)
- Correspondence: or ; Fax: +55-16-36037030
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12
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Hossain ASMMA, Sil BC, Iliopoulos F, Lever R, Hadgraft J, Lane ME. Preparation, Characterisation, and Topical Delivery of Terbinafine. Pharmaceutics 2019; 11:pharmaceutics11100548. [PMID: 31652587 PMCID: PMC6835747 DOI: 10.3390/pharmaceutics11100548] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022] Open
Abstract
Terbinafine (TBF) is commonly used in the management of fungal infections of the skin because of its broad spectrum of activity. Currently, formulations containing the free base and salt form are available. However, there is only limited information in the literature about the physicochemical properties of this drug and its uptake by the skin. In this work, we conducted a comprehensive characterisation of TBF, and we also examined its percutaneous absorption in vitro in porcine skin. TBF-free base was synthesised from the hydrochloride salt by a simple proton displacement reaction. Both the free base and salt form were further analysed using Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA). Delivery of TBF-free base in excised porcine skin was investigated from the following solvents: Isopropyl myristate (IPM), propylene glycol monolaurate (PGML), Transcutol® (TC), propylene glycol (PG), polyethylene glycol 200 (PEG 200), oleic acid (OL), ethanol (EtOH), and isopropyl alcohol (IPA). Permeation and mass balance studies confirmed that PG and TC were the most efficacious vehicles, delivering higher amounts of TBF-free base to the skin compared with a commercial gel (p < 0.05). These preliminary results are promising and will inform the development of more complex formulations in future work.
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Affiliation(s)
- A S M Monjur Al Hossain
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Dhaka, Dhaka-1000, Bangladesh.
| | - Bruno C Sil
- Department of Pharmaceutical Science and Pharmacology, London Metropolitan University, 166-220 Holloway Road, London N7 8DB, UK.
| | - Fotis Iliopoulos
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Rebecca Lever
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Jonathan Hadgraft
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
| | - Majella E Lane
- UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
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Dogra S, Shaw D, Rudramurthy SM. Antifungal Drug Susceptibility Testing of Dermatophytes: Laboratory Findings to Clinical Implications. Indian Dermatol Online J 2019; 10:225-233. [PMID: 31149563 PMCID: PMC6536077 DOI: 10.4103/idoj.idoj_146_19] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sunil Dogra
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipika Shaw
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
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14
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Gaziano R, Campione E, Iacovelli F, Marino D, Pica F, Di Francesco P, Aquaro S, Menichini F, Falconi M, Bianchi L. Antifungal activity of Cardiospermum halicacabum L. (Sapindaceae) against Trichophyton rubrum occurs through molecular interaction with fungal Hsp90. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:2185-2193. [PMID: 30034223 PMCID: PMC6047602 DOI: 10.2147/dddt.s155610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Dermatophytosis is a superficial fungal infection limited to the stratum corneum of the epidermis, or to the hair and nails, and constitutes an important public health problem because of its high prevalence and associated morbidity. Dermatophyte fungi, especially 2 species, Trichophyton rubrum and Trichophyton mentagrophytes, are the predominant pathogens. Topical antifungal drugs, mainly azoles or allyamines, are currently used for the treatment of dermatophytoses, although in some cases, such as in nail and hair involvement, systemic treatment is required. However, therapeutic efficacy of current antifungal agents can be limited by their side effects, costs, and the emergence of drug resistance among fungi. Plant extracts represent a potential source of active antimicrobial agents, due to the presence of a variety of chemical bioactive compounds. In the present work, we evaluated in silico and in vitro the antifungal activity of an extract of the medicinal plant Cardiospermum halicacabum against T. rubrum suggesting a potential interaction with Hsp90 as playing an important role in both pathogenicity and drug susceptibility of T. rubrum. Methods We investigated in vitro the effect of different concentrations of C. halicacabum (from 500 to 31.25 µg) against a clinical isolate of T. rubrum. Furthermore, using a computational assessment, the interaction between different C. halicacabum active compounds and the fungal Hsp90 was also investigated. Results Our results indicate a clear-cut antifungal activity of the total plant extract at the highest concentrations (500 and 250 µg). Among all tested C. halicacabum compounds, the luteolin and rutin molecules have been identified in silico as the most important potential inhibitors of Hsp90. Based on these data, luteolin and rutin were also individually assessed for their antifungal activity. Results demonstrate that both substances display an antifungal effect, even if lower than that of the total plant extract. Conclusion Our data indicate a strong fungistatic effect of C. halicacabum against T. rubrum, suggesting its potential therapeutic efficacy in the treatment of dermatophytoses. Additionally, C. halicacabum compounds, and particularly luteolin and rutin, are all possible Hsp90 interactors, explaining their fungistatic activity.
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Affiliation(s)
- Roberta Gaziano
- Microbiology Section, Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Elena Campione
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy,
| | | | - Daniele Marino
- Microbiology Section, Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Francesca Pica
- Microbiology Section, Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Paolo Di Francesco
- Microbiology Section, Department of Experimental Medicine and Surgery, University of Rome 'Tor Vergata', Rome, Italy
| | - Stefano Aquaro
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Francesco Menichini
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Mattia Falconi
- Department of Biology, University of Rome 'Tor Vergata', Rome, Italy,
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome 'Tor Vergata', Rome, Italy,
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15
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Ayrapetyan M, Googe PB, Jolly P, Levinson K, Popowitch E, Lachiewicz AM. A 61-year-old man with erythematous forearm papules three months after liver transplantation. Transpl Infect Dis 2018; 20:e12869. [PMID: 29512247 DOI: 10.1111/tid.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/20/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022]
Abstract
A 61-year-old Caucasian man presented with papules on his left forearm and hand three months after liver transplantation: images from physical exam, pathology, and microbiology are presented. Skin biopsy confirmed the presence of fungal elements within the hair shaft, which is consistent with Majocchi granuloma, also known as nodular granulomatous perifolliculitis. A combination of fungal culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient recovered with appropriate systemic antifungal therapy.
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Affiliation(s)
- Mesrop Ayrapetyan
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Paul B Googe
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Dermatology, The University of North Carolina, Chapel Hill, NC, USA
| | - Puneet Jolly
- Department of Dermatology, The University of North Carolina, Chapel Hill, NC, USA
| | - Kara Levinson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elena Popowitch
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anne M Lachiewicz
- Division of Infectious Diseases, The University of North Carolina, Chapel Hill, NC, USA
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Sardana K, Gupta A. Rational for Drug Dosimetry and Duration of Terbinafine in the Context of Recalcitrant Dermatophytosis: Is 500 mg Better than 250 mg OD or BD? Indian J Dermatol 2017; 62:665-667. [PMID: 29263545 PMCID: PMC5724319 DOI: 10.4103/ijd.ijd_435_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kabir Sardana
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital, New Delhi, India. E-mail:
| | - Aastha Gupta
- Department of Dermatology, Dr. Ram Manohar Lohia Hospital, New Delhi, India. E-mail:
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17
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Babu PR, Pravin AJS, Deshmukh G, Dhoot D, Samant A, Kotak B. Efficacy and Safety of Terbinafine 500 mg Once Daily in Patients with Dermatophytosis. Indian J Dermatol 2017; 62:395-399. [PMID: 28794551 PMCID: PMC5527721 DOI: 10.4103/ijd.ijd_191_17] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: Dermatophytosis are the most common fungal infections globally. Terbinafine is considered to have good potency against dermatophytes, but resistance to terbinafine is on the rise. Objective: The objective of this study was to evaluate the efficacy and safety of terbinafine 500 mg given once daily in treatment of patients with superficial dermatophytosis. Materials and Methods: It was a retrospective questionnaire-based survey. Each doctor was given survey questionnaire booklet containing survey forms. Clinical response was graded according to the improvement in the affected lesion. Mycological cure was defined as negative microscopy under potassium hydroxide examination and a negative culture in Sabouraud's dextrose agar. Patients were divided into three groups depending on the duration of therapy, Group A – terbinafine 500 mg for 2 weeks, Group B – terbinafine 500 mg for 4 weeks, and Group C – terbinafine 500 mg for 6 weeks. Results: Total 50 doctors completed the survey involving 440 patients. In Group A, out of 194 patients, 87% (n = 169) patients showed very good response. In Group B, out of 211 patients, 92% (n = 194) of the patients showed very good response with >75% improvement in their lesion. In Group C, out of 35 patients, 80% (n = 30) patients showed very good response. Adverse drug reactions of mild to moderate intensity related to terbinafine were seen in 57 patients. Conclusion: Our survey indicates that terbinafine in a dose of 500 mg given once daily was efficacious and safe in the treatment of patients with dermatophytosis.
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Affiliation(s)
- P Ravindra Babu
- Consultant Dermatologist, Raga Skin Care, Bengaluru, Karnataka, India
| | - A J S Pravin
- Department of Dermatology and Venerology, Kanyakumari Government Medical College, Nagercoil, Tamil Nadu, India
| | - Gaurav Deshmukh
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Dhiraj Dhoot
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Aniket Samant
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
| | - Bhavesh Kotak
- Medical Services Glenmark Pharmaceuticals, Mumbai, Maharashtra, India
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18
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Chandra F. Kerion Type of Tinea Capitis Treated with Double Pulse Dose Terbinafine. INDONESIAN JOURNAL OF TROPICAL AND INFECTIOUS DISEASE 2016. [DOI: 10.20473/ijtid.v6i2.1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: Tinea capitis is a common dermatophyte infection affecting hair and skin which always requires systemic treatment to get a clinical and mycologic cure, preventing relapse, and infection spread. Griseofulvin has been the antifungal therapy of choice for tinea capitis, but it often requires higher doses and a longer duration than recommended. Thus, effective alternative antifungal with good oral tolerability and shorter course of treatment are therefore required. The objective of this report is to evaluate the effectiveness of double pulse dose terbinafine for tinea capitis alternative therapy.Method: A case of kerion type of tinea capitis in a two-year-old girl was reported. Diagnosis was established based on clinical manifestations of alopecia, presented as erythematous macule with pustules, hemorrhagic crusts, and scales on the scalp, accompanied with occipital lymphadenopathy. Fungal culture showed growth of Microsporum canis (M. canis) colonies. Patient was treated with doubled pulse dose terbinafine 125 mg/day and 2% ketoconazole shampoo for two months.Result: Clinical improvements were found on 35th day of follow up, while mycologic cure was achieved on 60th day of follow up. Tolerability was excellent and no side effects observed.Conclusion: Double pulse dose terbinafine is effective for kerion type of tinea capitis. Key words: double pulse dose, kerion, M. canis, terbinafine, tinea capitis
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19
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Majid I, Sheikh G, Kanth F, Hakak R. Relapse after Oral Terbinafine Therapy in Dermatophytosis: A Clinical and Mycological Study. Indian J Dermatol 2016; 61:529-33. [PMID: 27688443 PMCID: PMC5029239 DOI: 10.4103/0019-5154.190120] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The incidence of recurrent tinea infections after oral terbinafine therapy is on the rise. Aim: This study aims to identify the appearance of incomplete cure and relapse after 2-week oral terbinafine therapy in tinea corporis and/or tinea cruris. Materials and Methods: A total of 100 consecutive patients clinically and mycologically diagnosed to have tinea corporis and/or tinea cruris were included in the study. The enrolled patients were administered oral terbinafine 250 mg once daily for 2 weeks. All clinically cured patients were then followed up for 12 weeks to look for any relapse/cure. Results: The common dermatophytes grown on culture were Trichophyton rubrum and Trichophyton tonsurans in 55% and 20% patients, respectively. At the end of 2-week oral terbinafine therapy, 30% patients showed a persistent disease on clinical examination while 35% patients showed a persistent positive fungal culture (persisters) at this time. These culture positive patients included all the clinically positive cases. Rest of the patients (65/100) demonstrated both clinical and mycological cure at this time (cured). Over the 12-week follow-up, clinical relapse was seen in 22 more patients (relapse) among those who had shown clinical and mycological cure at the end of terbinafine therapy. Thus, only 43% patients could achieve a long-term clinical and mycological cure after 2 weeks of oral terbinafine treatment. Majority of the relapses (16/22) were seen after 8 weeks of completion of treatment. There was no statistically significant difference in the body surface area involvement or the causative organism involved between the cured, persister, or relapse groups. Conclusions: Incomplete mycological cure as well as relapse is very common after standard (2-week) terbinafine therapy in our patients of tinea cruris/corporis.
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Affiliation(s)
- Imran Majid
- Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Gousia Sheikh
- Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Farhath Kanth
- Department of Dermatology, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rubeena Hakak
- Department of Microbiology, Government Medical College, Srinagar, Jammu and Kashmir, India
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Iizhar SA, Syed IA, Satar R, Ansari SA. In vitro assessment of pharmaceutical potential of ethosomes entrapped with terbinafine hydrochloride. J Adv Res 2016; 7:453-61. [PMID: 27222750 DOI: 10.1016/j.jare.2016.03.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/29/2022] Open
Abstract
The present study investigates the entrapment of terbinafine hydrochloride (TH) in ethosomal vesicles via unsonicated and sonication method. Carbopol 934P was incorporated in the best formulation, F6, obtained by sonication method. The formulated ethosomal gel obtained as such i.e. F6(∗) was exploited to achieve a zero order release profile of TH. The composition includes phospholipid, ethanol and propylene glycol. Drug entrapment efficiency (DEE), in-vitro and ex-vivo drug diffusion studies, FT-IR and stability studies of the prepared ethosomes were investigated. The size and shape of F6 ethosomes vesicles were characterized by SEM. In-vitro drug release studies were performed using sigma dialysis membrane in phosphate buffer, pH 7.4 for 12 h while drug content was determined by HPLC. DEE was ranked from 55.33 ± 1.32% to 69.11 ± 2.11%. Highest DEE was seen with F6 ethosomal formulation with a vesicle size of 248 ± 1.02 nm. FT-IR studies confirmed that there was no chemical interaction between drug and excipients used in the formulation. Ex-vivo result suggested that drug diffusion observed after 12 h from F6(∗) and marketed cream (MR) formulations was 74.01 ± 0.62% and 61.45 ± 0.86%, respectively. The results of similarity factor (f 2 values) for MR and F6(∗) ethosomal gel were 85.14 and 42.63, respectively. It revealed that F6(∗) showed dissimilar dissolution profiles. Transdermal flux value for F6(∗) and MR was found to be 144.61 ± 1.28 μg/cm(2)/h and 121.6 ± 1.16 μg/cm(2)/h, respectively. This study disclosed that F6(∗) resides at targeted site for a relatively longer period of time thereby signifying the improved patient compliance.
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Affiliation(s)
- Syed Ahmed Iizhar
- Department of Pharmaceutical Sciences, Ibn Sina National College of Medical Studies, Jeddah 21418, Saudi Arabia
| | - Ismail Ahmed Syed
- Department of Basic Sciences, Ibn Sina National College of Medical Studies, Jeddah 21418, Saudi Arabia
| | - Rukhsana Satar
- Department of Biochemistry, Ibn Sina National College of Medical Studies, Jeddah 21418, Saudi Arabia
| | - Shakeel Ahmed Ansari
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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