Fungicidal Activity Plus Reservoir Effect Allow Short Treatment Courses with Terbinafine in Tinea pedis

Abstract

Terbinafine, a synthetic allylamine, exerts fungicidal activity against dermatophytes, the causative pathogens of tinea pedis. As proven in numerous clinical trials, tinea pedis can be effectively and safely treated by topical terbinafine. In fact, a 1-week application of terbinafine 1% cream eradicated fungal pathogens at least as effectively as 4-week treatment courses with topical azole derivative antifungals and showed lower relapse rates. A new innovative single-application formulation of terbinafine 1% in a film-forming solution produces a high concentration gradient on the skin surface and enables a prolonged (up to 13 days) exposure of the skin to terbinafine. High drug penetration into the skin results in an otherwise not obtained drug reservoir in the horny layer, the location of dermatophytes in tinea pedis. Although azole antimycotics can also effectively penetrate into the horny layer of the skin, short-term therapy might not be feasible due to its primarily fungistatic activity against dermatophytes. Thus, we conclude that the high efficacy of short-term treatment with terbinafine in patients with tinea pedis is possible due to its fungicidal activity coupled with a distinct reservoir formation in the upper layers of the epidermis.

Treatment of Tinea Capitis

“…It is metabolized by the liver primarily through N-demethylation enzymes. More than 15 metabolites have been identified and none of them have demonstrated antifungal activity [34]. Terbinafine is an inhibitor of the CYP2D6 and has minimal drug interactions that are clinically limited to cimetidine and rifampin [27].…”

Efficacy and tolerability of topical sertaconazole versus topical terbinafine in localized dermatophytosis: A randomized, observer-blind, parallel group study

“…[6] On the other hand, the allylamines (e.g., terbinafine, naftifine) are fungicidal. [7] The available topical formulation of terbinafine (1%) forms a reservoir in the upper epidermal layers which enable just once-daily application. [7] Available literature indicates that superior cure rates and better compliance observed with terbinafine are attributable to its fungicidal action and the convenience of once-daily application.…”

Comparable Efficacy of Terbinafine and Itraconazole in the Treatment of Tinea Pedis

“…There are several forms of tinea pedis such as papulosquamous, hyperkeratotic, intertriginous, vesico-bullous, mixed type etc. 1,3 In this study, we have taken papulosquamous type, intertriginous type, hyperkeratotic type and mixed type in both the group A and B. Group-A was given terbinafine 250 mg daily and intraconazole 200 mg 77 daily in group-B for 2 weeks. Terbinafine is a synthetic allaylamine, inhibits ergosterol synthesis by inhibiting squalene epoxidase.…”