Successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole

Ardeshna, Kenit P; Rohatgi, Shaurya; Jerajani, Hemangi

doi:10.4103/0378-6323.183632

Cited by 18 publications

(15 citation statements)

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“…15,29,30 Itraconazole is a triazole antifungal drug which is also increasingly being used as a first-line drug for dermatophytosis, but it is being given for longer periods as compared to before. 6,18 Though combination therapy is widely practised in India, no much of the literature is available regarding the effectiveness of the combination therapy. Only one study is available indicating efficacy of combination therapy.…”

Section: Discussionmentioning

confidence: 99%

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Comparative evaluation of efficacy and safety of terbinafine and itraconazole in the management of tinea corporis et cruris

Dhoot¹,

Shah²,

Shah³

et al. 2020

IJCED

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The management of dermatophytosis is challenging in India and there are reports of using systemic antifungals at higher doses. But there are multiple reports of increased treatment failures with terbinafine at standard dosage as well, hence we conducted this study to compare efficacy and safety of high dose of terbinafine with itraconazole at standard dose. Topical ciclopirox olamine was used in both arms.This was randomized, open label, comparative study where 80 patients with tinea corporis et cruris infection were included. Patients were either prescribed terbinafine 250mg twice a day or itraconazole 100mg twice a day for 4 weeks. Efficacy was assessed based on complete, clinical and mycological cure rate. Safety was assessed by evaluating adverse events and monitoring liver function of patients.Total 76 patients completed the study with 38 in each group. 81.5% patients achieved complete cure in terbinafine group compared to 76.31% patients in itraconazole group. At the end of six weeks, there was a statistically significant improvement (p value<0.05) in the total symptom score (erythema, scaling, and pruritus) in Group I as well as in Group II compared to baseline. None of the patients showed any significant side effect in both Itraconazole and Terbinafine groups. No changes in liver function were observed in both the groups. This study shows that the high dose of terbinafine in combination with topical ciclopirox is effective and safe in management of tinea corporis et cruris.

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Section: Discussionmentioning

confidence: 99%

“…16,17 But due to frequent relapses at short intervals, some physicians in India have used it in doses of 200 mg once a day for prolonged periods. 7,18 High dose of itraconazole may not be beneficial due to non-linear pharmacokinetic property. 10 Ciclopirox Olamine (CPO), a hydroxypyridone derivative has been recently approved in India.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of efficacy and safety of terbinafine and itraconazole in the management of tinea corporis et cruris

Dhoot¹,

Shah²,

Shah³

et al. 2020

IJCED

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show abstract

“…Itraconazole is a triazole antifungal drug which is also increasingly being used as a first-line drug for tinea corporis and tinea cruris, but it is being given for longer periods as compared to before. [1112]…”

Section: Discussionmentioning

confidence: 99%

“…[910] Because of frequent relapses at short intervals, some physicians have used it in doses of 200 mg once a day for prolonged periods. [1112]…”

Section: Introductionmentioning

confidence: 99%

Efficacy of oral terbinafine versus itraconazole in treatment of dermatophytic infection of skin – A prospective, randomized comparative study

et al. 2019

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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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“…Recently, a combination of oral itraconazole with oral isotretinoin was reported to successfully treat recurrent dermatophytosis in a patient. [ 6 ] It was proposed that retinoids lead to increased desquamation of normal epidermis resulting in rapid sloughing off of keratinocytes and removal of fungal spores, thereby decreasing the fungal load. [ 6 ] In this randomized clinical trial, we evaluated if adding oral isotretinoin confers an added benefit over oral terbinafine alone in the treatment of recurrent dermatophytosis.…”

Section: Introductionmentioning

confidence: 99%

Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis

Verma

Senthilnathan

Bhatia

et al. 2021

Indian Dermatology Online Journal

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Background: Recurrent dermatophytosis is becoming arduous to treat. Recently, oral itraconazole with oral isotretinoin was successful in a patient suffering from recurrent dermatophytosis. Objectives: To evaluate if oral isotretinoin confers any added benefit over oral terbinafine in the treatment of recurrent dermatophytosis. Materials and Methods: This was an open-label randomized clinical trial including 100 adult patients with recurrent tinea cruris and/or tinea corporis randomized into two groups; Group A (oral isotretinoin 0.5 mg/kg/day and oral terbinafine 250 mg twice daily) and Group B (oral terbinafine 250 mg twice daily) for 4 weeks, and followed up for 3 months. Fungal culture and antifungal susceptibility testing against terbinafine, fluconazole, amphotericin B, itraconazole, and griseofulvin were performed. Results: Out of the 100 patients, 91 patients (44 in Group A and 47 in Group B) completed the trial. Complete cure was seen in 19/44 (43.18%) patients in Group A and 20/47 (42.55%) patients in Group B ( P = 0.951). Recurrence occurred in 12/19 (63.1%) patients in Group A and 13/20 (65%) patients in Group B ( P = 0.904). Cheilitis and dryness of lips were the most common adverse effects seen in 32/44 (72.73%) patients in Group A. A total of 50 cultures were grown. The commonest species isolated was Trichophyton interdigitale in 36 (72%) patients, having a mean minimum inhibitory concentration of 3.13 μg/mL for terbinafine. However, for itraconazole, it was 0.13 μg/mL, and varied minimum inhibitory concentration (MIC) values were seen for fluconazole, griseofulvin, and amphotericin B. Conclusion: The addition of isotretinoin to terbinafine has no added benefit in treating patients with recurrent dermatophytosis.

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Successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole

Cited by 18 publications

References 0 publications

Comparative evaluation of efficacy and safety of terbinafine and itraconazole in the management of tinea corporis et cruris

Comparative evaluation of efficacy and safety of terbinafine and itraconazole in the management of tinea corporis et cruris

Efficacy of oral terbinafine versus itraconazole in treatment of dermatophytic infection of skin – A prospective, randomized comparative study

Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis

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