Treatment of chromoblastomycosis with terbinafine: Experience with four cases

Abstract

Terbinafine at 500 mg/day doses represents one of the best treatments for chromoblastomycosis due to its efficacy and excellent tolerability.

Chromoblastomycosis: clinical presentation and management

“…14,15 The antifungals that have shown greatest efficacy are itraconazole (200-400 mg daily) and terbinafine (500-1000 mg daily) given for at least 6-12 months, preferably at the higher doses if tolerated. 6,[16][17][18][19] Both drugs have shown high in vitro activity against the causative agents of chromoblastomycosis. 20,21 Pulse itraconazole (400 mg daily for 1 week every month) has been shown to be as effective as the conventional daily regimen, reducing the total drug dosage required and possibly increasing compliance.…”

Chromoblastomycosis Caused byPhialophora richardsiae

“…It is important to know the clinical type of chromoblastomycosis in order to offer a more accurate prognosis for the patient presenting with this difficult-totreat disease 9,19 . Despite many reports showing different clinical types with diverse cure rates, there is no study showing a correlation between a specific clinical type and the cure of chromoblastomycosis [17][18][19] .…”

“…However, in some cases, monotherapy has been ineffective or is associated with a less than acceptable response; there have also been reports on the development of resistance to itraconazole 17,18 . To achieve a good response rapidly and prevent microbiologic resistance, combination therapy with itraconazole and terbinafine may be effective during the early stages of treatment because of the synergistic effect 6,17,18 . In our case, itraconazole monotherapy did not result in a clinical response; however, after administration of terbinafine in combination with itraconazole, the skin lesion was markedly improved.…”

“…Due to the marked chronicity of the lesions and the well-known resistance of many cases to simple therapies, it is difficult to treat chromoblastomycosis 17,18 . The preferred treatment is usually surgical excision of small and localized lesions with wide surgical margins to prevent local recurrence.…”

“…The preferred treatment is usually surgical excision of small and localized lesions with wide surgical margins to prevent local recurrence. For deep or extensive cutaneous involvement however, surgical treatment is often not feasible 6,18 . Prolonged treatment with systemic antifungal agents alone or in combination for deep or extensive lesions provides the best chance of a cure, but antifungal therapy for Phialophora infections has been generally disappointing 8,9,12 .…”