Short-duration therapy with terbinafine 1% cream in dermatophyte skin infections

Summary In a multicentre, double-blind, parallel-group study, the efficacy and safety of a single application of terbinafine 1% cream was compared with 3, 5 and 7 days' once-daily therapy in the treatment of tinea pedis and tinea corporis/cruris.
Seventy-eight patients with tinea pedis (58 male, 20 female; mean age 36, range 19–80) and 21 patients with tinea corporis or tinea cruris (16 male, 5 female; mean age 37, range 22–72), presenting in general practice, were entered into the study. Of these, 65 patients with tinea pedis and 14 with tinea corporis or cruris completed the study and were evaluable.
Twenty-eight days after commencing therapy 78, 83, 82 and 83% of patients with tinea pedis in the 1-, 3-, 5-, and 7-day treatment groups, respectively, were mycologically cured, and 61, 78, 71 and 67%, respectively, were 'effectively treated'. There was no statistically significant difference between treatment groups. Similarly high cure rates were seen in patients with tinea corporis and tinea cruris. Three months after commencing therapy there was little evidence of relapse.
The study shows that there is a significant potential for short-duration therapy with terbinafine 1% cream in tinea infections of the skin, emphasized here by the high cure rates obtained following a single application.     

皮肤癣菌感染的治疗进展

 皮肤癣菌是人类皮肤真菌感染中最常见的病原体,其引起的皮肤感染称为皮肤癣菌病。目前,医药市场上控制皮肤癣菌感染的抗真菌药物数量有限,而部分皮肤癣菌可能表现出对这些药物的耐药性或抗性,使得皮肤癣菌感染迁延难愈。本文综述皮肤癣菌感染的药物治疗和物理治疗方面的新进展。     

皮肤癣菌感染和变态反应性疾病的相关性研究进展

变态反应性疾病是常见病,病因复杂,皮肤癣菌是重要的致病真菌,也是常见的致敏原.近年陆续有个案报道,合并皮肤癣菌感染的变态反应性疾病抗真菌治疗有效.研究者发现,两者之间有密切联系,同时认为暴露于癣菌素抗原,可产生IgE抗体,在易感染个体中可引起过敏症状.概述皮肤癣菌致敏机制、皮肤癣菌抗原、合并皮肤癣菌病的变态反应性疾病治疗等方面以及两者相关性的研究,为部分变态反应性疾病病因学、发病机制及治疗方法提供新思路.     

Survey of dermatophyte infections in the Lausanne area Switzerland

BACKGROUND: The dermatophytes are important in the Swiss medical environment since 5-10% of consultations in dermatology concern mycotic infections. OBJECTIVE: To obtain information about the prevailing species of dermatophytes in the south-west of Switzerland and their pattern of infection. METHODS: An analysis was made of the dermatophytes isolated in the Department of Dermatology at the University Hospital of Lausanne and from samples collected in private practices of Switzerland during an 8-year period (1993-2000). The total number of samples sent for mycological analysis was 33,725. RESULTS: 4,193 cultures revealed a dermatophyte. Trichophyton rubrum was the most frequently isolated species accounting for 62.5% of the strains followed by T. mentagrophytes (24.5%) and Microsporum canis (5.0%). Less frequent isolates included Epidermophyton floccosum, M. langeroni, M. gypseum, T. soudanense, T. violaceum, T. verrucosum, T. gourvili and T. tonsurans. Analysis of the localisation of the isolated fungi confirms that the dermatophyte species have a predilection for certain body areas. CONCLUSIONS: The relative frequencies of isolation of the dermatophyte species partially depending of the record of the different tinea vary from one country to another. Our study reveals the importance of T. rubrum and the appreciable frequency of M. canis in the Swiss autochthonous population and the apparition of new species with immigrants.     

The prevalence of dermatophyte infections in hereditary palmo-plantar keratoderma

The prevalence of dermatophyte infections in hereditary palmo-plantar keratoderma of the Unna Thost variety was investigated. Sixty patients, who represented 7.5% of a well defined population, participated in the study. The prevalence was found to be about 40%. At the same time the correlation between direct microscopic examination and conventional culture methods was shown to be 88.5%.     

The immunofluorescence staining of fungi in chronic dermatophyte infections

Indirect immunofluorescence staining of fungi with specific antisera was demonstrated in biopsy specimens taken from six patients with chronic Trichophyton rubrum infections. However, there was no evidence of immunoglobulin or C₃ deposition in the vicinity of the organisms or elsewhere in the sections. Circulating antibodies to dermatophyte fungi are often not demonstrable in these patients. However, these results suggest that antibody affinity for epithelium docs not account for their absence in patients' serum.     

Some epidemiological aspects of dermatophyte infections in Southwest Iran

Distribution and prevalence of various species of dermatophytes are not the same in different areas of the world. The aim of the present study was epidemiologic evaluation of dermatophytic infections in our area. A retrospective epidemiologic study was carried out and all patients with dermatophyte positive smears identified at the Referral Center of Southwest Iran located in the city of Ahvaz between March 2005 and March 2007 were investigated. Body was divided into nine areas and information on age, sex, dermatophyte species and clinical presentation were recorded. The study included 428 patients, 233 (54.43%) men and 195 (45.56%) women, most of them aged 20-29 (29.8%). Regarding the body area involved, the groin, trunk and hands were the most prevalent areas. Tinea cruris and tinea corporis were the most common clinical presentation in both men and women. Epidermophyton floccosum was the most frequently isolated dermatophyte (39.25%), followed by Trichophyton verrucosum (27.33%) and Trichophyton rubrum (8.41%). Epidemiologic characteristics of dermatophytic infections in southwest Iran in comparison with other areas of the world and even Iran have changed significantly. As many factors such as area, weather conditions, occupation, and environmental factors are implicated in dermatophytic infections, it seems that dermatophytic infections change epidemiologically from time to time even in different areas of a country such as Iran. Accordingly, we think that the reason for this phenomenon in our area may change related to seeking healthy behaviors and hygiene in southwest Iran. We propose to do additional and larger epidemiologic studies regarding these variables.     

Chronic dermatophyte infections II. Antibody and cell-mediated immune responses

In patients infected with Trichophyton rubrum the T lymphocyte responses (lymphocyte transformation) to trichophytin were reduced, compared with control subjects. The same levels were seen in patients with intractable chronic infection and those who responded well to treatment but the site of infection affected the immune response, lower levels being seen in patients with palmo-plantar infection than in those with groin infections. In infections caused by T. mentagrophytes by contrast, lymphocyte responses to specific antigens were significantly increased.     

Chronic dermatophyte infections. I. Clinical and mycological features

One hundred and six patients with chronic dermatophytosis unresponsive to griseofulvin were studied. Trichophyton rubrum was the causative organism in 93% of cases. Chronic dermatophyte infections caused by organisms other than T. rubrum occurred predominantly, but not exclusively, in patients with underlying diseases. Forty-nine percent of the patients had a personal or family history of atopy but other abnormalities included disorders of keratinization, collagen vascular disease and systemic steroid therapy. The commonest sites of infection were the palms and soles, as opposed to toe webs or groins in control patients with griseofulvin-responsive dermatophyte infections. A significant proportion of chronically infected patients had raised IgE levels. Only 11% of the chronically infected group showed delayed hypersensitivity responses to intradermal trichophytin but 58% showed immediate hypersensitivity responses to trichophytin as well as other fungal and non-fungal allergens.     

Treatment of chronic dermatophyte infections. The use of ketoconazole in griseofulvin treatment failures

Twenty-eight patients with chronic dermatophytosis who had failed to respond to griseofulvin were treated with ketoconazole for periods of up to 18 months. Seventy-two per cent of patients with unresponsive infections on the trunk, proximal limb or groins responded to therapy without early relapse in under 6 months. By contrast 82%, of patients with sole or toe nail infections either failed to respond to therapy or relapsed within 6 months of stopping the drug. There was no evidence that the initial minimum inhibitory concentration of the organism influenced the outcome or that drug resistance developed during treatment.     

Oral ketoconazole as an alternative to griseofulvin in recalcitrant dermatophyte infections and onychomycosis

In an open study 58 patients with chronic dermatophytosis mainly caused by Trichophyton rubrum and five patients with Tinea capitis were treated with ketoconazole. The indications were ineffectiveness of or side effects to griseofulvin. Response to treatment varied from 1 week in scalp infections to 11 weeks in toe-nail lesions. Dermatophytosis of hands and feet were cured in 25%, marked improvement observed in further 30%. Toe- and finger-nail infections were cured in 20% and 43%, respectively, and marked improvement seen in further 36% and 14%, respectively. All scalp infections were cured without relapse. Recurrence of infections before 6 months after treatment was seen in 55-60% of hand and foot lesions and 33-38% of finger and toe-nail infections. In a double-blind study 20 patients with onychomycosis caused by T. rubrum the efficacy of ketoconazole was compared to that of griseofulvin. Cure rates in the griseofulvin group were 25% for finger-nails and zero for toe-nails, while 50% and 57% experienced marked improvement. In the ketoconazole group, 25% of finger-nail infections were cured and 75% markedly improved, while the corresponding figures for toe-nails were 11% and 89%, respectively. Adverse reactions to ketoconazole were seen in 29 (46%) of the patients in the open study and in 2 (20%) in the double-blind study and comprised mainly minor complaints. Side effects caused discontinuation in 12 patients, in two of whom due to toxic hepatitis.