Terbinafine (250 mg/day): an effective and safe treatment of cutaneous sporotrichosis

Background  There are a few studies on the treatment of sporotrichosis. The standard drug used is itraconazole. However, the use of itraconazole is limited by its interaction with other drugs.
Objective  To evaluate the effectiveness and safety of 250 mg terbinafine for the treatment of cutaneous sporotrichosis in patients in whom itraconazole use is not possible.
Methods  We performed a descriptive study of cutaneous sporotrichosis cases treated with 250 mg terbinafine for which itraconazole was contraindicated or resulted in severe or moderate pharmacological interactions. Sporotrichosis was diagnosed based on the isolation of S. schenckii .
Results  Fifty patients seen between July 2005 and September 2007 were included. Forty-five (92%) patients reported contact with a sick cat and 47 (94%) presented comorbidities (high blood pressure: 64.0%; diabetes mellitus: 30.0%; dyslipidemia: 16.7%; depression: 10.0%; migraine: 2.1%; Parkinsonís disease: 2.1%; peptic ulcer disease: 2.1%; heart failure: 2.1%, and arrhythmia: 2.1%). All patients used some medication interacting with itraconazole (psycholeptics: 36.0%; antidiabetic agents: 28.0%; hypolipemiant agents: 18.0%; calcium-channel blockers: 16.0%; anticonvulsants: 8.0%; cardiotropic drugs: 6.3%; antacids: 6.3%, and antiparkinsonian agent: 2.1%). Most patients (96%) were cured within a mean period of 14 weeks. The drug was discontinued due to a skin rash in one patient. There were no cases of recurrence of the mycosis within a mean follow-up period of 37 weeks.
Conclusions  This study suggests that 250 mg/day terbinafine is an effective and well-tolerated alternative to drug therapy of cutaneous sporotrichosis in a population in which itraconazole use is not possible.