Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes

Mohammad Enamul Hoque; Suraiya Akhter; Wahida Rahman; Md. Mominul Hoque

doi:doi:10.11648/ijcd.20240701.11

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Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes

Mohammad Enamul Hoque^*, Suraiya Akhter, Wahida Rahman, Md. Mominul Hoque

Published in International Journal of Clinical Dermatology (Volume 7, Issue 1)

Received: 8 January 2024 Accepted: 24 January 2024 Published: 5 February 2024

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Abstract

Background: Dermatophytosis, a prevalent fungal infection, is instigated by species like Trichophyton, Epidermophyton and Microsporum. The current approach for treating dermatophytosis involves a blend of systemic and topical antifungal therapies, applicable to all patients except those with localized, untreated Tinea. Notably, there is a growing incidence of inadequate response to the standard treatment regimen in recent times. Objective: To evaluate the efficacy and safety of combination treatment of oral terbinafine and itraconazole in patients with extensive superficial dermatophytes. Materials and Methods: This research comprised a randomized clinical trial involving 50 individuals diagnosed with extensive superficial dermatophytosis. Study conducted at the Department of Dermatology and Venereology, Combined Military Hospital Cumilla, the study spanned from July 2022 to June 2023. During the six-week duration, patients underwent treatment with terbinafine and itraconazole, with follow-up examinations every two weeks, including relevant investigations. Evaluation of treatment outcomes occurred at both four and six weeks. Statistical analysis was performed using version 25 of the Statistical Package for the Social Sciences (SPSS). Results: This study shows the majority of the participants within the age range of 16-30 years (56.0%) and the average age of the participants is 31.74±11.77 years. In terms of gender, the majority are male (78.0%). The most prevalent diagnosis is Tinea corporis (68.0%), followed by Tinea cruris (36.0%), Tinea faciei (28.0%), and Tinea incognito (12.0%). The majority of participants (85.0%) have had the disease for 12 months or less. The most common sites are the trunk (35.0%), whole body (26.0%), and crural area (24.0%). The majority of participants experience severe itching (56.0%), followed by moderate itching (34.0%), and a smaller percentage report mild itching (10.0%). The majority of participants showed improvement, with percentages increasing from 66.0% after 2 weeks to 84.0% after 4 weeks. The percentage of cured individuals also increased over time, reaching a substantial 90.0% after 6 weeks. Conclusion: The amalgamation of terbinafine and itraconazole demonstrates a superior clinical cure rate compared to use of single systemic antifungals. However, the observed clinical cure rate percentage is lower when juxtaposed with findings from previous studies. Notably, none of the used combination of systemic antimycotic medication has displayed success against tinea infections previously treated with topical formulations containing steroids.

Published in	International Journal of Clinical Dermatology (Volume 7, Issue 1)
DOI	10.11648/ijcd.20240701.11
Page(s)	1-5
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Safety, Combination Treatment, Terbinafine, Itraconazole, Dermatophytes

References

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[3]	Hay R. Therapy of skin, hair and nail fungal infections. J. Fungi (Basel). 2018; 4(3): 99.
[4]	Rajabian A, Hosseinzadeh H. Dermatological effects of nigella sativa and its constituent, thymoquinone. In: Preedy VR, Watson RR, editors. Nuts and Seeds in Health and Disease Prevention. San Diego, CA: Elsevier; 2020. Pp. 329–55.
[5]	Dogra S, Uprety S. The menace of chronic and recurrent dermatophytosis in India: Is the problem deeper than we perceive? Indian Dermatol Online J. 2016; 7(2): 73-76.
[6]	Rengasamy M, Chellam J, Ganapati S. Systemic therapy of dermatophytosis: Practical and systematic approach. Clin Derm Rev. 2017; 1(3): 19-23.
[7]	Babu PR, Pravin A, Deshmukh G, Dhoot D, Samant A, Kotak B. Efficacy and safety of terbinafine 500 mg once daily in patients with dermatophytosis. Indian J Dermatol. 2017; 62(4): 395-399.
[8]	Dutta B, Rasul E, Boro B. Clinico-epidemiological study of tinea incognito with microbiological correlation. Indian J DermatolVenereolLeprol. 2017; 83(3): 326.
[9]	Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019; 80(4): 853-67.
[10]	Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Shear NH, Piguet V, et al. Tineacapitis in children: A systematic review of management. J EurAcadDermatolVenereol. 2018; 32(12): 2264-2274.
[11]	Kumar G, Saxena K, Koti VR. A comparative study on efficacy of oral terbinafine and itraconazole on dermatophytic infections. Int J Res Dermatol. 2022 Jul; 8(4): 381-387.
[12]	Shi TW, Zhang JA, Zhang XW, Yu HX, Tang YB, Yu JB. Combination treatment of oral terbinafine with topical terbinafine and 10% urea ointment in hyperkeratotic type tinea pedis. Mycoses. 2014; 57(9): 560-4.
[13]	Li RY, Wang AP, Xu JH, Xi LY, Fu MH, Zhu M, et al. Efficacy and safety of 1% terbinafinefilmforming solution in Chinese patients with tineapedis: A randomized, double-blind, placebocontrolled, multicenter, parallel-group study. Clin Drug Investig. 2014; 34(3): 223-30.
[14]	Sharma P, Bhalla M, Thami GP, Chander J. Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis. J Dermatolog Treat. 2020; 31(7): 749-753.
[15]	Newland JG, Abdel-Rahman SM. Update on terbinafine with a focus on dermatophytoses. ClinCosmetInvestigDermatol. 2009; 2: 49–63.
[16]	Majid I, Sheikh G, Kanth F, Hakak R. Relapse after oral terbinafine therapy in dermatophytosis: A clinical and mycological study. Indian J Dermatol. 2016; 61(5): 529–33.
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APA Style

Hoque, M. E., Akhter, S., Rahman, W., Hoque, M. M. (2024). Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. International Journal of Clinical Dermatology, 7(1), 1-5. https://doi.org/10.11648/ijcd.20240701.11

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ACS Style

Hoque, M. E.; Akhter, S.; Rahman, W.; Hoque, M. M. Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. Int. J. Clin. Dermatol. 2024, 7(1), 1-5. doi: 10.11648/ijcd.20240701.11

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AMA Style

Hoque ME, Akhter S, Rahman W, Hoque MM. Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. Int J Clin Dermatol. 2024;7(1):1-5. doi: 10.11648/ijcd.20240701.11

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@article{10.11648/ijcd.20240701.11,
  author = {Mohammad Enamul Hoque and Suraiya Akhter and Wahida Rahman and Md. Mominul Hoque},
  title = {Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes},
  journal = {International Journal of Clinical Dermatology},
  volume = {7},
  number = {1},
  pages = {1-5},
  doi = {10.11648/ijcd.20240701.11},
  url = {https://doi.org/10.11648/ijcd.20240701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.ijcd.20240701.11},
  abstract = {Background: Dermatophytosis, a prevalent fungal infection, is instigated by species like Trichophyton, Epidermophyton and Microsporum. The current approach for treating dermatophytosis involves a blend of systemic and topical antifungal therapies, applicable to all patients except those with localized, untreated Tinea. Notably, there is a growing incidence of inadequate response to the standard treatment regimen in recent times. Objective: To evaluate the efficacy and safety of combination treatment of oral terbinafine and itraconazole in patients with extensive superficial dermatophytes. Materials and Methods: This research comprised a randomized clinical trial involving 50 individuals diagnosed with extensive superficial dermatophytosis. Study conducted at the Department of Dermatology and Venereology, Combined Military Hospital Cumilla, the study spanned from July 2022 to June 2023. During the six-week duration, patients underwent treatment with terbinafine and itraconazole, with follow-up examinations every two weeks, including relevant investigations. Evaluation of treatment outcomes occurred at both four and six weeks. Statistical analysis was performed using version 25 of the Statistical Package for the Social Sciences (SPSS). Results: This study shows the majority of the participants within the age range of 16-30 years (56.0%) and the average age of the participants is 31.74±11.77 years. In terms of gender, the majority are male (78.0%). The most prevalent diagnosis is Tinea corporis (68.0%), followed by Tinea cruris (36.0%), Tinea faciei (28.0%), and Tinea incognito (12.0%). The majority of participants (85.0%) have had the disease for 12 months or less. The most common sites are the trunk (35.0%), whole body (26.0%), and crural area (24.0%). The majority of participants experience severe itching (56.0%), followed by moderate itching (34.0%), and a smaller percentage report mild itching (10.0%). The majority of participants showed improvement, with percentages increasing from 66.0% after 2 weeks to 84.0% after 4 weeks. The percentage of cured individuals also increased over time, reaching a substantial 90.0% after 6 weeks. Conclusion: The amalgamation of terbinafine and itraconazole demonstrates a superior clinical cure rate compared to use of single systemic antifungals. However, the observed clinical cure rate percentage is lower when juxtaposed with findings from previous studies. Notably, none of the used combination of systemic antimycotic medication has displayed success against tinea infections previously treated with topical formulations containing steroids.
},
 year = {2024}
}

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TY - JOUR
T1 - Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes
AU - Mohammad Enamul Hoque
AU - Suraiya Akhter
AU - Wahida Rahman
AU - Md. Mominul Hoque
Y1 - 2024/02/05
PY - 2024
N1 - https://doi.org/10.11648/ijcd.20240701.11
DO - 10.11648/ijcd.20240701.11
T2 - International Journal of Clinical Dermatology
JF - International Journal of Clinical Dermatology
JO - International Journal of Clinical Dermatology
SP - 1
EP - 5
PB - Science Publishing Group
SN - 2995-1305
UR - https://doi.org/10.11648/ijcd.20240701.11
AB - Background: Dermatophytosis, a prevalent fungal infection, is instigated by species like Trichophyton, Epidermophyton and Microsporum. The current approach for treating dermatophytosis involves a blend of systemic and topical antifungal therapies, applicable to all patients except those with localized, untreated Tinea. Notably, there is a growing incidence of inadequate response to the standard treatment regimen in recent times. Objective: To evaluate the efficacy and safety of combination treatment of oral terbinafine and itraconazole in patients with extensive superficial dermatophytes. Materials and Methods: This research comprised a randomized clinical trial involving 50 individuals diagnosed with extensive superficial dermatophytosis. Study conducted at the Department of Dermatology and Venereology, Combined Military Hospital Cumilla, the study spanned from July 2022 to June 2023. During the six-week duration, patients underwent treatment with terbinafine and itraconazole, with follow-up examinations every two weeks, including relevant investigations. Evaluation of treatment outcomes occurred at both four and six weeks. Statistical analysis was performed using version 25 of the Statistical Package for the Social Sciences (SPSS). Results: This study shows the majority of the participants within the age range of 16-30 years (56.0%) and the average age of the participants is 31.74±11.77 years. In terms of gender, the majority are male (78.0%). The most prevalent diagnosis is Tinea corporis (68.0%), followed by Tinea cruris (36.0%), Tinea faciei (28.0%), and Tinea incognito (12.0%). The majority of participants (85.0%) have had the disease for 12 months or less. The most common sites are the trunk (35.0%), whole body (26.0%), and crural area (24.0%). The majority of participants experience severe itching (56.0%), followed by moderate itching (34.0%), and a smaller percentage report mild itching (10.0%). The majority of participants showed improvement, with percentages increasing from 66.0% after 2 weeks to 84.0% after 4 weeks. The percentage of cured individuals also increased over time, reaching a substantial 90.0% after 6 weeks. Conclusion: The amalgamation of terbinafine and itraconazole demonstrates a superior clinical cure rate compared to use of single systemic antifungals. However, the observed clinical cure rate percentage is lower when juxtaposed with findings from previous studies. Notably, none of the used combination of systemic antimycotic medication has displayed success against tinea infections previously treated with topical formulations containing steroids.

VL - 7
IS - 1
ER -

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Author Information

Mohammad Enamul Hoque

Department of Dermatology and Venereology, Army Medical College Cumilla & CMH Cumilla, Cumilla, Bangladesh

Contact Email
Suraiya Akhter

Department of Pathology, Army Medical College Cumilla, Cumilla, Bangladesh
Wahida Rahman

Department of Pharmacology & Therapeutics, Army Medical College Cumilla, Cumilla, Bangladesh
Md. Mominul Hoque

Department of Agricultural Extension, Agro-meteorological Information System, Dhaka, Bangladesh

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Hoque, M. E., Akhter, S., Rahman, W., Hoque, M. M. (2024). Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. International Journal of Clinical Dermatology, 7(1), 1-5. https://doi.org/10.11648/ijcd.20240701.11

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ACS Style

Hoque, M. E.; Akhter, S.; Rahman, W.; Hoque, M. M. Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. Int. J. Clin. Dermatol. 2024, 7(1), 1-5. doi: 10.11648/ijcd.20240701.11

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AMA Style

Hoque ME, Akhter S, Rahman W, Hoque MM. Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes. Int J Clin Dermatol. 2024;7(1):1-5. doi: 10.11648/ijcd.20240701.11

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@article{10.11648/ijcd.20240701.11,
  author = {Mohammad Enamul Hoque and Suraiya Akhter and Wahida Rahman and Md. Mominul Hoque},
  title = {Efficacy and Safety of Combination Treatment of Oral Terbinafine and Itraconazole in Patients with Extensive Superficial Dermatophytes},
  journal = {International Journal of Clinical Dermatology},
  volume = {7},
  number = {1},
  pages = {1-5},
  doi = {10.11648/ijcd.20240701.11},
  url = {https://doi.org/10.11648/ijcd.20240701.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.ijcd.20240701.11},
  abstract = {Background: Dermatophytosis, a prevalent fungal infection, is instigated by species like Trichophyton, Epidermophyton and Microsporum. The current approach for treating dermatophytosis involves a blend of systemic and topical antifungal therapies, applicable to all patients except those with localized, untreated Tinea. Notably, there is a growing incidence of inadequate response to the standard treatment regimen in recent times. Objective: To evaluate the efficacy and safety of combination treatment of oral terbinafine and itraconazole in patients with extensive superficial dermatophytes. Materials and Methods: This research comprised a randomized clinical trial involving 50 individuals diagnosed with extensive superficial dermatophytosis. Study conducted at the Department of Dermatology and Venereology, Combined Military Hospital Cumilla, the study spanned from July 2022 to June 2023. During the six-week duration, patients underwent treatment with terbinafine and itraconazole, with follow-up examinations every two weeks, including relevant investigations. Evaluation of treatment outcomes occurred at both four and six weeks. Statistical analysis was performed using version 25 of the Statistical Package for the Social Sciences (SPSS). Results: This study shows the majority of the participants within the age range of 16-30 years (56.0%) and the average age of the participants is 31.74±11.77 years. In terms of gender, the majority are male (78.0%). The most prevalent diagnosis is Tinea corporis (68.0%), followed by Tinea cruris (36.0%), Tinea faciei (28.0%), and Tinea incognito (12.0%). The majority of participants (85.0%) have had the disease for 12 months or less. The most common sites are the trunk (35.0%), whole body (26.0%), and crural area (24.0%). The majority of participants experience severe itching (56.0%), followed by moderate itching (34.0%), and a smaller percentage report mild itching (10.0%). The majority of participants showed improvement, with percentages increasing from 66.0% after 2 weeks to 84.0% after 4 weeks. The percentage of cured individuals also increased over time, reaching a substantial 90.0% after 6 weeks. Conclusion: The amalgamation of terbinafine and itraconazole demonstrates a superior clinical cure rate compared to use of single systemic antifungals. However, the observed clinical cure rate percentage is lower when juxtaposed with findings from previous studies. Notably, none of the used combination of systemic antimycotic medication has displayed success against tinea infections previously treated with topical formulations containing steroids.
},
 year = {2024}
}

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VL - 7
IS - 1
ER -

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