Evaluation of treatment of tinea corporis and tinea cruris with oral terbinafine using direct microscopic examination with special stains

Abstract

Terbinafine is a fungicidal allylamine drug and was considered a drug of choice to treat dermatophyte infection. However recently there was an increase in the incidence of clinical failure and relapses with terbinafine. Aims and Objectives: This study was undertaken to assess the effectiveness and safety of oral terbinafine 250 mg given in patients suffering from tinea cruris and tinea corporis for 6 weeks. Materials and Method: In a prospective, open-label randomized controlled comparative trial 40 patients suffering from tinea cruris and tinea corporis were recruited. Only patients with tinea cruris and tinea corporis, confirmed through positive microscopy before the start of treatment were eligible for inclusion in the trial. The patients were distributed into two groups and randomly allocated into group A and group B of 20 patients each. Both groups received the same treatment i.e., oral Terbinafine 250mg once daily for 6 weeks. Patients of both groups were followed up at weeks 2, 4, 6 during treatment and at the end of 8 weeks. Mycological control test for group A and group B patients were done by KOH mount at baseline and each visit. Patients of group B underwent mycological control testing in the form of KOH mount with the concurrent use of DMSO and CSB at baseline and each visit. By the end of treatment clinical and mycological cure were evaluated. Results: In group A (mycological testing with only KOH was done), fungal elements were detected in 100%, 40%, 20%, 0% and 0% of baseline patients, 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. In group B (mycological testing with KOH and DMSO+CSB was done), fungal elements were detected in 100%, 75%, 50%, 10% and 15% of baseline patients, 2 weeks, 4 weeks, 6 weeks and 8 weeks respectively. Even after 2 weeks of completion of oral terbinafine 250 mg for 6 weeks,the clinical cure was not seen in 40% and 35% patients in groupA and group B. Conclusion: Although mycological cure was achieved in more than 90% of patients in group A and group B after 8 weeks clinical cure was achieved in only 60% and 65 % patients in group A and group B respectively. Implying that we need to continue oral terbinafine for a longer period to achieve mycological as well as a clinical cure.