Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature

Gupta, Aditya K.; Lynde,; Lauzon,; Mehlmauer,; Braddock,; Miller, '; Rosso, Del

doi:10.1046/j.1365-2133.1998.02140.x

Cited by 90 publications

(51 citation statements)

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“…As is well known, drugs used against dermatophytosis exhibit several side effects and have limited efficacy 37,38) and there is a real need for new molecules with antifungal properties for the treatment of superficial mycoses.…”

Section: )mentioning

confidence: 99%

Evaluation of Antifungal Activity of Piper solmsianum C. DC. var. solmsianum (Piperaceae)

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Silva

et al. 2005

Biological & Pharmaceutical Bulletin

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The incidence of opportunistic fungal infections in immunocompromised patients, such as those undergoing treatment with immunosuppressive drugs, intensive chemotherapy, AIDS patients and neonates, is increasing at an alarming rate. 1,2) These mycoses are very difficult to eradicate, and present an enormous challenge for healthcare providers. 3,4) The diversity of plant species in Brazil, together with their known ethnopharmacological uses, creates enormous potential for finding new structures with antifungal properties. 5,6) The Piperaceae is a vast family of plants, which has been extensively used for medicinal purposes.7) It comprises about 10 genus and approximately 2000 species, most of them herbaceous, 8) which are found mainly in tropical areas. Piper and Peperomia, the two greatest genera of the family, are well-represented in the Brazilian flora. 9)Within the Piperaceae family, the genus Piper has over 700 species, distributed throughout the tropical and subtropical regions of the world. Its phytochemistry has been object of extensive reviews. 10,11) With regard to the ethnopharmacological information, while the pungent and aromatic fruits of some species of Piper are used as spices, most of them find wide application in traditional systems of medicine 10,11) as insecticides, 7,[12][13][14] antivirals, 15,16) antimicrobials [17][18][19][20][21] and particularly antifungals. [22][23][24][25][26][27][28] These biological properties have been attributed to the presence of lignans and/or amides, such as alkyl or olefinic isobutylamides, 7,23,29) flavonoids, kawa-lactones, butenolides and cyclohexane epoxides, among others. 10)Among the different species of Piper growing in Brazil, Piper solmsianum (syn. P. leucathum or P. santosanum) known popularly as "pariparoba", is a shrub that measures 1-3 m. There are few reports on the chemical or biological studies of this plant. In contrast, phytochemical studies indicated the presence of aliphatic hydrocarbons, monoterpenes, sesquiterpenes, arylpropanoids and neolignans. [30][31][32] Recently, we have demonstrated that the fractions and some pure compounds (lignans) from the leaves of this plant exhibit significant activity against Gram-positive bacteria. 33)The current study extends our previous work on the biological properties of P. solmsianum and describes the in vitro antifungal activity of extracts, fractions and pure compounds against a panel of opportunistic pathogenic fungi using the agar dilution method. MATERIALS AND METHODS Plant MaterialPiper solmsianum C. DC. var. solmsianum (Piperaceae) was collected in May, 2001, in Ponta Grossa, State of Paraná, Brazil, and identified by Dr. Elsie Franklin Guimarães (Rio de Janeiro Botanic Museum Herbarium). A voucher specimen was deposited in the same herbarium under the number RB 368597.Phytochemical Analyses Air-dried leaves (1.36 kg) of P. solmsianum var. solmsianum were cut into small pieces and macerated at room temperature for one week in methanol. After filtration, the solvent was removed by rotary evaporat...

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Section: )mentioning

confidence: 99%

Evaluation of Antifungal Activity of Piper solmsianum C. DC. var. solmsianum (Piperaceae)

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Filho

Silva

et al. 2005

Biological & Pharmaceutical Bulletin

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“…This species is the cause of between 80-90% of all chronic and recurrent infections (TorresRodrigues et al 1998). The fact that current dermatophytosis therapy can cause considerable side-effects and adverse effects in some patients (Gupta et al 1998), renders plant-derived compounds of special interest because they are generally safer and often more effective substitutes for the synthetically produced antimicrobial agents. The essential oil of H. ovalifolia leaves is thus of particular interest as a source of new anti infective agents for dermatophytic infections in humans.…”

Section: Discussionmentioning

confidence: 99%

“…Dermatophytosis is the most frequent superficial fungal infection in Brazil. The drugs used against dermatophytosis exhibit several side effects and have limited efficacy (Gupta et al 1998, Carazo et al 1999. So that there is a distinct need for the discovery of new safer and more effective antifungal agents.…”

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Antimicrobial activity of Hyptis ovalifolia towards dermatophytes

Souza¹,

Oliveira

Ferri

et al. 2003

Mem. Inst. Oswaldo Cruz

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The essential oil and the aqueous, hexane and methanolic fractions from Hyptis ovalifolia leaves were evaluated for their antifungal activity in vitro against 60 strains of dermatophytes: 10 strains of Microsporum canis, 10 of M. gypseum, 20 of Trichophyton rubrum and 20 of T. mentagrophytes. The extracts inhibited growth of the dermatophytes tested at different concentrations. The most biologically active was the essential oil from the leaves which inhibited 57 isolates (95%) at a concentration of ≤ 500 µg/ml.Key words: dermatophytes -Hyptis ovalifolia -antifungal activity Mycotic infections are probably the most common cause of skin disease in developing countries of tropical regions. Dermatophytosis is the most frequent superficial fungal infection in Brazil. The drugs used against dermatophytosis exhibit several side effects and have limited efficacy (Gupta et al. 1998, Carazo et al. 1999. So that there is a distinct need for the discovery of new safer and more effective antifungal agents. The use of medicinal herbs in the treatment of skin diseases including mycotic infections is an age-old practice in many parts of the world (Irobi et al. 1993). This use has been supported by the isolation of active antifungal compounds from plant extracts (Costa et al. 2000.Previous reports on the activity of ethanolic extract from leaves of Hyptis ovalifolia against dermatophytes have been reported by Souza et al. (2002). In this study the antifungal activity of the essential oil and the aqueous, hexane, and methanolic fractions from H. ovalifolia leaves against 60 dermatophytes is described. partitioned between hexane/methanol. The hexane, methanol and aqueous fractions were reduced to dryness and solutions of each as well as of the essential oil were dissolved in dimethyl sulfoxide (DMSO) prepared for subsequent bioassay. MATERIALS AND METHODS Plant material -Hyptis ovalifoliaDermatophyte isolates -The microorganisms used for the biological evaluation were clinical isolates provided by Laboratório de Micologia, Instituto de Patologia Tropical e Saúde Pública, UFG, and identified by standard procedure (Rebell & Taplin 1970). They were: 10 Microsporum canis, 10 M. gypseum, 20 Trichophyton rubrum and 20 T. mentagrophytes. Sabouraud's dextrose agar at 25ºC was used to maintain isolates. In antifungal assays, the samples were transferred to potato dextrose agar and maintained for 7 days at 25ºC.Antifungal assay -The susceptibility test was performed as described by Cáceres et al. (1993), with the following modifications. The extracts were solubilized in DMSO and a two-fold serial dilution was performed in Sabouraud with chloramphenicol and cycloheximide agar medium, to obtain a concentration range of 3.9 to 1000 µg/ ml, poured into Petri dishes. Thirty seven wells of 3 mm were opened using a Steers inoculator. To each well 10 µl of a dermatophyte suspension were added. This suspension was prepared using 0.85% sterile physiological saline with Tween 80 (0.05%) and adjusted with a spectrophotometer at 530 nm to obtain 90% tra...

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“…Terbinafine is a large-spectrum antifungal allylamine, usually prescribed for nail and cutaneous dermatophytosis [18]. Benign side effects are observed in about 10% of patients, usually affecting the digestive tract and the skin (ageusia, nausea, diarrhea, erythema, pruritus, urticaria), occurring in 4.9 and 2.3% of patients, respectively [19, 20]. In rare cases, there have been reports of hepatitis, severe hematological abnormalities, and serious cutaneous side effects have been reported, such as bullous pemphigoid [21], acute generalized exanthematous pustulosis [22,23,24], toxic epidermal necrolysis [25, 26], hypersensitivity reaction (‘DRESS syndrome’) [27], erythema multiforme [26, 28], pustular psoriasis [29] or SCLE [11,12,13,14,15,16,17].…”

Section: Discussionmentioning

confidence: 99%

Terbinafine-Induced Subacute Cutaneous Lupus Erythematosus

Farhi¹,

Viguier²,

Cosnes

et al. 2006

Dermatology

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Background: Nearly 10% of lupus erythematosus (LE) are drug induced. More than 60 different drugs are involved in iatrogenic LE. We report herein 3 cases of terbinafine-induced LE. Observations: Three patients receiving terbinafine for a suspected dermatophytic infection developed a subacute cutaneous LE, within 7 weeks following terbinafine introduction. The patients’ medical history included sicca syndrome, lung carcinoma and Kikuchi disease, respectively. Clinical remission occurred within 15 weeks following terbinafine withdrawal. Discussion: Sixteen cases of terbinafine-induced LE have been previously reported, including 13 women. The median age was 54 years. Prior autoimmunity was reported in 10 cases, including 5 pre-existing LE. The median delay between terbinafine introduction and LE onset was 5 weeks. The median time until clinical recovery following terbinafine withdrawal was 8 weeks. Conclusion: Terbinafine should be prescribed only in patients with proven dermatophytosis. We recommend cautious monitoring in patients with pre-existing autoimmunity. The diagnosis of terbinafine-induced LE should lead to the immediate and definitive withdrawal of the drug.

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Cutaneous adverse effects associated with terbinafine therapy: 10 case reports and a review of the literature

Cited by 90 publications

References 14 publications

Evaluation of Antifungal Activity of Piper solmsianum C. DC. var. solmsianum (Piperaceae)

Evaluation of Antifungal Activity of Piper solmsianum C. DC. var. solmsianum (Piperaceae)

Antimicrobial activity of Hyptis ovalifolia towards dermatophytes

Terbinafine-Induced Subacute Cutaneous Lupus Erythematosus

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