End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients

Singh, Sanjay; Shukla, Prakriti

doi:10.4103/ijdvl.ijdvl_526_17

Cited by 41 publications

(47 citation statements)

References 4 publications

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“…There have been concerns over increasing instances of failure to terbinafine in tinea corporis, tinea cruris and tinea faciei in the country. [ 103 104 ] Resistance to terbinafine due to mutations in the squalene epoxidase ( SQLE ) gene of Trichophyton interdigitale and T. rubrum has been documented in studies from Chandigarh and New Delhi. [ 59 60 ] High MIC's (Minimum inhibitory concentration) were observed and a higher dose (250 mg twice daily) or increased duration was found to be more effective in a study, hence the authors concluded that increased exposure to terbinafine, resulting in higher levels of the drug in the stratum corneum, could offset the higher MIC and the effect of SQLE mutation to some degree.…”

Section: Discussionmentioning

confidence: 99%

Indian association of dermatologists, venereologists and leprologists (IADVL) task force against recalcitrant tinea (ITART) consensus on the management of glabrous tinea (INTACT)

Rengasamy

Shenoy

Dogra

et al. 2020

Indian Dermatol Online J

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Section: Discussionmentioning

confidence: 99%

Indian association of dermatologists, venereologists and leprologists (IADVL) task force against recalcitrant tinea (ITART) consensus on the management of glabrous tinea (INTACT)

Rengasamy

Shenoy

Dogra

et al. 2020

Indian Dermatol Online J

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“…In recent years, the incidence of tinea corporis refractory to terbinafine treatment has been on the rise. 116 , 120 – 124 Terbinafine acts by inhibiting the enzyme squalene epoxidase, which is responsible for synthesis of ergosterol – an essential component of fungal cell wall. 122 Resistance to terbinafine has largely been attributed to point mutations in the squalene epoxidase target gene ( SQLE ).…”

Section: Treatmentmentioning

confidence: 99%

Tinea corporis: an updated review

Leung¹,

Lam²,

Leong³

et al. 2020

DIC

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Background Tinea corporis is a common fungal infection that mimics many other annular lesions. Physicians must familiarize themselves with this condition and its treatment. Objective This article aimed to provide a narrative updated review on the evaluation, diagnosis, and treatment of tinea corporis. Methods A PubMed search was performed with Clinical Queries using the key term ‘tinea corporis.’ The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English language. The information retrieved from the mentioned search was used in the compilation of the present article. Results Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Dermoscopy is a useful and non-invasive diagnostic tool. If necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion. Fungal culture is the gold standard to diagnose dermatophytosis especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment. The standard treatment of tinea corporis is with topical antifungals. Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient. Conclusion The diagnosis of tinea corporis is usually clinical and should pose no problem to the physician provided the lesion is typical. However, many clinical variants of tinea corporis exist, rendering the diagnosis difficult especially with prior use of medications, such as calcineurin inhibitors or corticosteroids. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made and appropriate treatment initiated.

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“…However, recent reports from the subcontinent has revealed an emerging trend of terbinafine resistance in Trichophyton species. A recent study from India demonstrated low cure rates of 2% at 2 weeks duration and 30.6% at 4 weeks in patients treated with terbinafine 3 . Terbinafine resistance in Trichophyton mentagrophytes complex and Trichophyton rubrum has been ascribed to point mutation in the squalene epoxidase (SE) gene, the gene essential for the ergosterol biosynthesis [4][5][6] .…”

mentioning

confidence: 97%

Rapid detection of terbinafine resistance in Trichophyton species by Amplified refractory mutation system-polymerase chain reaction

Shankarnarayan

Shaw

Sharma

et al. 2020

Sci Rep

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Dermatophytosis has gained interest in India due to rise in terbinafine resistance and difficulty in management of recalcitrant disease. The terbinafine resistance in dermatophytes is attributed to single nucleotide polymorphisms (SNPs) in squalene epoxidase (SE) gene. We evaluated the utility of amplified refractory mutation system polymerase chain reaction (ARMS PCR) for detection of previously reported point mutations, including a mutation C1191A in the SE gene in Trichophyton species. ARMS pcR was standardized using nine non-wild type isolates and two wild type isolates of Trichophyton species. Study included 214 patients with dermatophyte infection from March through December 2017. Antifungal susceptibility testing of isolated dermatophytes was performed according to CLSI-M38A2 guidelines. Among dermatophytes isolated in 68.2% (146/214) patients, Trichophyton species were predominant (66.4%). High (>2 mg/L, cut off) minimum inhibitory concentrations to terbinafine were noted in 15 (15.4%) Trichophyton mentagrophytes complex isolates. A complete agreement was noted between ARMS PCR assay and DNA sequencing. C to A transversion was responsible for amino acid substitution in 397 th position of SE gene in terbinafine resistant isolates. Thus, the ARMS PCR assay is a simple and reliable method to detect terbinafine-resistant Trichophyton isolates.

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End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients

Abstract: The effectiveness of terbinafine in dermatophytosis was abysmal in this study.

Cited by 41 publications

References 4 publications

Indian association of dermatologists, venereologists and leprologists (IADVL) task force against recalcitrant tinea (ITART) consensus on the management of glabrous tinea (INTACT)

Indian association of dermatologists, venereologists and leprologists (IADVL) task force against recalcitrant tinea (ITART) consensus on the management of glabrous tinea (INTACT)

Tinea corporis: an updated review

Rapid detection of terbinafine resistance in Trichophyton species by Amplified refractory mutation system-polymerase chain reaction

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