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

Rengasamy, Madhu; Shenoy, Manjunath Mala; Dogra, Sunil; Asokan, Neelakandhan; Khurana, Ananta; Poojary, Shital; Jayaraman, Jyothi; Valia, Ameet R; Sardana, Kabir; Kolalapudi, Seetharam Anjaneyulu; Marfatia, Yogesh S; Rao, P Narasimha; Bhat, Ramesh M; Kura, Mahendra M; Pandhi, Deepika; Barua, Shyamanta; Kaushal, Vibhor

doi:10.4103/idoj.idoj_233_20

Cited by 43 publications

(34 citation statements)

References 115 publications

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“…There was no statistically significant difference in cure rates between 100- and 200-mg doses of itraconazole, which is also as previously reported, albeit with much shorter treatment durations . Notably, itraconazole, 200 mg, is most often used by clinicians empirically . The MICs for 3 treatment failures could be obtained and were all less than 0.5 μg/mL, the recently proposed upper limit of wild-type MIC of the prevalent Indian strain .…”

Section: Discussionsupporting

confidence: 78%

Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris

et al. 2022

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ImportanceWith worldwide emergence of recalcitrant and resistant dermatophytosis, itraconazole is increasingly being used as the first-line drug for treatment of tinea corporis/cruris (TCC). Apparent inadequacy with low doses has led to empirical use of higher doses and antifungal combinations.ObjectiveTo compare cure rates, treatment durations, safety profiles, and relapse rates of itraconazole 100, 200, and 400 mg/d for the treatment of TCC.Design, Setting, and ParticipantsThis double-blind randomized clinical trial included adult patients with treatment-naive TCC involving at least 5% body surface area. Patients were recruited from the dermatology outpatient department of a tertiary care hospital in New Delhi, India between March 1, 2020, and August 31, 2021.InterventionsPatients were randomized to 1 of the 3 treatment groups. Biweekly blinded assessments were performed until cure or treatment failure. Posttreatment follow-up of at least 8 weeks was conducted to detect relapses.Main Outcome and MeasuresCure rates, treatment durations, safety profiles, and relapse rates were assessed. Secondary outcomes included comparison of rapidity of clinical response and cost-effectiveness between groups.ResultsOf the 149 patients assessed, the mean (SD) age was 34.3 (12.2) years, 69 patients (46.4%) were women, and 80 patients (53.6%) were men. The difference in cure rate between the 100- and 200-mg groups was statistically nonsignificant (hazard ratio [HR], 1.44; 95% CI, 0.91-2.30; P = .12), while the difference between the 100- and 400-mg groups (HR, 2.87; 95% CI, 1.78-4.62; P &lt; .001) and between the 200- and 400-mg groups (HR, 1.99; 95% CI, 1.28-3.09; P = .002) was statistically significant. Mean (SD) treatment durations were statistically significantly different between the 100- and 400-mg groups (7.7 [4.7] weeks vs 5.2 [2.6] weeks; P = .03) and between the 200- and 400-mg groups (7.2 [3.8] weeks vs 5.2 [2.6] weeks; P = .004), but the difference between the 100- and 200-mg groups was not statistically significant. A total of 55 patients (47.4%) relapsed after treatment. Relapse rates were comparable across groups. No patient discontinued treatment due to adverse effects. Treatment with the 200-mg dose incurred a 63% higher cost and 400 mg a 120% higher cost over 100 mg in achieving cure.Conclusions and RelevanceIn this randomized clinical trial, high overall efficacy was observed among the 3 itraconazole doses for treatment of TCC, but with prolonged treatment durations and considerable relapse rates. Treatment with the 200- and 100-mg doses did not differ significantly in efficacy or treatment durations, while 400 mg scored over the other 2 on these outcomes. Considerable additional cost is incurred in achieving cure with the 200- and 400-mg doses.Trial RegistrationClinical Trials Registry of India Identifier: CTRI/2020/03/024326

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Section: Discussionsupporting

confidence: 78%

Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris

et al. 2022

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“…33 Itraconazole and terbinafine are the recommended antifungal agents to be used as first-line treatment options for systemic therapy. 8 Commonly prescribed oral AFs were itraconazole capsules (41%) followed by terbinafine tablets (11%) which is in accordance with a similar study by Chandrajeet et al, 31 and Naaz et al 34 The topical AFs were ketoconazole cream (19%) followed by luliconazole (11%) which is similar to Chandrajeet et al's 31 findings of 19.65% and Naaz et al 34 reported luliconazole (34%) followed by ketoconazole (30%). The prescriptions were analysed for co-prescribed antihistamines and found that CPM tablets (68%) were highly prescribed followed by hydroxyzine Hcl (25%).…”

Section: Treatment Pattern and Prescribing Practicesupporting

confidence: 83%

“…These corticosteroids both topical and systemic are absolutely contraindicated for fungal infections. Many experts have strongly discouraged the use of Topical corticosteroids (TCs) either alone or in combination with other agents in the clinical practice of tinea management 7,8 . On some occasions, they are given mistakenly by unaware physicians for the treatment of misdiagnosed Tinea 9 .…”

Section: Introductionmentioning

confidence: 99%

“…Many experts have strongly discouraged the use of Topical corticosteroids (TCs) either alone or in combination with other agents in the clinical practice of tinea management. 7,8 On some occasions, they are given mistakenly by unaware physicians for the treatment of misdiagnosed Tinea. 9 It is also dispensed by some unaware pharmacists dispensing topical steroid-containing preparations as over-the-counter (OTC).…”

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confidence: 99%

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A clinicoepidemiological study on tinea incognita with assessment of its treatment strategies and drug prescribing practices in a tertiary care hospital

Balasubramanian,

Gopalan,

Akbar Ali

et al. 2023

Mycoses

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“…Itraconazole is considered as one of the most reliable therapeutic options in the management of glabrous tinea 1 or dermatophytosis in India. 2 Though, its efficacy is unquestionable, intra-patient and inter-patient differences in bioavailability, requirement of acid and food for optimal absorption, and the poor gastrointestinal tolerability had shown fluctuations in results.…”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy of Super Bioavailable Itraconazole Capsules 50 mg vs 65 mg Twice Daily in the Management of Glabrous Tinea

Shah¹,

Mistry²,

Dharmender³

et al. 2023

IDR

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Owing to pharmacokinetic challenges of itraconazole, super-bioavailable itraconazole (SB) was developed and recently approved in strengths of 50mg and 65mg. But comparative study was lacking between these two strengths in glabrous tinea (dermatophytosis) management. Hence, this study was planned to compare the efficacy of both these strengths in dermatophytosis. Methods: One hundred eligible patients were enrolled in this prospective, randomized, clinical study during May-2022 to September-2022 at tertiary hospital in Ahmedabad in adults. Efficacy and safety assessments were done at week-3 and 6 with follow up at week-10 for relapse. Primary objective was to assess the proportion of patients achieving complete cure at week-6 following treatment in both the groups. Secondary outcomes compared safety, clinical and mycological cure rates. Results: Of the 100 patients enrolled, 98 patients (50 in SB-50mg and 48 in SB-65mg group) included in the final analysis. At week 6, 20 patients (40%) and 30 patients (62.5%) achieved complete cure (p < 0.05) in SB-50mg and SB-65mg groups, respectively. In completely cured patients, relapse was reported in 3 (15%) and 5 (17%) patients of SB-50mg and SB-65mg groups, respectively (p = 1). A significant difference was noted in clearance of symptoms and lesions in SB-65mg group (p < 0.05). Moreover, similar results were also obtained in sub-group analysis of recalcitrant dermatophytosis. Both the treatments were found to be safe and well tolerated with no discontinuation. Conclusion: Study result concluded the superiority of SB-65mg over SB-50mg in terms of cure rate and resolution of symptoms in dermatophytosis management.

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

Cited by 43 publications

References 115 publications

Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris

Effect of Different Itraconazole Dosing Regimens on Cure Rates, Treatment Duration, Safety, and Relapse Rates in Adult Patients With Tinea Corporis/Cruris

A clinicoepidemiological study on tinea incognita with assessment of its treatment strategies and drug prescribing practices in a tertiary care hospital

Comparative Efficacy of Super Bioavailable Itraconazole Capsules 50 mg vs 65 mg Twice Daily in the Management of Glabrous Tinea

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