Oral Isotretinoin Combined with Oral Terbinafine Versus Oral Terbinafine Alone to Treat Recurrent Dermatophytosis

Abstract

Background: Recurrent dermatophytosis is becoming arduous to treat. Recently, oral itraconazole with oral isotretinoin was successful in a patient suffering from recurrent dermatophytosis. Objectives: To evaluate if oral isotretinoin confers any added benefit over oral terbinafine in the treatment of recurrent dermatophytosis. Materials and Methods: This was an open-label randomized clinical trial including 100 adult patients with recurrent tinea cruris and/or tinea corporis randomized into two groups; Group A (oral isotretinoin 0.5 mg/kg/day and oral terbinafine 250 mg twice daily) and Group B (oral terbinafine 250 mg twice daily) for 4 weeks, and followed up for 3 months. Fungal culture and antifungal susceptibility testing against terbinafine, fluconazole, amphotericin B, itraconazole, and griseofulvin were performed. Results: Out of the 100 patients, 91 patients (44 in Group A and 47 in Group B) completed the trial. Complete cure was seen in 19/44 (43.18%) patients in Group A and 20/47 (42.55%) patients in Group B ( P = 0.951). Recurrence occurred in 12/19 (63.1%) patients in Group A and 13/20 (65%) patients in Group B ( P = 0.904). Cheilitis and dryness of lips were the most common adverse effects seen in 32/44 (72.73%) patients in Group A. A total of 50 cultures were grown. The commonest species isolated was Trichophyton interdigitale in 36 (72%) patients, having a mean minimum inhibitory concentration of 3.13 μg/mL for terbinafine. However, for itraconazole, it was 0.13 μg/mL, and varied minimum inhibitory concentration (MIC) values were seen for fluconazole, griseofulvin, and amphotericin B. Conclusion: The addition of isotretinoin to terbinafine has no added benefit in treating patients with recurrent dermatophytosis.

Management of dermatophytosis: Real-world Indian perspective

“…[ 39 ] According to another study, adding isotretinoin to terbinafine provided no further effect in treating recurrent dermatophytosis patients. [ 40 ]…”

Therapeutic Updates on the Management of Tinea Corporis or Cruris in the Era of Trichophyton Indotineae

“…However, Verma et al . [ 46 ] reported no added benefit of combining isotretinoin 0.5 mg/kg and terbinafine 250 mg BD, with similar cure rates observed in both groups after 4 weeks of treatment (43.18% in the combination group and 42.55% in the terbinafine monotherapy group), in 100 patients of recurrent tinea corporis or cruris. Khattab et al .…”

“…In a later study conducted on patients with recurrent tinea corporis or cruris, Verma et al . [ 46 ] reported a cure rate of 42.5% after treatment with 4 weeks of terbinafine 250 mg BD. A recurrence rate of 65% was observed in a follow-up period of 3 months.…”

Diagnosis of a recurred lesion in dermatophytosis patients after 2 weeks of antifungal therapy: A prospective observational study

“…Recent studies reported a rise in the prevalence of recurrence at the treated site of dermatophytosis. [ 1 2 3 4 5 6 ] However, despite extensive research, diagnosis of recurred lesions at the treated site of dermatophytosis has become a challenge for physicians. Recently, few researchers reported that dermatophytosis patients may develop various lesions such as complicated/drug-resistant tinea, adverse effect unique to prolonged topical steroid use (“topical steroid withdrawal syndrome”), and chronic eczema/post-traumatic eczema at the previous sites of dermatophytosis.…”