Terbinafine (Lamisil) versus griseofulvin in moccasin type tinea pedis

Abstract

Terbinafine (Lamisil) is the first orally effective agent in a new family of antifungal drugs, the allylamines. As compared to the azoles, it has a unique site of action on sterol synthesis due to its inhibition of squalene epoxidase. The drug is highly effective against dermatophyte infections in vitro. In the study reported here, terbinafine is compared to griseofulvin in patients with moccasin-type tinea pedis. Terbinafine was given at 125 mg twice daily and griseofulvin was given at 250 mg (microsize) twice daily. Thirty-six patients were enrolled in a randomized double-blind study. Mycological culture microscopy was carried out and clinical signs and symptoms were assessed weekly for 6 weeks during therapy and at follow-up 2 weeks later. Twenty-eight of the 36 patients were evaluable for drug efficacy. Twelve out of sixteen (75%) of the terbinafine group were mycologically and clinically cured by the end of therapy (6 weeks) and 14 out of 16 (88%) were cured at the time of follow-up 2 weeks later. Two patients were mycologically cured, but moderate signs or symptoms were present at follow-up. In the griseofulvin-treated group 3 out of 12 (27%) were cured at the end of treatment and 5 out of 11 (45%) at follow-up evaluation. Follow-up after 6–15 months showed continued resolution in the terbinafine-treated patients, but relapse of infection in griseofulvin-treated patients. Terbinafine was found to be both safe and significantly more effective in this application than griseofulvin.