Treatment of tinea imbricata: a randomized clinical trial using griseofulvin, terbinafine, itraconazole and fluconazole.
BACKGROUND
Griseofulvin has been the mainstay of treatment for tinea imbricata (TI) for decades; however, there have been few reports of efficacy of newer antifungals in the treatment of this condition. Many patients with TI have several obstacles to treatment due to their remote geographical locations and the primitive nature of their societies.


OBJECTIVE
The aim of this study was to compare the efficacy of itraconazole, terbinafine and fluconazole with that of griseofulvin after 4 weeks of therapy.


METHODS
Patients aged 12-76 years with the clinical diagnosis of TI were randomly assigned to one of four treatment groups: griseofulvin 500 mg twice daily for 4 weeks, terbinafine 250 mg daily for 4 weeks, itraconazole 200 mg twice daily for 1 week or fluconazole 200 mg once weekly for 4 weeks. Disease activity was monitored weekly. Laboratory measurements included monitoring complete blood count and liver function enzymes. Fifty-nine patients were included in the efficacy analysis: 13 in the fluconazole group, 15 in the griseofulvin group, 12 in the terbinafine group and 19 in the itraconazole group.


RESULTS
Significant remission was achieved in the terbinafine and griseofulvin groups, lasting up to 8 weeks after cessation of therapy. The fluconazole group experienced no significant remission, and remission was of short duration in the itraconazole group. No adverse events were reported, and non-compliance with medications or follow-up was the only reason for removal from the study.


CONCLUSIONS
Griseofulvin and terbinafine are effective in the treatment of TI. The decision of whether to treat at all and which medication to choose depends greatly on the extent of involvement, the social situation, and the availability of resources such as laboratory testing and follow-up.
Wingfield
A B
AB
Department of Dermatology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, U.S.A.
Fernandez-Obregon
A C
AC
Wignall
F S
FS
Greer
D L
DL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006118:Griseofulvin / Q000627:therapeutic use; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology; D000077291:Terbinafine; D014005:Tinea / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome
D000935:Antifungal Agents; D009281:Naphthalenes; D017964:Itraconazole; D006118:Griseofulvin; D015725:Fluconazole; D000077291:Terbinafine