Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
Users online: 9512  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page

Table of Contents 
Year : 2011  |  Volume : 56  |  Issue : 1  |  Page : 121-122
Intermittent pulse-dosed terbinafine in the treatment of tinea corporis and/or tinea cruris

1 Department of Dermatology, Sri Devaraj Urs Medical College, Tamaka, Kolar, India
2 Department of Microbiology, Sri Devaraj Urs Medical College, Tamaka, Kolar, India

Date of Web Publication10-Mar-2011

Correspondence Address:
V Shivakumar
No. 66, 11th Cross, Indiranagar 1st Stage, Bangalore, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0019-5154.77579

Rights and Permissions

How to cite this article:
Shivakumar V, Okade R, Rajkumar V, Sajitha K, Prasad S R. Intermittent pulse-dosed terbinafine in the treatment of tinea corporis and/or tinea cruris. Indian J Dermatol 2011;56:121-2

How to cite this URL:
Shivakumar V, Okade R, Rajkumar V, Sajitha K, Prasad S R. Intermittent pulse-dosed terbinafine in the treatment of tinea corporis and/or tinea cruris. Indian J Dermatol [serial online] 2011 [cited 2023 Dec 10];56:121-2. Available from:


Dermatophyte infections are amongst the most common dermatologic conditions. [1] Systemic therapy is indicated when the lesions are widespread, recurrent, chronic, or fail to respond to topical therapy. [2] The conventional oral antifungal regimens are of long duration and are associated with toxicity and poor compliance. Hence, a newer cost-effective regimen with a well-tolerated oral antifungal agent is desirable. Terbinafine's fungicidal action, combined with its improved pharmacokinetic properties, makes it an ideal drug for the purpose. [3],[4]

Here we report the results of an open trial on the efficacy of intermittent (once in 3 days) pulse-dosed oral terbinafine therapy (total of 7 doses) in patients with tinea corporis and/or cruris, as there are no previous studies on this topic in literature.

A total of 100 patients (above 16 years of age) clinically diagnosed to have extensive (>100 cm 2 ) tinea corporis and/or cruris and who were not on systemic or topical antifungal therapy were recruited for this open-label study. The study was undertaken over a period of 1 year from May 2007 to April 2008. Pregnant and lactating women; patients on immunosuppressive therapy; and those with liver disorders, HIV infection, or with known hypersensitivity to drugs were excluded. Mycological investigations included microscopy using 10% KOH mount and fungal culture on Sabouraud's dextrose agar.

Of the 100 patients initially recruited, dermatophytes were isolated from 46 patients who met the study criteria. These patients received one 250-mg tablet of terbinafine once in 3 days, with a total of seven tablets completing the therapy. After a period of 3 weeks, the clinical condition in all the patients was assessed and mycological investigations as above were repeated. Patients were followed-up every 3 weeks till the end of the 12 th week.

The primary efficacy measure was mycological cure (negative KOH mount and/or culture). The secondary measures of efficacy were clinical changes from baseline at weeks 3 and 12. Patients were categorized as 'healed' (absence of signs and symptoms), 'markedly improved' (>50% clinical improvement), 'partial response' (<50% clinical improvement), 'no change,' or 'worsened.' Clinical cure was defined as complete absence of symptoms and signs or marked improvement.

In this study, the average age of patients was 36 years with male predominance (67%). The majority of patients had both tinea corporis and cruris (45%), while 37% had tinea corporis alone. At the end of 3 weeks of treatment with terbinafine, 43 (93.4%) of the 46 patients had responded completely as evidenced by the disappearance of symptoms, resolution of skin lesions, and negative fungal cultures. None of the patients reported any adverse effect to the drug.

There were three (6.5%) treatment failures. One of these, who showed no clinical response at all, had persistent lesions due to T. tonsurans. The other two patients responded only partially as evidenced by persistence of clinical lesions. One of these patients had long-standing extensive skin involvement, while the other was a diabetic. Fungal cultures showed persistence of T. rubrum and T. mentagrophytes infections respectively in them.

Thus 93.4% of patients who were administered intermittent pulse-dosed oral terbinafine were cured of infection at the end of 3 weeks. However, one patient relapsed during the 2 nd month of follow-up and skin scrapings from his lesion grew T. rubrum, as it had earlier.

Thus, at the end of the total follow-up period (81.6 ± 4.1 days), 42 of 46 patients enrolled at the beginning of the study were clinically and mycologically cured, giving an overall cure rate of 91.3%.

The elimination of terbinafine from several body compartments is biphasic, with a rapid initial elimination followed by a slower secondary elimination. [5]

The fungicidal property of the drug, its ability to rapidly penetrate the stratum corneum and the nail plate, and its relatively longer post-antibiotic effect (PAE) [6] suggest that an intermittent pulse-dosed treatment regimen may provide better therapeutic outcome with a low relapse rate. [3],[4]

In this study, intermittent pulsed terbinafine (once in 3 days) for a period of 3 weeks achieved a cure rate of 91.3% with a very low relapse rate in the treatment of tinea corporis/cruris confirming the above favourable pharmacokinetic properties of terbinafine.

Therefore, pulsed intermittent terbinafine therapy can be considered as a good therapeutic option in the management of tinea corporis and/or cruris. This reduces the cost of treatment and the risk of cumulative toxicity and increases patient compliance, thereby making the treatment cost effective.

   References Top

1.Gupta AK, Chaudhry M, Elewski B. Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatol Clin 2003;21:395-400.  Back to cited text no. 1
2.Rand S. Overview: The treatment of dermatophytosis. J Am Acad Dermatol 2000;43(5):S104-11.  Back to cited text no. 2
3.Finlay AY. Global overview of Lamisil. Br J Dermatol 1994;130 (Suppl.43): 1-3.  Back to cited text no. 3
4.Narain U, Bajaj AK, Misra K. Onychomycosis. Ind J Dermatol 2002;47:68- 75.  Back to cited text no. 4
5.Faergemann J, Zehender H, Millerioux L. Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails during and after 250mg terbinafine orally once daily for 7 and 14 days. Clin Exp Dermatol 1994;19:121-6.  Back to cited text no. 5
6.Hazen KC. Evaluation of in vitro susceptibility of dermatophytes to oral antifungal agents. J Am Acad Dermatol 2000;43:S125-9.  Back to cited text no. 6

This article has been cited by
1 Evaluation of efficacy and safety of oral terbinafine and itraconazole combination therapy in the management of dermatophytosis
Priyanka Sharma, Mala Bhalla, Gurvinder P. Thami, Jagdish Chander
Journal of Dermatological Treatment. 2020; 31(7): 749
[Pubmed] | [DOI]
2 Limited effectiveness of four oral antifungal drugs (fluconazole, griseofulvin, itraconazole and terbinafine) in the current epidemic of altered dermatophytosis in India: results of a randomized pragmatic trial*
S. Singh, U. Chandra, V.N. Anchan, P. Verma, R. Tilak
British Journal of Dermatology. 2020; 183(5): 840
[Pubmed] | [DOI]
3 In vitro antifungal resistance profile of Candida strains isolated from Saudi women suffering from vulvovaginitis
Mohamed T. Yassin, Ashraf A. Mostafa, Abdulaziz A. Al-Askar, Rashad Bdeer
European Journal of Medical Research. 2020; 25(1)
[Pubmed] | [DOI]
4 End of the road for terbinafine? Results of a pragmatic prospective cohort study of 500 patients
Sanjay Singh, Prakriti Shukla
Indian Journal of Dermatology, Venereology and Leprology. 2018; 84(5): 554
[Pubmed] | [DOI]
5 Sensitivity of Vaginal Isolates of Candida to Eight Antifungal Drugs Isolated From Ahvaz, Iran
Zahra Salehei,Zahra Seifi,Ali Zarei Mahmoudabadi
Jundishapur Journal of Microbiology. 2012; 5(4): 574
[Pubmed] | [DOI]


Print this article  Email this article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (276 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


 Article Access Statistics
    PDF Downloaded190    
    Comments [Add]    
    Cited by others 5    

Recommend this journal