How long does it take for Lamisil to show results. What factors influence the effectiveness of terbinafine. How to properly use terbinafine for various fungal infections. When to expect improvements in symptoms after starting Lamisil treatment.

Understanding Terbinafine: The Active Ingredient in Lamisil

Terbinafine, the active ingredient in Lamisil, is an antifungal medication used to treat various fungal infections. It works by inhibiting the growth of fungi, ultimately eliminating the infection. Terbinafine is available in several forms, including creams, gels, sprays, solutions, and oral tablets, each designed for specific types of fungal infections.

The effectiveness of terbinafine depends on several factors:

• The type and severity of the fungal infection
• The form of terbinafine used (topical or oral)
• Proper application or dosage
• Consistency in following the prescribed treatment regimen
• Individual response to the medication

Terbinafine Treatment Duration: What to Expect

The duration of terbinafine treatment varies depending on the type and location of the fungal infection. Here’s a general overview:

• Jock itch: 2 to 4 weeks (oral tablets)
• Athlete’s foot: 2 to 6 weeks (oral tablets), 1 to 2 weeks (topical forms)
• Ringworm: 4 weeks (oral tablets)
• Fungal nail infections: 6 weeks to 3 months or longer (oral tablets)

It’s crucial to complete the full course of treatment as prescribed by your healthcare provider, even if symptoms improve before the end of the treatment period. Premature discontinuation may result in the recurrence of the fungal infection.

Proper Application Techniques for Topical Terbinafine

To maximize the effectiveness of topical terbinafine formulations, follow these application techniques:

Cream or Gel

1. Wash and dry your hands thoroughly.
2. Clean and dry the affected area.
3. Apply a thin layer of cream or gel to the infected skin and surrounding area.
4. Gently rub the medication into the skin.
5. Wash your hands after application.

Spray

1. Shake the bottle well before use.
2. Hold the spray bottle about 10cm away from the affected area.
3. Apply a thin, even layer to cover the infected skin and surrounding area.
4. Allow the spray to dry naturally.

Solution (Lamisil Once)

1. Apply to clean, dry feet after bathing.
2. Cover the entire foot surface, including between toes.
3. Allow the solution to dry for 1-2 minutes.
4. Do not wash feet for 24 hours after application.

For optimal results, apply topical forms once or twice daily as directed, typically for 1 to 2 weeks.

Oral Terbinafine: Dosage and Administration

Oral terbinafine tablets are typically prescribed for more severe or persistent fungal infections. The standard dosage is one 250mg tablet taken once daily. Here are some key points to remember:

• Take the tablet with or without food, at the same time each day.
• Swallow the tablet whole with a full glass of water.
• Do not crush, chew, or break the tablet.
• Continue taking the medication for the full prescribed duration, even if symptoms improve earlier.

The length of treatment with oral terbinafine varies depending on the infection type and severity, ranging from 2 weeks for simple skin infections to several months for fungal nail infections.

Timeframe for Visible Improvements with Terbinafine

While terbinafine begins working immediately upon application or ingestion, visible improvements in symptoms may take some time to appear. The timeline for noticeable results can vary based on the type and severity of the infection:

• Skin infections (e.g., athlete’s foot, jock itch, ringworm): Symptoms may begin to improve within a few days to a week of starting treatment.
• Nail infections: Visual improvements may not be apparent for several weeks or even months. Complete clearing of the infection can take 6 to 12 months, as the healthy nail needs time to grow out.

It’s important to note that while symptoms may improve relatively quickly, the underlying fungal infection may still be present. This is why completing the full course of treatment is crucial for preventing recurrence.

Factors Affecting Terbinafine Effectiveness

Several factors can influence how quickly and effectively terbinafine works:

• Infection severity: More severe or long-standing infections may take longer to respond to treatment.
• Immune system function: Individuals with compromised immune systems may experience slower response times.
• Consistency of use: Skipping doses or applications can reduce effectiveness and prolong treatment duration.
• Proper application: Incorrect use of topical formulations may lead to suboptimal results.
• Concurrent medications: Some medications may interact with terbinafine, affecting its efficacy.
• Underlying health conditions: Certain medical conditions can impact the body’s response to antifungal treatments.

To maximize terbinafine’s effectiveness, follow your healthcare provider’s instructions carefully and address any potential contributing factors.

Potential Side Effects and Precautions

While terbinafine is generally well-tolerated, it’s important to be aware of potential side effects and take necessary precautions:

Common Side Effects

• Gastrointestinal disturbances (nausea, diarrhea, stomach pain)
• Headache
• Skin rash or itching
• Altered taste sensation (with oral tablets)

Precautions

• Inform your healthcare provider of any existing medical conditions, especially liver disease.
• Disclose all medications and supplements you’re currently taking to avoid potential interactions.
• Avoid using terbinafine if you’re pregnant or breastfeeding without consulting your doctor.
• Do not use terbinafine on open wounds or near mucous membranes.
• Discontinue use and seek medical attention if you experience severe side effects or allergic reactions.

By being aware of these potential issues and following proper usage guidelines, you can minimize risks and maximize the benefits of terbinafine treatment.

Complementary Measures to Enhance Terbinafine Effectiveness

To support the action of terbinafine and promote faster healing, consider implementing these complementary measures:

• Keep the affected area clean and dry.
• Wear breathable fabrics and avoid tight-fitting clothing or shoes.
• Use antifungal powders in shoes to prevent reinfection.
• Change socks daily and avoid walking barefoot in public areas.
• Maintain good overall hygiene practices.
• Boost your immune system through a balanced diet, regular exercise, and adequate sleep.
• Manage underlying health conditions that may contribute to fungal infections.

These additional steps can help create an environment less conducive to fungal growth and support your body’s natural defenses against infection.

When to Consult a Healthcare Professional

While terbinafine is effective for many fungal infections, there are instances where you should seek medical advice:

• If symptoms persist or worsen after completing the prescribed course of treatment
• If you experience severe side effects or allergic reactions
• If the infection spreads or affects a large area of the body
• If you have diabetes or a weakened immune system
• If you’re unsure about the diagnosis or appropriate treatment
• If you’re pregnant, breastfeeding, or planning to become pregnant

A healthcare professional can provide personalized advice, adjust your treatment plan if necessary, and rule out any underlying conditions that may be contributing to persistent fungal infections.

Long-Term Management and Prevention of Fungal Infections

After successfully treating a fungal infection with terbinafine, it’s important to focus on prevention to avoid future recurrences. Here are some strategies for long-term management:

• Maintain good foot hygiene, especially if you’re prone to athlete’s foot.
• Keep your nails short and clean to prevent fungal nail infections.
• Avoid sharing personal items like towels, socks, or nail clippers.
• Use antifungal powders or sprays in shoes and on feet regularly.
• Wear flip-flops or water shoes in public showers, locker rooms, and pool areas.
• Choose breathable, moisture-wicking fabrics for clothing and socks.
• Address any underlying health conditions that may increase your risk of fungal infections.
• Consider periodic use of over-the-counter antifungal products as a preventive measure, especially in high-risk situations.

By incorporating these practices into your daily routine, you can significantly reduce the likelihood of future fungal infections and maintain healthy skin and nails.

Understanding Recurrent Infections

If you experience frequent fungal infections despite proper treatment and preventive measures, it may be worth investigating potential underlying causes. These could include:

• Immune system disorders
• Hormonal imbalances
• Nutritional deficiencies
• Chronic stress
• Genetic predisposition

In such cases, working closely with a healthcare provider to identify and address these factors can lead to more effective long-term management of fungal infections.

Terbinafine vs. Other Antifungal Treatments

While terbinafine is a highly effective antifungal medication, it’s not the only option available. Understanding how it compares to other treatments can help you make informed decisions about your fungal infection management:

Terbinafine vs. Azoles (e.g., fluconazole, itraconazole)

• Terbinafine is generally more effective against dermatophytes (fungi that cause skin and nail infections).
• Azoles may be preferred for certain types of yeast infections.
• Terbinafine often requires shorter treatment durations for nail infections.

Terbinafine vs. Over-the-Counter Antifungals

• Prescription-strength terbinafine is typically more potent than OTC options.
• OTC treatments may be sufficient for mild, superficial infections.
• Terbinafine is often necessary for more severe or persistent infections.

Oral vs. Topical Terbinafine

• Oral terbinafine is more effective for nail infections and widespread skin infections.
• Topical formulations are preferred for localized skin infections due to fewer systemic side effects.
• Combination therapy (oral and topical) may be recommended in some cases for optimal results.

Your healthcare provider will consider factors such as the type and severity of your infection, your overall health, and potential drug interactions when recommending the most appropriate antifungal treatment for your specific situation.

The Future of Antifungal Treatments

As research in the field of antifungal therapy continues to advance, new treatments and approaches are being developed to combat fungal infections more effectively. Some areas of ongoing research include:

• Novel antifungal compounds with broader spectrum activity
• Combination therapies to enhance efficacy and reduce treatment duration
• Nanotechnology-based delivery systems for improved drug penetration
• Immunotherapies to boost the body’s natural defenses against fungal infections
• Personalized treatment approaches based on genetic factors and individual fungal strains

While terbinafine remains a cornerstone of antifungal treatment, these advancements may lead to even more effective and tailored therapies in the future, potentially reducing treatment durations and improving outcomes for patients with fungal infections.

Emerging Resistant Strains

As with many antimicrobial medications, there is growing concern about the development of antifungal resistance. This underscores the importance of using antifungal treatments judiciously and completing prescribed courses to help prevent the emergence of resistant fungal strains.

Researchers are actively working on strategies to combat antifungal resistance, including:

• Developing new classes of antifungal drugs with novel mechanisms of action
• Exploring combination therapies to overcome resistance
• Investigating natural compounds with antifungal properties
• Improving diagnostic tools for rapid identification of resistant strains

These efforts aim to ensure that effective treatments remain available for fungal infections in the face of evolving resistance patterns.

Conclusion: Maximizing the Benefits of Terbinafine Treatment

Terbinafine, whether in topical or oral form, is a potent antifungal medication that can effectively treat a wide range of fungal infections. While the time it takes for Lamisil (terbinafine) to work can vary depending on several factors, most patients begin to see improvements within a few days to weeks of starting treatment.

To achieve the best results with terbinafine treatment:

• Follow your healthcare provider’s instructions carefully
• Complete the full course of treatment, even if symptoms improve earlier
• Apply topical formulations correctly and consistently
• Be patient, especially with nail infections, as visible improvements may take time
• Implement complementary measures to support healing and prevent reinfection
• Monitor for side effects and consult your healthcare provider if concerns arise
• Adopt long-term preventive strategies to reduce the risk of future infections

By understanding how terbinafine works, what to expect during treatment, and how to support its effectiveness, you can maximize the benefits of this powerful antifungal medication and achieve optimal outcomes in managing fungal infections.

How and when to take or use terbinafine

The treatment you use will depend on where the infection is on your body and how severe it is.

For large areas of skin, or if the area is hairy, it’s best to use the spray.

If you buy terbinafine in a pharmacy or shop, follow the instructions that come with your medicine.

Dosage

Your doctor or pharmacist will tell you how much terbinafine to use and how long you need to use it for, depending on your infection.

If you’re using the cream, gel or spray, you’ll usually need to use it once or twice a day.

If you’re using the solution, you only use it once.

If you’re taking the tablets, the usual dose is 1 tablet, taken once a day. You’ll usually take the tablets for 2 to 6 weeks. This depends on the type of infection you have and how serious it is.

How to use terbinafine cream or gel

Put the cream or gel on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the cream or gel.
2. Wash and dry the infected skin where the cream or gel will go. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Unscrew the cap.
4. Squeeze out a small amount of the cream or gel onto your finger (enough to put a thin layer on your skin).
5. Gently rub it into the infected areas. Avoid putting it near your mouth, lips and eyes.
6. Replace the cap.
7. Wash your hands.

If you’re using the cream or gel on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine spray

Put the spray on the infected area once or twice a day for 1 to 2 weeks.

1. Wash your hands before using the spray.
2. Wash and dry the infected skin before using the spray. If you’re treating your feet, it’s also important to wash and dry between your toes first.
3. Take the cap off and prepare the spray by pressing the top of the spray down once or twice.
4. Hold the bottle about 10cm away from the infected area and spray until your skin is thoroughly wet. Avoid getting it near your mouth, lips and eyes.
5. Replace the cap.
6. Wash your hands.

If you’re using the spray on the area between your toes, or on your bottom or groin, you can cover the skin with a clean strip of gauze afterwards. This type of light dressing is available to buy at pharmacies and is especially helpful to use at night.

How to use terbinafine solution (Lamisil Once)

The solution for athlete’s foot comes in a tube with a nozzle. It’s a single treatment that you only use once.

Use the solution on both feet even if one of them looks fine. If one foot looks less infected than the other, put the solution on the less infected foot first.

1. Use the solution after a shower or bath. Before using the solution, make sure your feet are dry, including between your toes.
2. Remove the cap.
3. Put the solution all over your toes, including between each toe, and on the sole, top and sides of your foot. This should use about half the tube. Finish treating this foot before treating the other.
4. Do not rub or massage the solution in.
5. Leave the solution to dry on your feet for 1 to 2 minutes.
6. Replace the cap and throw the tube away.
7. Wash your hands.
8. Put on your normal shoes and socks.

Do not wash or splash your feet with any water for 24 hours after using the solution.

After 24 hours, wash your feet with warm, soapy water in the bath or shower and gently pat them dry.

How to take terbinafine tablets

Swallow the tablet whole with a drink of water.

You can take terbinafine tablets with or without food. It’s best to take your tablets at the same time each day.

If you have a fungal nail infection, you’ll probably need to take the tablets for several months. These infections take a while to clear.

How long to take or use it for

If you’re using the cream, gel or spray, you’ll usually need to use it for 1 to 2 weeks. Talk to your doctor if your symptoms do not get better within 2 weeks.

If you’re taking the tablets, you’ll usually take them for:

• 2 to 4 weeks if you have jock itch
• 2 to 6 weeks if you have athlete’s foot
• 4 weeks if you have ringworm
• 6 weeks to 3 months (sometimes longer) if you have a fungal nail infection

It’s important to keep taking or using terbinafine until you finish the course, even if your symptoms get better. Follow the instructions from your doctor or on the leaflet that comes with the medicine.

If you stop using your terbinafine too soon, or if you do not use it as recommended, the fungal infection could come back.

Talk to your doctor if you’re thinking of stopping your treatment for any reason.

If you forget to take it or use it

If you forget to use your terbinafine cream, gel or spray, just use it as soon as you remember and then keep following your usual routine.

If you forget to take a terbinafine tablet, take it as soon as you remember, unless it’s nearly time for your next dose. In this case, just skip the missed dose and take your next one at the usual time. Then carry on until you have finished the course.

Do not take 2 doses to make up for a missed dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember your medicines.

If you take or use too much

If you use too much terbinafine cream, gel or spray or use it more often than you need to, it may make your skin irritated or red. If this happens, use less of the cream, gel or spray the next time.

Taking 1 or 2 extra terbinafine tablets is unlikely to harm you.

If you take more than this, you may get side effects including stomach pain, feeling or being sick, diarrhoea, headache or feeling dizzy.

Urgent advice: Contact 111 for advice now if:

• you take a lot of terbinafine tablets at the same time (4 or more) even if you have no side effects
• you take 2 or more terbinafine tablets and have side effects

Call 111 or go to 111.nhs.uk. Call 111 if you need advice for a child under the age of 5 years.

If you need to go to A&E do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the terbinafine packet, or the leaflet that came with your medicine, and any remaining medicine with you.

Side Effects, Dosage, Precautions, Uses

1. Will Terbinafine treat ringworm?

Yes. Terbinafine has been popularly used to treat infections like ringworm of the foot, groin, and body (tinea corporis). The medicine comes in different forms like cream, gel, and spray. Applying Terbinafine to the affected area 2–3 times daily provides benefits. Terbinafine is one of the most successful medicines used to treat ringworm infections.

2. How long does it take for Terbinafine to work?

The duration and efficacy of treatment depend on the type of fungal infection. Typically, terbinafine takes 4 to 6 weeks in cases of ringworm and athlete’s foot. However, nail infections take a little longer to heal – between 6 to 12 weeks. Toenails take even longer to heal than fingernails.

3. Can terbinafine cause liver damage?

Yes. Terbinafine has been known to cause liver damage, even leading to requiring liver transplants. You should be aware of signs of liver damage like red urine, yellowing skin or eyes, etc. Get a medical opinion if you develop such signs. Inform your doctor of your past liver problems, if any, before opting for terbinafine.

4. Is terbinafine an antibiotic?

No. Terbinafine is not an antibiotic. Both antifungals and antibiotics are anti-microbial. However, antibiotics work against bacterial microorganisms, for example, penicillin or amoxicillin fight bacteria like E. coli or streptococci. Terbinafine has no known antibacterial properties. It cannot fight against such bacterial growth because it is antifungal instead. It kills fungi causing hair, skin, and nail infections.

5. Can Terbinafine cause acne?

No. Commonly, terbinafine is not known to cause acne. However, the topical use of terbinafine can cause peeling or severe itching of the skin at the area of application. These can be allergic side effects. Consult our experts to know more about the skin reactions that take place with terbinafine.

6. Can Terbinafine cream be used on the face?

No. Terbinafine cream cannot be used on the face. Take special care when using the cream for other body parts as well. Wash your hands properly after the application of the medicine. Do not touch your eyes, nose, or ears in the process. Get medical help immediately if terbinafine has been used incorrectly.

7. Does terbinafine affect birth control?

No. There is no evidence that terbinafine affects birth control. Your oral pills can be continued alongside the oral pills. Terbinafine has not been reported to increase or decrease fertility either. However, vomiting due to terbinafine may render the oral pill useless. Contact our medical expert to know about the topic in detail.

8. How safe is terbinafine?

Terbinafine is generally considered to be a safe medication. The serious side effects happen only in rare, severe cases. Ensure you give proper details to the doctor about your past medical records. You also must not use terbinafine if you have recorded previous allergies to the drug. Stay alert regarding signs of liver or muscle damage.

9. What should you not take with terbinafine?

Avoid substances like coffee when using terbinafine. Avoid going out in the sun as terbinafine increases your likelihood of developing sunburns. Terbinafine is a safe medication that does not react adversely with other drugs. However, keep your doctor informed if you’re taking antidepressants, oral contraceptives, beta-blockers, amiodarone, warfarin, or tamoxifen.

10. Does Terbinafine make your hair fall out?

Yes. Terbinafine is one of the antifungal drugs that is known to cause severe hair fall in a few cases. However, this side effect is very rare and may affect only 1 in 10,000 people. Get in touch with our medical expert to know more about this condition.

Therapeutic possibilities of systemic pharmacotherapy of dermatomycosis | Belousova T.A., Goryachkina M.V.

D fungal skin diseases are one of the most frequently discussed problems in various dermatological forums and scientific journals. The relevance of this topic is determined, on the one hand, by the significant prevalence of this pathology, which, according to the literature, accounts for 37% to 42% of all diseases of the skin and nails. On the other hand, there is a rich representation in dermatological practice of other pathological skin conditions associated with fungal infections: allergic dermatosis, viral, bacterial infections. In persons suffering from dermatophytosis for a long time, allergic dermatitis develops 3 times more often, and drug allergy – 4 times more often . Clinicians are well aware that in foot mycosis, a common complication is the addition of recurrent erysipelas, followed by the development of lymphostasis and elephantiasis, and plantar warts are recorded 4 times more often than in the general population. In 20–30% of patients suffering from widespread chronic dermatosis (psoriasis, hereditary keratosis, eczema), mycoses, and above all foot mycosis, act as a second disease, worsening the course of the underlying dermatosis. Dermatophytosis is characterized by a long progradient course with periods of exacerbations in the summer, involvement in the pathological process, in addition to the skin, of the nail plates, which in 40% of patients leads to disfiguring changes in the nails and significantly worsens their quality of life. A study of the quality of life of patients with onychomycosis conducted by domestic dermatologists within the framework of the Hot Line project showed that the vast majority of those examined experienced significant physical and psychological problems due to the disease. U 89% had difficulties in nail care, 73% had pain when walking, 75% had inconvenience when wearing shoes. 98% of patients experienced feelings of irritation and disappointment from the appearance of their nails, 95% believed that they could infect others and experienced inconvenience when taking off their shoes in front of strangers. Large changes in the quality of life were found in women. Smaller changes in the quality of life due to the disease in men explain their low level of access to doctors for onychomycosis, and as a result, a higher incidence (1.3 times) compared to women. The prolonged course and aggravation of mycosis leads to a further decrease in the quality of life in both sexes.

Lately the incidence of mycosis tends to increase continuously . This is facilitated by an increase in the age structure of the population of elderly and senile people, among whom the number of patients with mycoses reaches 50%. This contingent is a reservoir and a constant source of infection, especially in the case of intrafamilial transmission, which, according to epidemiological studies, is currently observed in 28% of young and middle-aged patients. The growth of dermatophytosis is promoted by an increase in the population of people with immunodeficiency conditions of a congenital or acquired nature (AIDS, atopic conditions, long-term use of immunosuppressive drugs). The deterioration of the ecological situation, material and social conditions of existence for the majority of the population of Russia has led to an increase in background somatic conditions predisposing to the development of mycoses. These primarily include “debilitating” conditions and diseases: hypovitaminosis, anemia, alcoholism, drug addiction, chronic bacterial, protozoal, viral infections, prolonged psycho-emotional and physical stress. The unrelenting trend towards an increase in the number of patients with endocrine-metabolic, osteoarticular pathology and vascular diseases of the lower extremities also contribute to the development of fungal infections, and above all mycoses of the feet. According to epidemiological studies within the framework of the Achilles project, among reliably Factors predisposing to onychomycosis in adults Vascular disease ranks first (21%), obesity ranks second (16%) and foot pathology ranks third (15%). Mycoses of the feet are observed in almost a third of patients with such a common disease at the present time as diabetes mellitus, especially often with diabetic foot syndrome. In patients of middle and older age, permanent injury to the skin and nails of the feet with flat feet and calluses, corns, hallux valgus , osteoarthritis contributes to the introduction of pathogenic fungi when visiting swimming pools, baths, saunas, sports clubs, fitness centers that are so popular today. In children and adolescents, infection with mycosis is promoted by constant trauma and sweating during sports and dry skin in atopic status.

The widespread occurrence of dermatophytosis, persistent chronic course, the variety of their clinical manifestations with involvement in the pathological process in addition to the skin, its appendages, the need for long-term treatment causes great interest of practitioners in the choice of specific drugs and methods of their use in these diseases. Currently, the arsenal of antimycotic drugs for systemic and local therapy is quite wide and this list is constantly being replenished. The modern principle of treatment of skin dermatomycosis is the use of drugs aimed at the destruction or inhibition of the reproduction of the etiological agent – a pathogenic fungus in the affected skin, nails or hair. With good reason, it can be argued that only etiotropic therapy is an effective approach to the treatment of fungal skin diseases. Etiotropic therapy can be carried out in the form of systemic, local or combination-combined. Currently priority in the treatment of dermatophytosis is given to the systemic use of drugs, which guarantees the penetration of the drug into the affected skin structures, hair and nails. It has been shown that the inclusion of systemic antifungal drugs in the complex treatment of patients with mycoses increases the cure rate by a factor of three compared to therapy with external antimycotics. At the same time, the transport of the medicinal substance is carried out in three ways: through the blood with passive diffusion, by introducing into the keratinocytes of the basal layer, and mainly by excretion by the sebaceous and sweat glands. Thus, there is a gradual accumulation of the antimycotic in the epidermis, in the hair and nail matrix in concentrations far exceeding the minimum inhibitory concentrations for the growth of the fungus. Due to the lipophilic and keratophilic properties characteristic of these drugs, antimycotics are able to accumulate for a long time and remain in the final targets of their route – the skin and its appendages and are slowly excreted after the end of the drug intake, while maintaining minimally inhibitory concentrations.

According to the type of action on the pathogen, antifungal drugs are divided into fungicidal and fungistatic , according to the source of production – into synthetic and natural.

Systemic antimycotics are conditionally divided into 5 large groups:

– antifungal antibiotics,

– azole compounds,

– allylamine derivatives,

– 5-fluorocytosine derivatives,

90 002 – iodine-containing preparations.

In modern clinical practice, drugs of the first three groups are mainly used. At the same time, the spectrum of antifungal activity in different groups differs significantly. Azole, allylamine compounds are broad-spectrum antimycotics, as they are active against most pathogenic fungi. The range of action of antifungal antibiotics is very limited. For example, griseofulvin acts only on dermatophytes, and nystatin, levorin – only on fungi of the genus Candida . To date, five systemic antimycotics are widely used in the treatment of patients with mycoses: terbinafine, griseofulvin, ketoconazole, itraconazole and fluconazole.

Griseofulvin has long been (for 40 years) the only antifungal drug for general use. In our country, the drug was first obtained in 1960. The drug is a chlorine-containing antibiotic, a biosynthesis product of fungi of the genus Penicillium . This antimycotic has a fungistatic effect, blocking the division and maturation of fungal cell nuclei, and, by binding to cytoplasmic microtubules, disrupts the intracellular transport of various substances, including cell wall components. Griosefulvin is active only against dermatophyte fungi (genus Trichophyton, Epidermophyton, Microsporum ). The limited spectrum of action of these types of fungi is explained by the fact that the penetration of griseofulvin into the cell is provided by a special transport system that is available only in dermatophytes. The drug is not completely absorbed in the gastrointestinal tract. The acid reaction of the gastric juice contributes to the better absorption of this antimycotic, and therefore it is taken with food, washed down with vegetable oil, which stimulates the evacuation of bile and increases the solubility of the antibiotic. Due to the unequal adsorption of the drug in the digestive tract, the level of griseofulvin in the blood serum fluctuates, and to maintain the minimum inhibitory concentration, a constant intake of the drug for several months at fairly high doses is required. A significant drawback of the drug is its low keratophilicity. The concentration of griseofulvin in stratum corneum decreases in parallel with the decrease in plasma levels, and 48-72 hours after withdrawal, it is not detected in the stratum corneum. In this regard, monotherapy with griseofulvin has a very low efficiency: with mycosis of the feet, the cure reaches no more than 40% of patients, with generalized rubrophytosis – 59%. A very negative point is the development of a large number of complications and side effects when taking the drug. The most common complications include toxic–allergic reactions and drug intolerance, which is associated with the common origin of griseofulvin and penicillin and the presence of common antigens in dermatophytes and skin. The photosensitizing properties of the drug are the cause of the development of photodermatitis and exacerbations of photosensitive dermatosis. Taking the drug can cause a hepatotoxic effect, less often – agranulocytosis. The most common side effects are nausea, vomiting, epigastric discomfort, headache and dizziness.

Ketoconazole – the first systemic antimycotic from the azole group was synthesized in the late 70s. Great hopes were placed on this drug, since its therapeutic effect was provided not only by fungistatic, but also by fungicidal action against a wide range of pathogens of mycoses: dermatophytes, yeasts and molds. The fungistatic activity of ketoconazole is associated with damage to the cytoplasmic membrane of fungi and an increase in its permeability as a result of inhibition of the biosynthesis of ergosterol, phospholipids, triglycerides by suppressing 14a-dimethylase. Fungicidal properties are due to the accumulation of ergosterol precursors in the fungal cell, which leads to its destruction. Clinical results of the use of ketoconazole showed that the drug inhibits not only 14a-dimethylase of fungal cells, but also a similar enzyme of the person himself. In patients during treatment, significant disturbances in the synthesis of cholesterol, prostaglandins, male and female sex hormones, hormones of the adrenal cortex were detected, which inevitably affected the endocrinological status in the form of a decrease in libido, potency, and the appearance of gynecomastia. In addition, it turned out that the drug has a pronounced hepatotoxic effect due to the effect of the drug on the cytochrome P-450 and C-oxidase system of liver cells and the accumulation of ketoconazole metabolic products that damage liver cells. In 5-10% of patients during treatment with the drug, an increase in hepatic transaminases is observed, which requires its abolition. When prescribing ketoconazole, it is necessary to take into account its possible interaction with many pharmacological preparations. It prolongs the half-life of antihistamines (terfenadine and astemizole), which can lead to the development of arrhythmias, and potentiates the effect of indirect anticoagulants. The absorption of the drug worsens with the simultaneous use of antacids. Common side effects of ketoconazole are nausea, vomiting, and decreased appetite. To avoid these phenomena, it is recommended to take an antimycotic after meals or at night.

Ketoconazole is the drug of choice for the treatment of patients with versicolor versicolor, dermatophytosis (especially in cases of combined dermatophyte-candidiasis-mold flora), candidiasis of the skin and mucous membranes, systemic and deep mycoses. Currently, ketoconazole is practically not used for the treatment of foot fungus due to low efficiency. Monotherapy provides a cure for only 34-42% of patients, combined therapy (removal of nail plates, repeated cleaning of nail beds with the use of fungicidal-keratolytic agents) increase the effectiveness of treatment up to 86%. At the same time, side effects and complications are observed in 25% of patients. In modern dermatological practice, ketoconazole is successfully used in the form of short courses in patients with common forms of versicolor versicolor and in patients with widespread seborrheic dermatitis. The drug is prescribed at 200 mg / day for 2-3 weeks. High efficiency (100% cure) in patients with versicolor versicolor was noted when using the drug according to the following method: a single dose of 400 mg of the drug along with acidic juice, followed by intense physical activity (up to sweat) after a two-hour exposure. This ensures the active release of the drug by sweat and sebaceous glands by simple diffusion. An hour later, the patient takes a shower and puts on boiled and ironed linen. A week later, all treatment procedures are repeated.

Itraconazole – another representative of the azole class was synthesized abroad in 1980 and has been actively used in mycological practice since the early 90s. The drug has a fungistatic effect. Like other drugs from the azole group, itraconazole inhibits the synthesis of ergosterol by acting on the enzyme 14a-dimethylase, which is dependent on the cytochrome P-450 system. Violation of the synthesis of ergosterol in the fungal cell membrane determines its fungistatic effect. The presence of a long side lipophilic chain in the itraconazole molecule determines its higher affinity for cytochrome p-450 of fungal rather than human enzymatic cells. Therefore, in therapeutic doses, the drug does not affect the metabolism of human steroids. Compared to ketoconazole, itraconazole has less toxicity due to its lower potential for drug interactions. The hepatotoxicity of the drug is also significantly lower compared to ketoconazole and griseofulvin. Pharmacokinetic features of the drug favorably distinguish it from other systemic antimycotics. If you follow the recommendations for taking it (the drug is better absorbed with food, when washed down with acidic juice, along with food rich in lipids), it is almost completely absorbed in the intestine. The drug quickly enters various tissues and organs, where it accumulates in concentrations exceeding plasma. The lipophilicity of the drug contributes to its greater accumulation in the sebaceous hair follicles and seborrheic areas of the skin. Within 2-4 hours after taking 100 mg of the drug, its concentration in the skin and sebum becomes 4-5 times higher than in plasma and remains at this level for a week. Itraconazole appears in the distal parts of the nail plate within a week from the start of treatment, and its concentration gradually increases during treatment. Characteristically, the accumulation of the drug most actively occurs in the nail bed and hyperkeratotic masses, that is, in the main areas of accumulation of pathogenic fungi. Once in the nail, high concentrations of itraconazole remain in it after discontinuation for several months, without returning to the bloodstream.

The drug is active against dermatophytes, yeast fungi, molds and dimorphic fungi, as well as causative agents of multi-colored lichen and deep mycoses. It is the basic drug in the treatment of severe, systemic, opportunistic and deep mycoses. In dermatomycology, the drug has proven itself well in the treatment of patients with mycosis of the feet with multiple total lesions of the nails, including those caused by dermatophyte-mold flora. Recently, a sparing pulse regimen of taking the drug has been used to treat this severe form of dermatophytosis. During the week, the patient is prescribed 200 mg of the drug in the morning and evening for a week. This is followed by a three-week break and a new weekly course of treatment. With onychomycosis of the feet, at least 3-4 courses are carried out, and with damage to the nails of the hands, at least 2. With this mode of administration, a cure, according to a number of authors, is observed in 79.4–89.8% of patients. When combining itraconazole with various means of general therapeutic correction, external therapy, surgical treatment, as shown in a number of studies, the cure can be increased to 87–95%. When prescribing itraconazole, adverse reactions developed in 7–12.5% ​​of patients, especially with long-term use and doubling the doses of the drug. Most often (in 5.2% of cases), nausea, discomfort and pain in the abdomen, a feeling of fullness in the stomach, and constipation were noted. A number of patients had a transient increase in the level of hepatic transaminases.

Fluconazole was synthesized in 1982 and is the third representative of the azole class in the domestic pharmaceutical market. It is a water-soluble bistriazole compound. The mechanism of its action is similar to other antimycotics from the azole group and consists in inhibiting the formation of ergosterol. The drug has a high specificity with respect to cytochrome P-450-dependent fungal enzymes and does not adversely affect steroidogenesis and other metabolic processes in the human body. Fluconazole differs from other drugs in hydrophilicity, it is almost completely adsorbed and absorbed regardless of food intake. It is characterized by high (up to 90%) bioavailability and rapid accumulation in high therapeutic concentrations in all tissues of the body. The drug almost does not bind to plasma proteins, and most of it is in free form, which is important when prescribing it to patients with hypoproteinemia. Fluconazole is not actively metabolized in the liver and is excreted unchanged in the urine by 70-90%. The drug is active against fungi of the genus Candida , dermatophytes, Malassezia furfur , pathogens of deep systemic mycoses. The drug is well tolerated, non-toxic, can be used in pediatric practice, including newborns. Most often, fluconazole is used in the treatment of candidal lesions of the skin and mucous membranes, and in the treatment of dermatophytosis – as an alternative remedy. Fluconazole is prescribed according to the pulse therapy regimen, 150 mg once a week. With dermatophytosis of smooth skin, the cure occurs with a duration of treatment of 4-6 weeks. For mycoses of the feet with nail involvement, the standard recommendations for the duration of treatment are 6-12 months, for onychomycosis of the hands – from 4 to 6 months, and the cure occurs in 83-9 months.2% of patients. Abroad, a pulse therapy scheme for onychomycosis is used with the appointment of the drug at a dose of 300 mg per week for 9 months.

Terbinafine (Lamisil) was synthesized abroad in 1983. In Russia, it has been used as a systemic antimycotic since 1992. The drug belongs to a fundamentally new class of synthetic antifungal drugs of the allylamine group. Compared to other antimycotics, terbinafine acts at the earliest stages of sterol metabolism of the cytoplasmic membrane of fungal cells – at the level of the squalene epoxidase cycle, inhibiting the squalene epoxidase enzyme. Lamisil acts on fungal cells in two ways – fungistatically and to a greater extent fungicidal, and therefore the sanitizing effect is achieved by a lower concentration of the drug. The fungistatic effect is associated with inhibition of the formation of the main component of the cell wall of the fungus, ergosterol. The fungicidal effect of the drug is due to the accumulation of large amounts of squalene, which destroy the membrane of fungi. The latter significantly worsen the condition of cell membranes, since, like a sponge, they extract lipid components from them. Gradually accumulating inside the cell, lipid granules eventually rupture the defective cytoplasmic membrane, which eventually leads the fungal cell to death. The undeniable advantages of the drug include its high specificity and selectivity of action specifically on fungal cells , since fungal squalene epoxidase is 10,000 times more sensitive to Lamisil than a similar human enzyme. Terbinafine does not affect the synthesis of human steroidogenic structures, as it does not interact with the enzyme 14a-dimethylase. Due to the fact that squalene epoxidase does not belong to cytochrome P-450 enzymes, Lamisil interacts little with drugs metabolized by this enzyme system. Therefore, the drug can be prescribed to patients with concomitant somatic pathology and taking other medications. Lamisil is well absorbed in the gastrointestinal tract, without requiring any conditions of admission. After 2 hours, more than 70% of the drug is adsorbed. Terbinafine enters the tissues by excretion by the sebaceous glands and simple diffusion. Special distribution routes (due to its lipophilicity) include lymphatic transport, which allows the drug to quickly reach infiltrative-suppurative lesions in complicated forms of dermatophytosis. The pronounced lipophilicity of Lamisil ensures accumulation in tissues rich in keratin and / or lipids: in the dermis, the stratum corneum of the skin, hair follicles, nails and hair. After 2 weeks from the start of treatment, the concentration of Lamisil in the stratum corneum significantly exceeds the therapeutic values ​​and remains at a high level for a long time after discontinuation. Lamisil enters the nails the slowest of all due to their considerable thickness, lower lipid content and the possibility of getting into them only by sweating through the vessels of the nail bed and matrix. At the same time, the achieved therapeutic concentration remains stable in the nail for a long time even after discontinuation of the drug. Lamisil is active primarily against dermatophytes, as well as some types of yeast-like fungi , less against mold fungi and pathogens of deep mycoses. The drug has been used by clinicians around the world for 20 years (in our country 10 years) and is unsurpassed in patients with skin and nail dermatophytosis (78.3-100% cure rate). The high therapeutic efficacy of the antimycotic is combined with high safety, since it has the lowest minimum inhibitory concentration (MIC) against dermatophytes compared to systemic antimycotics of the azole group. Conducted numerous studies in our country and abroad have shown that when prescribing Lamisil at a dose of 250 mg per day for 2 weeks, mycotic foci on the skin regressed in 100% of patients, after 6–8 weeks in 9Onychomycosis of the hands was cured in 2.6-94% of patients, and after 9-12 weeks – onychomycosis of the feet. The high therapeutic possibilities of Lamisil in patients with trichomycosis were noted in the works of domestic and foreign dermatologists. With arthroponous and zoophilic trichophytosis, infiltrative-suppurative microsporia with 4-8 weeks of treatment, sanitation of foci occurred in 90-93% of patients. Domestic dermatomycologists have made a great contribution to improving the method of using Lamisil in microsporia of the scalp. Increasing the daily dose of lamisil by 50% compared with the traditional allowed to achieve clinical and mycological cure in a greater percentage of patients (86%) versus 77.8% when using the traditional treatment regimen.

Terbinafine is a mild systemic antifungal drug. With long-term therapy in the standard regimen of 250 mg per day, adverse reactions and complications are observed in 5–10.4% of cases. Most often (in 4.9% of patients), they are represented by disorders of the gastrointestinal tract in the form of discomfort and pain in the abdomen, nausea, vomiting, dyspepsia. Most of these symptoms are allergic in nature and are greatly reduced by a hypoallergenic diet. A transient increase in the level of hepatic transaminases and other hepatic complications are rare (in 3.3% of patients). Compared with Lamisil, the frequency of hepatic disorders when taking itraconazole occurs 2 times, and when taking ketoconazole 57 times more often. The drug does not have embryotoxicity, teratogenic and mutagenic effects.

Thus, high therapeutic efficacy, especially against the main pathogens of mycosis of the skin, hair, nails, high safety profile, high level of adsorption, excellent pharmacokinetic properties, the practical absence of resistance of fungi to antimycotics, the possibility of using it together with other drugs, convenient for the patient the mode of administration makes Lamisil the drug of first choice for the treatment of patients with ringworm .

Experience with treatment of uncomplicated smooth skin microsporia with Lamisil 1% spray uMEDp

Zoonotic and anthroponotic microsporia often occurs in children after contact with animals. One of the effective topical preparations for the treatment of microsporia, which do not have an irritating effect on the skin, is Lamisil Spray, a 1% preparation of terbinafine.

Fig. 1. Microsporia in the form of a “ring in a ring”, iris

Fig. 2. Microsporia of the hairy skin of the chin, seborrheic form; the glow of the affected hair in the rays of the Wood’s lamp

Fig. 3. Microsporia of the scalp, trichophytoid form; glow in the rays of a Woods lamp

Fig. Fig. 4. Foci of microsporia on the smooth skin of the shoulder before (A) and after (B) treatment

Microsporia is a zooanthroponotic anthropurgic mycosis of the skin, hair, and sometimes nails, caused by various types of fungi of the genus Microsporum, with a contact mechanism of transmission of the pathogen.

The term “anthropurgic” (Greek) means “associated with human activity” [1].

The Hungarian scientist D. Gruby in 1843 first described the fungi Microsporum, later the French dermatologist and mycologist R. Sabouraud connected the detection of micromycetes with the development of a certain clinical picture of the disease. Microsporia ranks second in prevalence among diseases of mycotic etiology in humans, second only to foot mycoses [2].

Dermatomycetes are divided into 3 groups depending on the predominant habitat: geophilic fungi – living in the soil and rarely causing the development of dermatomycosis; zoophilic – mainly pathogenic for animals, but capable of infecting humans as well; anthropophilic – causing disease in humans and very rarely in animals. Thus, the division is not strict [3, 4].

Ways of transmission

Infection with anthropophilic fungi occurs through direct contact or indirectly, through household items. At present, anthroponotic microsporia is much less common than zoonotic, mainly in the Asian part of Russia and Siberia [5, 6].

The main sources of human infection with zoophilic fungi are cats, and especially kittens, since the latter, on the one hand, are more susceptible to disease due to the imperfection of the immune system and relatively well-developed delicate undercoat – a nutrient medium for microsporums, on the other hand, children contact and play more often with kittens than with adult cats. Up to 80% of all infections occur through direct contact [3]. The main contingent is children aged 6-14 years. Adults are 9–18% of patients, but this ratio did not always exist: in the 1970s–1980s, the proportion of adults among patients with microsporia was only 3–5% [3, 7].

Anthropophilic pathogens ( M. ferrugineum and M. audouinii ) are transmitted directly from person to person or through household items. Mycosis caused by M. canis is most often transmitted from animals, less often from person to person or through household items [3, 4].

The peak incidence of microsporia in central Russia falls on August-October, when there is a maximum prevalence of epizootics among stray animals with which children come into contact both in rural areas and in cities. Thus, there are two “waves” of microsporia – from July to September and from August to October – which are decisive in the formation of the incidence rate.

The incubation period for zoonotic microsporia is 5–8 days, for anthroponotic microsporia it is 4–6 weeks [1, 5].

Clinical picture

The initial manifestations of anthroponotic microsporia of smooth skin are similar to those of superficial trichophytosis. Foci with clear boundaries, often merge into figures of bizarre outlines. In the foci, the primary elements can be vesicles or nodules (depending on the reactivity of the body and the formation of allergies), the secondary ones are crusts. More often, 1-2 large foci are observed, in the classical version – in the form of iris .

In anthroponotic microsporia of the hairy skin, the foci are often small, multiple, located in the marginal zones; inflammatory phenomena in the foci are slightly expressed, fine-lamellar peeling is observed; not all hairs break off, at different levels – from 2 to 8 mm above the skin (Fig. 1).

With zoonotic microsporia of smooth skin, the foci are small, often multiple, with a tendency to merge, 1–2 cm in size, visually difficult to distinguish from foci with superficial trichophytosis, although there are usually more foci with microsporia; eyebrows and eyelashes are more often affected, vellus hairs are involved in the process at 80–90% of cases. Microsporides are often recorded – allergic rashes in the form of erythematous-squamous or lichenoid nodules, rarely – with a violation of the general condition, fever [2, 6].

Zoonotic microsporia of the scalp – 1-2 large foci up to 3-5 cm in size, with clear boundaries and scaly flaking on the surface; on the periphery, multiple small screenings are often observed, also giving resemblance to superficial trichophytosis. The hairs in the foci are broken off at the same level, 6–7 mm (Fig. 2) [2, 6].

Modern pathomorphosis

the occurrence of infiltrative-suppurative microsporia has increased, sometimes up to the formation of kerion Celsii; vesicular rashes in the foci are more common (evidence of severe allergy to fungi). Such forms of microsporia, when localized on the scalp, are often accompanied by a reaction of the lymph nodes.

Clinical manifestations of microsporia caused by geophilic microsporums (rare, sporadic cases) are indistinguishable from those of zoonotic microsporia, but the process is localized mainly on the hands, occurs in persons who often come into contact with the soil (“gardener’s mycosis”).

Pathomorphology

In the hair follicles, an infiltrate of leukocytes, acanthosis, spongiosis is determined; in the stratum corneum – a few spores, elements of mycelium; with infiltrative and suppurative forms – edema of the papillary layer, swelling of the vascular endothelium, suppuration [8, 9].

Diagnosis

Microscopic examination of hair in 10% aqueous KOH solution looks like it is surrounded by a “sheath” of mosaically arranged spores (Adamson’s sheath). In the thickness of the hair, mainly mycelial filaments are found, as well as in scales from smooth skin [10].

Species of the fungus can be determined by culture. With microscopic examination, an experienced laboratory assistant can distinguish three large groups of fungi: dermatomycetes, molds, yeasts and yeast-like fungi [9, 10].

The diagnosis of microsporia is confirmed by the detection of luminescence in the rays of a Wood’s lamp (with a wavelength of 325–380 nm): a green glow of the affected hair, more intense (emerald) – with anthroponotic microsporia (Fig. 3).

Treatment

Smooth skin microsporia without vellus hair usually takes up to 12 days (excluding cure control, which takes another 15 days), vellus hair microsporia and multifocal microsporia 20 days, scalp microsporia – 30 days (subject to systemic griseofulvinotherapy, since without it, the treatment of microsporia of the scalp is delayed for 4-6 months).

Until now, it was believed that the best method for treating smooth skin microsporia without damage to vellus hair is the combined use of 2% iodine tincture and antifungal ointments: sulfuric salicylic tar, clotrimazole (Candide), bifonazole (Mycospor), ciclopiroxolamine (Batrafen). Ketoconazole (Nizoral) and terbinafine have a good effect on mycoses caused by fungi of the genus Trichophyton, but in microsporia they are not so active when applied systemically [11, 12], in contrast to the external one, in which terbinafine creates fungicidal concentrations [13, 14].

In case of microsporia occurring with a pronounced exudative component, microsporides and vesiculation, it is recommended to replace the vaseline or lanolin-vaseline base at the beginning of treatment with Unguentum Zinci ; along with an antifungal drug has an anti-inflammatory and drying effect. In this case, it is useful to replace the tincture of iodine with Fukortsin (Castellani liquid). We do not recommend, even with a pronounced exudative component, to start microsporia therapy with Mycozolon, Triderm, etc. complex ointments containing corticosteroids: against the background of their use in microsporia of smooth skin, vellus hair is very often involved in the process, that is, the fungus is literally “driven into the hair”.

The main complication of external therapy is the so-called irritant dermatitis – skin irritation caused by iodine, tar and other antifungal drugs, so there is a constant search for new external drugs that do not irritate. One such drug is Lamisil Spray, a 1% terbinafine drug. Lamisil® is the original drug of terbinafine.

An original drug is a drug that has been synthesized for the first time and has passed a full cycle of research, the active ingredients of which are protected by a patent for a certain period. Terbinafine was developed in 1983 by the Swiss company Sandoz, which later became part of the pharmaceutical concern NOVARTIS.

The fungicidal effect of terbinafine on dermatomycetes is known to be due to the accumulation of squalene due to blocking of the enzyme cascade at the stage of cell wall ergosterol synthesis [12, 15].

The drug has a wide spectrum of action against pathogenic fungi: dermatomycetes, mold fungi, fungi of the genus Malassezia , as well as fungi of the genus Candida (for the treatment of which azoles are the drugs of choice).

Attention is drawn to the features of the pharmacokinetics of terbinafine: rapid accumulation in all layers of the epidermis in fungicidal concentration after a single application. The rapid formation of fungicidal concentration is generally characteristic of all dosage forms of terbinafine (cream, derm-gel, spray).

The death of dermatomycetes occurs at a very low concentration of the drug –

0.003 µg/ml, for microsporums – 0.01 µg/ml [11, 13].

Another very important property of external preparations of terbinafine is that after the end of the course of treatment, the fungicidal concentration in the skin remains up to 10 days.

With ringworm of smooth skin caused by Trichophyton rubrum , as well as with exudative mycosis of the feet, the course of treatment is quite short – 2 weeks (2 times a day), its effectiveness is confirmed by laboratory tests [11].

A low percentage (12%) of dermatomycosis recurrence has been reported after treatment with terbinafine.

When used externally, the drug has, in addition to fungicidal, anti-inflammatory and antibacterial action; spray 1% Lamisil® also has a cooling, drying, antipruritic effect [16].

Despite the fact that the specially developed dosage form of Lamisil® 1% spray penetrates well into the skin in the lesion, the drug enters the systemic circulation in very small quantities, which is due to the absence of undesirable and side effects.

Spray 1% Lamisil® is indicated for fungal infections of the feet and hands (especially with an exudative component), mycoses of smooth skin, pityriasis versicolor (varicolored) lichen, mycoses of large folds, microsporia and trichophytosis of the scalp (as part of combination therapy).

In case of mycosis of the scalp, mycosis with exudation, the manufacturer recommends applying a spray of 1% Lamisil® 2 times a day for 2 weeks [6, 11].

Materials and methods

Under our supervision there were 12 patients, 10 patients with widespread microsporia of smooth skin (more than 5 foci), 2 patients with microsporia of the hairy skin of the chin (boys 16 years old) and pubis (girl 14 years old). The age of the patients ranged from 12 to 16 years.

In 5 out of 12 patients, the skin process was characterized as very common, with 12–16 lesions, localized in the back, chest, forearms and shoulders. In 4 patients, the process was characterized as widespread, represented by 7–8 foci, localized on the skin of the abdomen and thighs. In 3 more patients, the process was limited in nature with the number of foci 3–5, but among these patients there were 2 patients with lesions of the hairy skin of the chin (Fig. 2) and pubis.

Lesions on smooth skin were represented by rounded or oval figures up to 2 cm in size, with clear boundaries and a peripheral ridge. In eight out of 12 patients, part of the foci had the form of a “ring in a ring”. Peeling in the foci was represented by small plates in 10 cases out of 12; in 6 cases out of 12, the formation of cortical scales in the region of the peripheral ridge also took place.

The lesion of the scalp in one young man was represented by diffuse small-lamellar peeling on a slightly erythematous background, without the formation of a peripheral ridge, and this form of microsporia was characterized by us as seborrheic. In the rays of the Wood’s lamp, an intense glow of the affected long hair was observed (Fig. 3).

In the lesions on the hairy skin of the pubis, one girl showed peeling against a pronounced erythematous background; foci 1.5–2 cm in size with the formation of a peripheral ridge of small nodules; there were 4 foci in total, partly with a tendency to merge. In the rays of the Wood’s lamp, the glow of broken hair was determined.

On smooth skin in 7 out of 12 patients, the luminescence of vellus hair was determined in the rays of the Wood’s lamp.

Lamisil® 1% Spray was prescribed to 5 patients by a combined method: Lamisil spray was applied in the morning, Exoderil cream was rubbed in the evening.

Another 5 patients received Lamisil® 1% Spray twice a day, morning and evening. This group included 2 boys and 3 girls with widespread microsporia in the neck and chest area and a developed cover of vellus hair.

In 2 patients with lesions of the scalp of the chin and pubis, two times the application of a spray of 1% Lamisil® was combined with the appointment of itraconazole 200 mg orally 1 time per day for 21 days. Spray 1% Lamisil® in these two patients was applied 2 times a day for 14 days, after which the treatment was continued with a cream containing bifonazole.

The effectiveness of therapy in patients with microsporia was evaluated according to the following criteria: resolution of inflammation, cessation of formation of exudative cortical scales, absence of luminescence in the foci, resolution of the peripheral ridge, absence of elements of pathogenic fungi in scrapings, determined three times in accordance with the Instructions for the treatment and prevention of microsporia Ministry of Health and Social Development of the Russian Federation.

Of the 12 patients with microsporia, 4 with smooth skin lesions had an exudative form, with a large number of cortical scales. Itching, as a non-permanent symptom, was observed in 6 out of 12 patients.

Results of treatment

During the first three days of application of Lamisil® 1% Spray, four out of 12 patients noted a sensation of tingling, including two patients with exudative mycosis. Later, these feelings disappeared. By the 5th day of therapy with a spray of 1% Lamisil®, a decrease in the severity of exudation in the foci was observed.

A clear trend towards resolution of lesions on smooth skin without damage to vellus hair was noted by the 7th day of treatment in both groups (Fig. 4). By the 12th day of therapy, hyperemia in the foci was practically resolved, the peripheral ridge flattened and disappeared (Fig. 4).

In no case during the treatment period were registered fresh rashes.

The timing of the disappearance of the luminescence of the affected hair in the groups with the combined use of 1% Lamisil® spray and Exoderil cream and in the groups with two times the application of Lamisil® 1% spray did not differ significantly and amounted to 9-12 days.

In the first group of patients who received 1% Lamisil® spray in the morning and Exoderil cream in the evening, patients with exudative form had a faster discharge and resolution of cortical scales 1–2 days earlier. At the same time, the resolution of infiltrative elements, the papular peripheral ridge went more quickly, also by 1–2 days on average, in the second group with the use of Lamisil® 1% spray 2 times a day.

In 2 patients with microsporia of the pilar skin of the chin and pubis, who received combination therapy with Lamisil® 1% external spray for 14 days, bifonazole cream for 6 days, and oral itraconazole for 21 days, the total duration of treatment was 21 days.

Discussion

The efficacy of terbinafine treatment in patients with smooth skin microsporia, including those with vellus hair disease, has been repeatedly demonstrated in many randomized trials. Our experience can also serve as an example of the effectiveness of terbinafine preparations.

Lamisil® 1% spray dosage form is convenient for the treatment of common fungal infections with a large area of ​​involvement. This achieves both an antifungal effect and an effect on other components of the pathological process (elimination or reduction of itching, resolution of infiltration and peeling).

A distinctive and very valuable feature of the dosage form of Lamisil® 1% spray is a very good penetration of the active substance into the horny structures and even into the vellus hair, with almost complete absence of its entry into the systemic circulation.

With multiple foci, it is advisable to prescribe systemic therapy with griseofulvin, but for a shorter period than with microsporia of the scalp, 2–3 weeks [17].

Treatment of microsporia of the scalp is advisable to carry out in a hospital, where there is the possibility of a full treatment of lesions, depilation of the affected hair. Inpatient treatment is especially indicated in the presence of contraindications to systemic therapy with griseofulvin [17].