Author:
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1.
Das S, De A, Saha R, Sharma N, Khemka M, Singh S, Reja AHH, Kumar P, 2020. The current indian epidemic of dermatophytosis: a study on causative agents and sensitivity patterns. Indian J Dermatol 65: 118–122.
-
2.
Rudramurthy SM, Shankarnarayan SA, Dogra S, Shaw D, Mushtaq K, Paul RA, Narang T, Chakrabarti A, 2018. Mutation in the squalene epoxidase gene of Trichophyton interdigitale and Trichophyton rubrum associated with allylamine resistance. Antimicrob Agents Chemother 62: e02522–e17.
-
3.
Sardana K, Gupta A, 2017. Rational for drug dosimetry and duration of terbinafine in the context of recalcitrant dermatophytosis: is 500 mg better than 250 mg OD or BD? Indian J Dermatol 62: 665–667.
-
4.
Sardana K, Khurana A, Gupta A, 2019. Parameters that determine dissolution and efficacy of itraconazole and its relevance to recalcitrant dermatophytosis. Expert Rev Clin Pharmacol 12: 443–452.
-
5.
Artis WM, Odle BM, Jones HE, 1981. Griseofulvin-resistant dermatophytosis correlates with in vitro resistance. Arch Dermatol 117: 16–19.
-
6.
Gupta AK, Lyons DC, 2015. The rise and fall of oral ketoconazole. J Cutan Med Surg 19: 352–357.
-
7.
Bishnoi A, Vinay K, Dogra S, 2018. Emergence of recalcitrant dermatophytosis in India. Lancet Infect Dis 18: 250–251.
-
8.
Sardana K, 2021. Recalcitrant dermatophytoses. Sardana K, Mahajan K, Mrig PA, eds. Fungal Infections: Diagnosis and Treatment, 2nd edition. New Delhi, India: CBS Publishers & Distributors, 180–195.
-
9.
Sardana K, Khurana A, 2018. Overview of causes and treatment of recalcitrant dermatophytosis. Sardana K, Khurana A, eds. IADVL Manual on Management of Dermatophytosis, 1st edition. New Delhi, India: CBS Publishers & Distributors, 80–104.
-
10.
Khurana A, Masih A, Chowdhary A, Sardana K, Borker S, Gupta A, Gautam RK, Sharma PK, Jain D, 2018. Correlation of invitro susceptibility based on MICs and SQLE mutations with clinical response to terbinafine in patients with tinea corporis/cruris. Antimicrob Agents Chemother 62: e01038–e18.
-
11.
Singh S, Chandra U, Anchan VN, 2020. 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. Br J Dermatol 183: 840–846.
-
12.
Mahajan S, Tilak R, Kaushal SK, Mishra RN, Pandey SS, 2017. Clinico-mycological study of dermatophytic infections and their sensitivity to antifungal drugs in a tertiary care center. Indian J Dermatol Venereol Leprol 83: 436–440.
-
13.
Pathania S, Rudramurthy SM, Narang T, Saikia UN, Dogra S, 2018. A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital. Indian J Dermatol Venereol Leprol 84: 678–684.
-
14.
Sardana K, Kaur R, Arora P, 2018. Antifungal resistance a cause for treatment failure in dermatophytosis: a study focused on tinea corporis and cruris from a tertiary centre? Indian Dermatol Online J 9: 90–95.
-
15.
Sardana K, Arora P, Mahajan K, 2018. Intracutaneous pharmacokinetics of oral antifungals and their relevance in recalcitrant cutaneous dermatophytosis: time to revisit basics. Indian J Dermatol Venereol Leprol 83: 730–732.
-
16.
Daneshmend TK, Warnock DW, 1988. Clinical pharmacokinetics of ketoconazole. Clin Pharmacokinet 14: 13–34.
-
17.
Tigga RA, Das S, Bhattacharya SN, Saha R, Mushtaq K, Paul RA, Narang T, Chakrabarti A, 2018. Burden of chronic dermatophytosis in a tertiary care hospital: interaction of fungal virulence and host immunity. Mycopathologia 183: 951–959.
-
18.
Yan JY, Nie XL, Tao QM, Zhan SY, Zhang YD, 2013. Ketoconazole associated hepatotoxicity: a systematic review and meta- analysis. Biomed Environ Sci BES. 26: 605–610.
-
19.
Greenblatt HK, Greenblatt DJ, 2014. Liver injury associated with ketoconazole: review of the published evidence. J Clin Pharmacol 54: 1321–1329.
-
20.
Food and Drug Administration, 2013 FDA drug safety communication: FDA limits usage of Nizoral (ketoconazole) oral tablets due to potentially fatal liver injury and risk of drug interactions and adrenal gland problems. Available at: http://www.fda.gov/drugs/drugsafety/ucm362415.htm. Accessed February 12, 2021.
-
21.
Kyriakidis I, Tragiannidis A, Munchen S, Groll AH, 2017. Clinical hepatotoxicity associated with antifungal agents. Expert Opin Drug Saf 16: 149–165.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1147 | 400 | 43 |
| Full Text Views | 119 | 70 | 0 |
| PDF Downloads | 128 | 71 | 0 |
Real World Analysis of Response Rate and Efficacy of Oral Ketoconazole in Patients with Recalcitrant Tinea Corporis and Cruris
Pooja Arora
Pooja Arora
Dermatology, Dr. RML Hospital & PGIMER, New Delhi, India;
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Kabir Sardana
Kabir Sardana
Dermatology, Dr. RML Hospital & PGIMER, New Delhi, India;
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Anita Kulhari
Anita Kulhari
Dermatology, Dr. RML Hospital & PGIMER, New Delhi, India;
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Ravinder Kaur
Ravinder Kaur
Microbiology, Lady Hardinge Medical College, New Delhi, India;
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Deepti Rawat
Deepti Rawat
Microbiology, Lady Hardinge Medical College, New Delhi, India;
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Sanjeet Panesar
Sanjeet Panesar
Community Medicine, Dr. RML Hospital & PGIMER, New Delhi, India
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ABSTRACT.
Recalcitrant dermatophytosis has had an alarming rise in India with concomitant decreased effectiveness of conventional antifungal agents. This has prompted the use of second-line agents for treatment. In this retrospective study, we aimed to analyze the response rate, efficacy, relapse rate, and side effects of oral ketoconazole (KZ) in the treatment of recalcitrant tinea corporis and cruris. Institutional records were reviewed for patients presenting with tinea cruris or corporis who had failed treatment with conventional antifungal drugs and treated with oral KZ. Potassium hydroxide (KOH) findings, culture reports, and response to treatment was noted based on the percentage improvement in lesions and reduction in itching compared with baseline. Fourty-three patients (mean age 31.3 years) with tinea corporis/cruris who had taken prior treatment with antifungals were recruited in the study. KOH mount and culture were positive in 76.7% patients. Trichophyton mentagrophytes was the commonest species, isolated in 62.8% of patients. Ketoconazole showed the lowest minimum inhibitory concentration on antifungal susceptibility tests with various antifungals. With a dose of 400 mg daily, 67.4% of patients were cured of disease with mean duration of 9.4 weeks. Patients having less than 40% clearance at 2 weeks had a 68.9% less probability of getting cured of disease. Of the 29 patients cured, 37.9% relapsed because of various predisposing factors. Two patients developed increase in liver enzymes on treatment. Our analysis suggests that KZ can be used as alternative drug in cases with failure to conventional antifungal drugs. Though there are relapses, these can be partially explained by various predisposing factors that support fungal survival and transmission.
Author Notes
Authors’ addresses: Pooja Arora, Kabir Sardana, and Anita Kulhari, Dermatology, Dr RML Hospital & PGIMER, New Delhi, India, E-mails: drpoojamrig@gmail.com, article.sardana@gmail.com, and anitakulhari2008@gmail.com. Ravinder Kaur and Deepti Rawat, Microbiology, Lady Hardinge Medical College, New Delhi, India, E-mails: drkaur@hotmail.com and rawatdeepti@hotmail.com. Sanjeet Panesar, Community Medicine, Dr RML Hospital & PGIMER, New Delhi, India, E-mail: panesarsanjeet@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Das S, De A, Saha R, Sharma N, Khemka M, Singh S, Reja AHH, Kumar P, 2020. The current indian epidemic of dermatophytosis: a study on causative agents and sensitivity patterns. Indian J Dermatol 65: 118–122.
-
2.
Rudramurthy SM, Shankarnarayan SA, Dogra S, Shaw D, Mushtaq K, Paul RA, Narang T, Chakrabarti A, 2018. Mutation in the squalene epoxidase gene of Trichophyton interdigitale and Trichophyton rubrum associated with allylamine resistance. Antimicrob Agents Chemother 62: e02522–e17.
-
3.
Sardana K, Gupta A, 2017. Rational for drug dosimetry and duration of terbinafine in the context of recalcitrant dermatophytosis: is 500 mg better than 250 mg OD or BD? Indian J Dermatol 62: 665–667.
-
4.
Sardana K, Khurana A, Gupta A, 2019. Parameters that determine dissolution and efficacy of itraconazole and its relevance to recalcitrant dermatophytosis. Expert Rev Clin Pharmacol 12: 443–452.
-
5.
Artis WM, Odle BM, Jones HE, 1981. Griseofulvin-resistant dermatophytosis correlates with in vitro resistance. Arch Dermatol 117: 16–19.
-
6.
Gupta AK, Lyons DC, 2015. The rise and fall of oral ketoconazole. J Cutan Med Surg 19: 352–357.
-
7.
Bishnoi A, Vinay K, Dogra S, 2018. Emergence of recalcitrant dermatophytosis in India. Lancet Infect Dis 18: 250–251.
-
8.
Sardana K, 2021. Recalcitrant dermatophytoses. Sardana K, Mahajan K, Mrig PA, eds. Fungal Infections: Diagnosis and Treatment, 2nd edition. New Delhi, India: CBS Publishers & Distributors, 180–195.
-
9.
Sardana K, Khurana A, 2018. Overview of causes and treatment of recalcitrant dermatophytosis. Sardana K, Khurana A, eds. IADVL Manual on Management of Dermatophytosis, 1st edition. New Delhi, India: CBS Publishers & Distributors, 80–104.
-
10.
Khurana A, Masih A, Chowdhary A, Sardana K, Borker S, Gupta A, Gautam RK, Sharma PK, Jain D, 2018. Correlation of invitro susceptibility based on MICs and SQLE mutations with clinical response to terbinafine in patients with tinea corporis/cruris. Antimicrob Agents Chemother 62: e01038–e18.
-
11.
Singh S, Chandra U, Anchan VN, 2020. 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. Br J Dermatol 183: 840–846.
-
12.
Mahajan S, Tilak R, Kaushal SK, Mishra RN, Pandey SS, 2017. Clinico-mycological study of dermatophytic infections and their sensitivity to antifungal drugs in a tertiary care center. Indian J Dermatol Venereol Leprol 83: 436–440.
-
13.
Pathania S, Rudramurthy SM, Narang T, Saikia UN, Dogra S, 2018. A prospective study of the epidemiological and clinical patterns of recurrent dermatophytosis at a tertiary care hospital. Indian J Dermatol Venereol Leprol 84: 678–684.
-
14.
Sardana K, Kaur R, Arora P, 2018. Antifungal resistance a cause for treatment failure in dermatophytosis: a study focused on tinea corporis and cruris from a tertiary centre? Indian Dermatol Online J 9: 90–95.
-
15.
Sardana K, Arora P, Mahajan K, 2018. Intracutaneous pharmacokinetics of oral antifungals and their relevance in recalcitrant cutaneous dermatophytosis: time to revisit basics. Indian J Dermatol Venereol Leprol 83: 730–732.
-
16.
Daneshmend TK, Warnock DW, 1988. Clinical pharmacokinetics of ketoconazole. Clin Pharmacokinet 14: 13–34.
-
17.
Tigga RA, Das S, Bhattacharya SN, Saha R, Mushtaq K, Paul RA, Narang T, Chakrabarti A, 2018. Burden of chronic dermatophytosis in a tertiary care hospital: interaction of fungal virulence and host immunity. Mycopathologia 183: 951–959.
-
18.
Yan JY, Nie XL, Tao QM, Zhan SY, Zhang YD, 2013. Ketoconazole associated hepatotoxicity: a systematic review and meta- analysis. Biomed Environ Sci BES. 26: 605–610.
-
19.
Greenblatt HK, Greenblatt DJ, 2014. Liver injury associated with ketoconazole: review of the published evidence. J Clin Pharmacol 54: 1321–1329.
-
20.
Food and Drug Administration, 2013 FDA drug safety communication: FDA limits usage of Nizoral (ketoconazole) oral tablets due to potentially fatal liver injury and risk of drug interactions and adrenal gland problems. Available at: http://www.fda.gov/drugs/drugsafety/ucm362415.htm. Accessed February 12, 2021.
-
21.
Kyriakidis I, Tragiannidis A, Munchen S, Groll AH, 2017. Clinical hepatotoxicity associated with antifungal agents. Expert Opin Drug Saf 16: 149–165.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1147 | 400 | 43 |
| Full Text Views | 119 | 70 | 0 |
| PDF Downloads | 128 | 71 | 0 |