Topical terbinafine (Lamisil®) for superficial mycoses:: High cure rates in short treatment times

This review article compares the use of fungicidal terbinafine 1% cream in superficial mycoses with other more established and largely fungistatic agents. Topical azoles need to be applied two or three times daily for 4-6 weeks, whereas terbinafine has achieved cure rates in tinea pedis of 80-90% after only 1 or 2 weeks' treatment. Terbinafine twice daily for 1 week compared with clotrimazole twice daily for 4 weeks has produced mycological cure rates of 97.2% and 83.7%, respectively: a statistically significant result in favour of terbinafine. Terbinafine for 2 weeks produced a mycological cure in 69% of patients with moccasin-type tinea pedis. Treatment for 1-2 weeks with topical terbinafine has produced cure rates of 80-90% in tinea corporis and tinea cruris. Results have been similar in cutaneous candidosis and pityriasis versicolor. Two new terbinafine formulations are discussed: the 1% solution and 1% emulsion gel. One week's treatment with both formulations produces mycological cure rates in tinea pedis of 86% and 88% and in tinea corporis/cruris of 85% and 83%, respectively. Cure rates of 70-76% have been achieved in pityriasis versicolor after 1 week's treatment with the new formulations. The cream, solution and emulsion gel are all well tolerated, Though such newer drugs are relatively expensive, the much reduced duration of treatment and higher cure rates make them more cost-effective.