New multiple therapy of resistant and relapsing dermatophyte infections during epidemic status

Abstract

Background Resistant dermatophytosis is now running in many countries where fungal skin infection is a major health problem like Iraq and neighboring countries. Objective To evaluate the efficacy of a new therapeutic regimen in the treatment of resistant dermatophytosis using multiple drug therapies Patients and Methods: This is a prospective therapeutic study where 400 patients with varying types of dermatophytosis were included and treated by new 2 phases of therapy, each four weeks period and as follow: Phase one using combination of oral terbinafine and oral ketoconazole and topical terbinafine cream plus selenium sulfide shampoo. While phase two including combination of oral terbinafine and oral itraconazole and topical terbinafine cream plus ketoconazole shampoo to achieve complete cure rate. Follow-up was done for eight weeks to record relapse of fungal infection.  Results This study included 400 patients with chronic relapsing dermatophytosis, 250 (62.5%) males and 150(37.5%) females, their ages ranged from 6 -70 years. The duration of the disease ranged from 6-32 months with a mean of 11 months. The response to the phase one therapeutic regimen started after 5-7 days by decreasing in the redness, itching, inflammation, and scales. An obvious response was seen at the end of the first two weeks while full complete recovery response was achieved after four weeks. While phase two also showed 100% obvious cure rate. Follow up for eight weeks showed 2% relapse rate. This combination was well tolerated with no serious systemic or topical adverse effects were recorded in most of the patients.  Conclusion This new therapeutic multiple drug therapy is effective in all included types of dermatophytosis especially with chronic resistant course of the disease with very low relapse rate.