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Year : 2000  |  Volume : 66  |  Issue : 6  |  Page : 299-300

Comparative Study of Topical Terbinafine and Topical Ketoconazole in Pityriasis Versicolor

Correspondence Address:
Vipul Chopra

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Source of Support: None, Conflict of Interest: None

PMID: 20877107

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Fifty patients suffering from pityriasis versicolor were treated with either 2% ketoconazole cream (25 patients) or 1% terbinafine cream (25 patients). Diagnosis was confirmed by microscopic potassium hydroxide (KOH) examination and either of the cream was applied once daily for a duration of 2 weeks. Global assessment was done at the end of treatment with mycological and clinical cure rate of 88% and 96% in ketoconazole and terbinafine treated groups respectively. After a follow up of 3 months the relapse in ketoconazole group was 13.53% and 8.33% in terbinafine group with no side effects.

Keywords: Pityriasis versicolor, Ketoconazole, Terbinafine

How to cite this article:
Chopra V, Jain V K. Comparative Study of Topical Terbinafine and Topical Ketoconazole in Pityriasis Versicolor. Indian J Dermatol Venereol Leprol 2000;66:299-300

How to cite this URL:
Chopra V, Jain V K. Comparative Study of Topical Terbinafine and Topical Ketoconazole in Pityriasis Versicolor. Indian J Dermatol Venereol Leprol [serial online] 2000 [cited 2020 Jun 5];66:299-300. Available from: http://www.ijdvl.com/text.asp?2000/66/6/299/4952

  Introduction Top

Pityriasis versicolor is a mild superficial, chronically recurring fungal infection with no long term treatment or cure. Though not a life threatening disease, it produces multiple hypo/hyperpigmented macular scaly lesions on the chest, back, neck or face that are disfiguring and embarrassing to the patient. Many topical agents have been used with limited success and high recurrence rate. Because of known hepatotoxicity with oral ketoconazole, an alternative, topical 2% ketoconazole cream is used in pityriasis versicolor.[1] Terbinafine, an allylamine antifungal agent with a primarily fungicidal action is a safe and effective topical formulation for pityriasis versicolor.[2],[3]

  Materials and methods Top

Fifty patients with a clinical diagnosis of pityriasis versicolor confirmed by microscopic potassium hydroxide (KOH) examination were taken for the study. Patients were excluded if they had received any systemic or topical antimycotic therapy within a month of the start of the study or had associated other fungal infections or any serious concomitant illness. Patients who were not willing to come for follow up for 3 months or had extensive pityriasis versicolor or pregnant and lactating females, were also excluded from the study. Twenty five patients were distributed to each group randomly and treated either with 2% ketoconazole cream (Group-I) or 1% terbinafine cream (Group-II) once daily for 2 weeks. Patients were followed up at monthly intervals for 3 months from the start of the study. Clinical assessment in terms of pruritus, scaling and erythema was done on a scale of 0-3 (3-severe, 2-moderate, 1-mild, 0- absent). At the end of the treatment phase, clinical response was assessed globally with the use of a broad scale of healed, mild residual disease, considerable residual disease, unchanged or deteriorated. Patients with assessment in the top two categories, that is, healed and mild residual disease, were considered as responders and the same patients were considered cured if they had negative KOH smear.[1]

  Results Top

Demographic characteristics of the two groups were similar. Group-I and Group-II had an average age of 24.24 years and 23.16 years respectively. Clinical assessment showed no significant difference in erythema, pruritus and scaling between the two groups before and after the treatment. There was 100% clinical response to treatment in both groups. On global assessment, 80% in Group-I and 96% in Group-II were considered healed, leaving 20% in Group-1 and 4% in Group-II with mild residual disease. In Group1 88% were assessed as cured (clinically and mycologically clear) and 96% in Group-II [Table - 1].

All the cured cases remained disease free at the one month follow up. After 2 months, a single patient relapsed in both groups with scaling and positive KOH examination on microscopy. At three months follow up two more patients in Group-I and one in Group-II relapsed. Hematological and biochemical parameters, including liver function tests were within normal limits before and after the treatment. None of the patients in this study complained of any side effects that could be attributed to the treatment.

  Discussion Top

In the present study mycological and clinical cure rate was 88% in ketoconazole group and 96% in terbinafine group. Savin et al[1] found 84% mycological and clinical cure rate in their study while Balwada et al[4] found 90% cure as well as mycological response in ketoconazole treated group. Kagawa[5] reported 90% clinical and mycological response in pityriasis versicolor with 1% terbinafine cream. The results of the present study suggest that the efficacy and safety of 2% ketoconazole cream is siimilar to 1% terbinafine cream in the treatment of pityriasis versicolor.

  References Top

1.Savin RC, Horwitz SN. Double blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor. J Am Acad Dermatol 1986;15: 500-503.  Back to cited text no. 1    
2.Balfour JA, Faulds D. Terbinafine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial mycoses. Drugs 1992; 43: 259-284.  Back to cited text no. 2    
3.Villars V, Jones TC. Clinical efficacy and tolerability of terbinafine (Lamisil), a new topical and systemic fungicidal drug for treatment of dermatomycoses. Clin Exp Dermatol 1989; 14: 124-127.  Back to cited text no. 3    
4.Balwada RP, Jain VK, Dayal S.A double-blind comparison of 2% ketoconazole and 1% clotrimazole in the treatment of pityriasis versicolor. Indian J Dermatol Venereol Leprol 1996; 62: 298-300.  Back to cited text no. 4    
5.Kagawa S. Clinical efficacy of terbinafine in 629 Japanese patients with dermatomycosis. Clin Exp Dermatol 1989; 14:114-115.  Back to cited text no. 5    


[Table - 1]


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