Is terbinafine (antifungal medication) effective for treating intertrigo of fungal origin?

Terbinafine for Intertrigo of Fungal Origin

Topical terbinafine is an effective treatment for fungal intertrigo, with topical antifungal agents being the first-line treatment for Candida intertrigo and dermatophyte-related intertrigo. 1

Mechanism of Action and Efficacy

• Terbinafine is an allylamine antifungal that works by inhibiting squalene epoxidase in the fungal cell wall biosynthetic pathway, resulting in both depletion of ergosterol (fungistatic effect) and accumulation of squalene (fungicidal effect) 2
• It is highly effective against dermatophytes with fungicidal activity, making it particularly valuable for dermatophyte infections 3
• For Candida species, terbinafine has fungistatic rather than fungicidal activity 3
• Topical terbinafine 1% formulations applied once or twice daily for up to 2 weeks achieve mycological cure in >80% of patients with tinea corporis/cruris and cutaneous candidiasis 3

Treatment Approach for Fungal Intertrigo

• For intertrigo of fungal origin, topical antifungal agents are the first-line treatment 1
• For Candida intertrigo specifically, topical antifungal agents are the treatment of choice 1
• For dermatophyte-related intertrigo (tinea corporis), topical agents such as azoles, terbinafine, or tolnaftate are recommended 1
• Topical terbinafine 1% cream applied twice daily has shown clinical efficacy rates of around 80% in cutaneous dermatophyte infections 4

Considerations for Treatment Selection

• The choice between topical terbinafine and other antifungals should consider:
  • The causative organism (terbinafine is most effective against dermatophytes) 3
  • The extent and severity of the infection 1
  • Patient factors such as compliance and tolerability 1
• Predisposing factors for intertrigo should be identified and addressed for optimal treatment outcomes 1

Special Considerations

• For therapy-resistant cases or extensive infections, systemic antifungal therapy may be necessary 5
• In one case report, systemic and topical terbinafine led to clinical improvement in interdigital intertrigo caused by Fusarium solani, though mycological cure was not achieved 5
• For non-dermatophyte or mixed infections, the efficacy of terbinafine may be more limited and should be evaluated on a case-by-case basis 3

Safety Profile

• Topical terbinafine is generally well-tolerated with minimal side effects 3
• Common side effects of oral terbinafine include gastrointestinal disturbances and dermatological events such as nausea, diarrhea, taste disturbance, rash, and pruritus 2
• Rare but serious adverse reactions with oral therapy include Stevens-Johnson syndrome, toxic epidermal necrolysis, and hepatic toxicity 2
• Oral terbinafine is contraindicated in patients with active or chronic liver disease, severe kidney disease, lupus erythematosus, and porphyria 2

Treatment Duration

• For cutaneous fungal infections like intertrigo, topical terbinafine typically requires 1-2 weeks of treatment 3
• Mycological cure rates with terbinafine generally improve after treatment cessation, reflecting the drug's fungicidal mechanism and residual effect in tissue 3