Comparative Efficacy of Terbinafine, Itraconazole, and Griseofulvin in Treatment of Steroid-Modified Tinea.

BACKGROUND

Steroid-modified tinea or tinea incognito has emerged as a significant challenge in India due to the widespread misuse of topical corticosteroids, leading to chronic, treatment-resistant dermatophytosis.

AIM AND

OBJECTIVES

This study was performed to compare the efficacy and safety of antifungal drugs: oral terbinafine, itraconazole, and griseofulvin in the treatment of steroid-modified tinea. In addition, patient awareness about steroid misuse and consequent impact on quality of life were also assessed.

PATIENTS AND

METHODS

A total of 90 potassium hydroxide (KOH)-positive patients ( ≥18 years) with tinea corporis, cruris, or faciei, having a history of prior topical steroid use, were randomly assigned to receive terbinafine (250 mg twice a day), itraconazole (100 mg twice a day), or griseofulvin (500 mg twice a day) for eight weeks ( n = 30 each). Clinical severity scores, cure rates, dermatology life quality index (DLQI) scores, steroid misuse patterns, and any adverse drug reactions reported were recorded for each patient.

RESULTS

The group treated with itraconazole showed highest cure rate (70%) at eight weeks, followed by terbinafine (36.7%) and griseofulvin (26.7%) ( P = 0.529). Clinical severity scores reduced significantly in all three groups by the end of eight weeks (within-group comparison P = 0.001). DLQI scores improved most with itraconazole ( P = 0.003). Regarding a prior history of steroid use in the study population, the misuse of clobetasol propionate was seen in 46.7-76.7%, with 90-100% of patients being unaware of steroid content or its side effects.

LIMITATIONS: Limited sample size may have limited statistical ability to detect significant cure rates. Despite intention-to-treat analysis, loss of follow-up may introduce bias. Baseline differences in gender and comorbidities among the study groups may have confounded the observed outcomes. Additionally, the lack of blinding may have influenced outcome assessment.

CONCLUSION

Itraconazole appears to be the most effective for steroid-modified tinea, with superior clinical and quality-of-life outcomes. Steroid misuse, driven by pharmacist recommendations, underscores the need for public health interventions.