Comparative safety and efficacy evaluation of terbinafine and itraconazole: dose-based monotherapy versus combination therapy in the management of dermatophytosis: a pilot study in Bangladesh

Afsana Nahid; Sharmin Jahan; Muhammed Kamrul Hassan; Mohammad Anwarul Hassan; Toioba Akter; Ayesha Siddika; Rashed Mohammad Khan; Mohammed Emdadul Haque; Sabrina Hossain Chaitee; S. M. Hasinur Rahman

doi:10.18203/issn.2455-4529.IntJResDermatol20261928

Authors

Afsana Nahid Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Sharmin Jahan Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Muhammed Kamrul Hassan Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Mohammad Anwarul Hassan Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Toioba Akter Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Ayesha Siddika Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Rashed Mohammad Khan Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Mohammed Emdadul Haque Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
Sabrina Hossain Chaitee Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh
S. M. Hasinur Rahman Department of Dermatology and Venereology, Dhaka Medical College and Hospital, Secretariat Road, Shahbag, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20261928

Keywords:

Dermatophytosis, Itraconazole, Terbinafine, Anti-fungal resistance

Abstract

Background: Dermatophytosis is highly prevalent in South Asia and increasingly chronic and treatment‑resistant, with poor responses to standard systemic regimens in Bangladesh. This study compared dose‑based terbinafine and itraconazole monotherapies and their combination to identify an optimal regimen.

Methods: In a randomized, open‑label, parallel‑group trial at a tertiary hospital, adults (18-60 years) with KOH‑confirmed tinea corporis/cruris/faciei were assigned to: T1 (terbinafine 250 mg/day), I1 (itraconazole 200 mg/day), T+I (terbinafine 250 mg+itraconazole 200 mg/day), T2 (terbinafine 500 mg/day), or I2 (itraconazole 400 mg/day). Follow‑up at weeks 2, 4, 6 and 8 assessed total symptom score (itching, erythema, scaling; 0-9), Physician global assessment, composite cure (clinical plus negative KOH) and safety.

Results: One hundred fifty patients (30/group) were randomized with comparable baselines. Symptom scores declined significantly in all arms (p<0.001 within‑group). Week‑8 composite cure was highest with I2 (96.3%), followed by T+I (89.7%) and I1 (83.3%); T1 and T2 had higher failure (both 51.9%). Adverse events were mild and infrequent.

Conclusions: Itraconazole, particularly 400 mg/day, achieved the best efficacy with good tolerability, whereas escalating terbinafine to 500 mg/day conferred no benefit. Treatment of contemporary dermatophytosis in Bangladesh should prioritise itraconazole‑based regimens.

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