摘要:

SummaryMorphological modifications of growth forms of dermatophyte fungi, arthroconidia and germ tubes exposed to terbinafine incorporated in the stratum corneum were studied by scanning and transmission electron microscopy. Changes observed in arthroconidial morphology included pores and erosions present in the cell wall, with layers peeling off. The cell membrane was destroyed. Dilated vacuoles and small electron‐dense areas were evident in the arthroconidial cytosol. Although germination was partially arrested, inhibition of hyphal extension was seen on all body sites examined. Germ tubes were susceptible to terbinafine. with pores appearing along their length and collapsed hyphae seen following exposure to the drug. This study suggests that the outer and inner layers of the arthroconidial cell wall are the initial targets of terbinafine action, followed by alterations to the cytosol and intracellular organelle

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15650.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThis article describes common cutaneous mycoses in children: mucocutaneous candidiasis, pityriasis versicolor, tinea corporis, tinea pedis, onychomycosis and tinea capitis.Topical therapy is effective in tinea corporis and pedis, pityriasis versicolor and cutaneous candidiasis. It is ineffective in tinea capitis, in immunocompromised children and onychomycosis. Griseofulvin has been the main treatment until now in children, but it is only fungistatic, may cause interactions and has to be given for long periods. Ketoconazole has not been widely accepted for use in children because of hepatotoxicity and it is not as effective as griseofulvin. There are few data on paediatric use of fluconazole, although it is available in liquid form, has an excellent safety profile and may become important for treating paediatric mycoses. Similarly, there are only limited data on itraconazole in this area, with most experience in tinea capitis. There is only a 100–mg capsule available, which is not easy to administer in paediatric dosages. All azoles have the potential for drug interaction.Most experience in the treatment of children with the allylamine, terbinafine, has been in tinea capitis. A treatment time of 4 weeks with terbinafine and 8 weeks with griseofulvin has produced similar results at 12 weeks. There are also limited data on the use of terbinafine in paediatric onychomycosis. Terbinafine has the best safety profile, least risk of drug interactions and may be the most suitable alternative to griseofulvin in children. The lack of a liquid formulation may preclude its use. Itraconazole and fluconazole are also potential replacement drugs for griseofulvi

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15651.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummarySeveral studies indicate thatPityrosporum ovaleplays an important role in seborrhoeic dermatitis. Many of these are treatment studies which describe the effectiveness of antimycotics, paralleled by a reduction in the number of P.ovalecolonies and then recolonization, leading to a recurrence of seborrhoeic dermatitis.In this study 20 patients with seborrhoeic dermatitis of the scalp were treated with terbinafine (Lamisil®) 1% solution once daily for 4 weeks. Eleven of 18 patients (61%) were cured and they were still free of lesions 2 weeks after stopping treatment. No side‐effects related to treatment were seen. There was also a significant reduction in the number of P.ovalecolonies. This may explain both the good clinical effect and the observation that all patients who were cleared of P.ovalewere still free of lesions 2 weeks after stopping treatme

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15652.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryLamisil® (terbinafine) 250 mg daily and itraconazole 200 mg daily were compared in the treatment of dermalophyte toe onychomycosis over 12 weeks in a double‐blind randomized clinical trial. At the end of follow‐up (week 48) treatment with Lamisil® led to negative mycology in 7 3% of patients compared with 45–8% in the itraconazole group (P<00001), Globally the clinical symptoms of the target nail improved, a response which was in favour of Lamisil® (P=0·001), The percentages of patients who were clinically totally cured or who presented with only minimal symptoms were 76′3')() for the Lamisil®‐treated group compared with 58–1% in the itraconazole group. The unaffected nail length for big toes was significantly higher in the Lamisil®‐treated group (9·1 mm vs, 7·7mm; P= 0·0298). Onycholysis was also less in the Lamisil® group (P = 0·001). We conclude that 12 weeks” conlinitous oral therapy leads to higher cure rates with Lamisil® than with itraconazole and that both drugs

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15653.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryE‐selectin endothelial leucocyte adhesion molecule‐1 is expressed on endothelial cells in distinct inflammatory skin diseases. E‐selectin mediates the adhesion between activated endothelium and different inflammatory cells. To evaluate soluble E‐selectin as a marker of disease activity in patients with atopic dermatitis and psoriasis, the concentration of soluble E‐selectin, determined by ELISA, was studied in sera of patients before and after treatment and compared with normal non‐atopic controls. The disease severity was established using clinical scoring systems. Levels of soluble E‐selectin were significantly elevated in sera of patients with atopic dermatitis and psoriasis (as compared with controls). Clinical improvement, after treatment, in patients with atopic dermatitis, but not in psoriasis, was associated with a significant decrease in serum levels of soluble E‐selectin. There was a significant correlation of soluble E‐selectin and disease activity in patients with atopic dermatitis. These data indicate that soluble E‐selectin is another parameter to evaluate the inflammatory response in atopic dermatitis and psoriasis. Determination of soluble E‐selectin may be a useful measure of disease activity

ISSN:0007-0963    

DOI:10.1046/j.1365-2133.1996.d01-740.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryOne–hundred and ninety–five patients with toenail tinea unguium were recruited to a multicentre double–blind clinical trial. Patients were given 250mg terbinafine or 200 mg itraconazole daily for 12 weeks, with follow–up for a further 40 weeks. At the end of the study, mycological cure rates were 81% (70/86 assessed) for terbinafine and 63% (53/84 assessed) for itraconazole (two–tailed, P<0·05). The length of unaffected nail was 9·44 mm in the terbinafine group and 7·85 mm in the itraconazole group (two–tailed, P<0·05). Patient self–assessment also favoured terbinafine, with 65% evaluating it as good to very good, compared with 58% for itraconazole. Before treatment the terbinafine group had a mean of 6·7 and the itraconazole group 6·3 affected nails per patient. Total cure was achieved in 69% of terbinafine and 61% of itraconazole affected nails. We conclude that terbinafine is more effective than itraconazole In the treatment of toen

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15654.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryStudy 1. Eighteen HIV‐positive Caucasian homosexual men with initial positive fungal microscopy were recruited into this prospective, dual‐centre, open‐label study. They received a once‐daily oral dose of 250 mg terbinafine for 12 weeks.Eight were subsequently excluded after screening cultures proved negative. The mean CD4 count of the 10 evaluable subjects was 302/mm3. All 10 positive fungal cultures were confirmed as Trichophyton rubrum.Using an intention‐to‐treat analysis, healthy unaffected nail growth increased from a mean of 1·6mm at baseline to 5·2 mm after 12 weeks’ treatment. Clinical response after treatment was 6·4mm at 36 weeks and 8·0 mm at 48 weeks.Three of the 10 toenail infections were cured mycologically. This 30% cure rate was maintained over 48 weeks’ follow‐up, despite three patients discontinuing the study. One withdrew following a terbinafine‐induced drug rash. Two others stopped treatment during HIV‐related illnesses, but without terbinafine side‐effects.Study 2. Ten HIV‐positive subjects, nine culture‐positive for Candida albicans and one for Candida albicans and Candida glabrata, were recruited into this pilot study. They received 250mg oral terbinafine daily for 14 days. Their average CD4 count was 131/mm3.All patients remained culture‐positive throughout the study. Slight improvements in signs and symptoms were seen in one or two patients but this might well have been attributable to improved oral hygiene. Oral terbinafine at this dosage was therefore not thought an effective treatment for this indication in HIV‐positive patients. The drug was well tolerated and no serious treatment

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15655.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThe frequency of bronchopulmonary aspergillosis is increasing due to the growing number of patients requiring steroids or other immunosuppressive therapies. Conventional treatments are ineffective in some patients and side–effects are an important issue. The aim of this work was to evaluate the effectiveness and safety of terbinafine, a new allylamine antimycotic drug, in three immunocompetent patients affected by lower respiratory tract aspergillosis [one chronic empyema due toAspergillus fumigatus(AF) and two chronic necrotising aspergillosis] not responsive to the usual antimycotic therapies. Inin vitroand animal model systems, terbinafine is as active as amphotericin B and itraconazole. Patients received terbinafine at doses ranging from 5 to 15 mg/kg per day, according to clinical status, for 3–5 months, depending on the clinical course of the disease and compliance. In patient 1 a negative anti–AF precipitin was obtained together with eradication of AF from the pleural cavity, which allowed a successful intrathoracic myo–omento–mammoplasty. In patients 2 and 3, AF was eradicated, anti–AF immunoprecipitins decreased, and clinical and radiological findings significantly improved. On the basis of the effectiveness of terbinafine demonstrated in this preliminary work, large studies to evaluate the use of terbinafine in bronchopulmonary aspergillosis are warranted. Moreover, the drug is not associated with resistance or significant s

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15656.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryE‐cadherin is a calcium‐sensitive, cell‐to‐cell, adhesion molecule that is expressed widely in normal human epithelial tissue. Abnormal expression has been described in colorectal, breast and nasopharyngeal squamous cell carcinomas, where loss of E‐cadherin is associated with an increased metastatic potential. We have examined, by standard immunohistochemical techniques using the monoclonal antibody HECD‐1 (E‐cadherin monoclonal antibody), the distribution of E‐cadherin in normal human skin and in non‐melanoma neoplastic lesions. In the normal epidermis, E‐cadherin was strongly expressed on the surface of keratinocytes and specialized epithelial structures. Staining was absent from the lower pole of basal keratinocytes in contact with the basement membrane. Weak cytoplasmic staining was also noted in basal keratinocytes. No reactivity was demonstrated in dermal structures. The assessment of cutaneous tumours demonstrated an altered pattern of staining in most cases. Cell surface expression was reduced in 28 of 30 cases of basal cell carcinomas (BCC). Twenty showed an additional feature of positive staining on the dermal aspect of peripheral cells of tumour lobules. In squamous cell carcinomas (SCC) (n= 16), surface expression was attenuated in eight and absent in a further four. Strong surface expression, similar to normal skin was seen in all examples of Bowen's disease (n= 6), viral wart (n= 3), seborrhoeic keratosis (n= 3) and actinic keratosis (n= 4). This study demonstrates that, in BCC and SCC, but not in premalignant lesions, cell‐surface expression of E‐cadherin is reduced, consistent with the observation that the loss of E‐cadherin is associ

ISSN:0007-0963    

DOI:10.1046/j.1365-2133.1996.d01-739.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

SummaryThe anti‐Pneumocystiscariniiresponse of terbinafine together with that of three other compounds, trimethoprim sulphamethoxazole (TMP‐SMX), atovaquone (ATQ) and albendazole (ALB), has been investigated in immunosuppressed Sprague‐Dawley rats with established pneumocystosis. Drugs were administered orally (terbinafine in dosages of 40 and 80mg/kg per day, TMP 12·5 mg/kg per day plus SMX 62·5 mg/kg per day, ATQ 100 mg/kg per day and ALB 600 mg/kg per day) to six rat groups except one which served as a control, P.cariniipneumonia (PCP) was identified post‐mortem in nine (90%) of the control rats which exhibited a marked P.cariniiburden, and mean lung weights were higher with respect to the other treatment groups. During treatment, five rats in the control group died, whereas between 11 and 13 rats in all treatment groups survived. In the terbinafine groups (40 mg and 80 mg/kg per day), a mild P,cariniiinfection developed in three and two rats (27·2 and 18%), respectively, and almost the same infectivity score was obtained for those treated with 40 mg and 80 mg/kg per day. Histological changes in the lungs in animals receiving terbinafine treatment were minimal. Among the remaining compounds the rate of infection was seven (58·3%) for the ALB treatment group and five (45‐4%) for the ATQ group (mean score 19‐4 ±7‐1 and 23 ± 2·1, respectively). In the TMP‐SMX treatment group, there were 13 surviving rats and P.cariniiorganisms were found in two (15·3%, mean i

ISSN:0007-0963    

DOI:10.1111/j.1365-2133.1996.tb15657.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY