LAMISIL IN CUTANEOUS OR LYMPHOCUTANEOUS SPOROTRICHOSIS

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Sporotrichosis is a chronic, subcutaneous, lymphatic mycotic infection due to Sporothrix schenckii which occurs with worldwide prevalence. This disease follows introduction of the fungal spores into the skin or subcutaneous tissues by a thorn or splinter. Sporotrichosis can be a limited disease of the skin and subcutaneous lesions, or it may progress to a disseminated disease which, untreated, is fatal. Sporotrichosis is currently treated with orally administered saturated solution of potassium iodine (SSKI). This drug is inconvenient to take, its mechanism of action is unclear and it can cause several distressing side effects (actineform rash, metallic taste, parotid and lacrimal gland swelling). Amphotericin B is an effective treatment for disseminated disease but it is not effective for local cutaneous disease. Itrconazole has not been approved for use in sporotrichosis, however, it has been effectively utilized. Treatment for sporortrichosis is usually lengthy (3-6 months), regardless of whether SSKI or itraconazole is utilized. It is important that a safe, possibly more effective alternative to itraconazole be found to treat sporotrichosis. Terbinafine is safely used in Europe in the treatment of various fungal infections. It apears to have good efficacy against Sporothrix schenckii when utilized in a limited number of sporotrichosis cases, however, further evaluation of this drug is needed in a larger, more controlled fashion. The dose used in the limited cases was 250 mg twice daily for up to 12 weeks. It is proposed that two different doses be evaluated (500 mg qd and 1000 mg qd).