A double‐blind, randomized, stratified controlled study of the treatment of tinea imbricata with oral terbinafine or itraconazole

This study compared the efficacy of the new fungicidal allylamine antimycotic, terbinafine, with the triazole antimycotic, itraconazole, in patients with chronic tinea imbricata. Forty‐three patients received terbinafine 250 mg daily, and 40 received itraconazole 100 mg daily, for 4 weeks. A total of 72 patients were eligible for follow‐up at weeks 5 and 17. Of these, four patients, all from the itraconazole group, did not respond either clinically or mycologically. All of the remaining 68 patients were clinically and mycologically cured. No adverse effects were reported in either group. Terbinafine was assessed as having a superior clinical and mycological cure rate to itraconazole after 4 weeks (P=0·05) with borderline statistical significance. In addition, after 13 weeks of follow‐up, terbinafine provided a significantly reduced rate of reinfection/relapse from further T. concentricum infection compared with itraconazole (P<0·001). This superior protective effect may be explained by the fungicidal activity and the long persistance in the skin of terbinafine, and indicates the need for higher doses of itraconazole in this particular infection.