Available online at www.scholarsresearchlibrary.

com

Scholars Research Library

Annals of Biological Research, 2012, 3 (1):570-574 (http://scholarsresearchlibrary.com/archive.html)
ISSN 0976-1233 CODEN (USA): ABRNBW

Comparative efficiency of Itraconazole and Griseofulvin in the treatment of tinea corporis and cruris
Ebadi Amirreza , Rezaei Ali , Vazifeshenas Haleh , Jafari Behboud , 1 Ahmadizadeh Changiz
2 1 2 3 *1

Department of Microbiology, Ahar Branch, Islamic Azad University, Ahar, Iran Department of Clinical Science, Tabriz Branch, Islamic Azad University, Tabriz, Iran 3 Ardabil University of Medical Science and Health Services, Ardabil, Iran

ABSTRACT Tinea infections is the most common in the world. Tinea corporis and tinea craris is caused by Trichophyton rubram. Trichophyton mentagrofits and microspurm canis. Our goal is to comparative efficiency of Itraconazole and Griseofulvin in the treatment of tinea corporis and cruris. This study is a randomize double blind clinical trial that has done from 2009 up to 2010. 80 patients with tinea corporis and cruris devided in two group, 75 patients has reffered completely for visit. The first group was under the treatment with itraconazole 100 mg daily for 2 weeks and the same time with placebo second group with Griseofulvin 500mg by time for 4 nd rd th weeks. Remission of lesions have cared in 1 st. 2 , 3 , 4 week after the treatment and six weeks after end of treatment frome the point of clinic/KOH smear then results was analysed. The remission of lesions with Itraconazole was more than Griseofalvin (P=0.02).This stady showed that itraconaole 100 mg daily has more effects than Griseofulvin. Key words: Tinea Corporis, Tinea Curis, Dermatophit, Griseofulvin Itraconazole.

INTRODUCTION Fungal infection of groin and body is a prevalent disease. Grizeofulovin was used for treatment long time ago. But in most cases is along with a drug failure. Azoles compounds which were entered market in recent years have more antifungal effect ( itraconazole is ten times effective ketoconazole). Tinea infection is one of the most prevalent dermatological cases across the world. Annular shape skin infections in some parts of the body like groin occur at first by tricophyton roberum, tricophyton mentagrofightis and microsporm cannis dermatophytes (1). In order to diagnosis of the infection, identifying dermatophyte infections both fungal culturing agar media and fungal examination consisting Smir optaining using 10% or 15% KOH of the skin of donor are needed. Local fungicides maybe sufficient for treating of body and groin tinea. In any case, perhaps systematic treatment is needed when infectious region is large, secondary
58

Scholars Research Library

Jafari Behboud et al

Annals of Biological Research, 2012, 3 (1):570-574

infection occurs or in immunosuppressive people. In order to prevent tinea infections some cases must be observed consisting personal health, keeping dry the skin all the time and retraining from using the towel and clothes of infected people. Men are involved in the infection more than women. Causing organism can invade the stratum corneum and the hairs of involved regions (2). The scabs of affected persons maybe transfer by direct contact among people or by indirect contact with people that have infectious scabs. This kind of transferring is done by a microcondoria which causes to infect of host skin by scabs (3). This kind of infection can occur by other dermatophytes in the body especially from foot to groin (4). Most common prognostic factor for dermatophyte infections for older people is excessive sweat. Furthermore, closed clothes maybe create a media for dermatophyte organisms proliferating. Sporting is another factor involving people like athletes (5). Body and groin infections may appear as annular plaques with swollen and scabbed edges. Recovery process occurs from the center of damage and the process is not complete (2). The infection in groin and thigh has a good response to local treatments like azoles, alyl amines and benzyl amin derivatives and hydroxyl pyridine. In any case, repeated use of the drug for large regions of skin may not be easy and possible for patients. So, oral drugs may be used by patients (6). Grizeofelovin disappear from stratum corneum rapidly because it doesn't bond with keratin. The infection may have high recurrence in patients (7). Therefore, triazoles such as fluconasole and itraconasole are efficient treatments for body and thigh infections (1). Itraconasole is an industrial fungicide drug which was made in 1980 and has a large anti fungus activity. It controls -14 demethylase cytocrome P450 of fungal cell as well as causes to change the lanostrole to argostrole; so prevents the cell growth and synthesis (8). Complete bioavailability of oral itraconasole 55% and its absorption can increase by high pH and this is when that the drug is used after a meal. The drug is metabolized in liver by cytocrome P450 iso enzyme 3A4 and its metabolites are secreted to urine and bile (9). Itraconasole is effective in treatment of head, body, foot, nail, and groin tinea infection. The drug is available in capsule and liquid forms and most prevalent side effects consist of gastro intestinal disorders like stomachache, nausea and sometimes gastritis and hepatitis and other problems such as scratching, urticarial, edema, fever, headache, hypertension, hypocalcaemia, and rarely neutropenea (10). Grizeofolovin is a metabolic penicillum grizeofulum which was produced in 1939 from a culturing media by Axdford vecolghous (11). The drug controls fungal growth, mitosis activity of fungus cell and nucleic acid synthesis and interferes with cytoplasm microtubules' function by binding with Alfa and Beta tubules (12). Weak absorption of the drug from gastro intestinal tract which is 25%-70% and its absorption increase with fatty meal. The peak rate of plasma concentration occurs 4 hours after oral administration. Following oral administration of the drug, its effect appears in external part of stratum corneum. The standard dosage of the drug is 15-20 mg/kg a day for 6-8 weeks and the rate of recovery is 64%-96% (13). The drug has been used for head tinea treatment for years. It is available in capsule, tablet and oral suspension forms. Side effects of the drug consist of headache, gastrointestinal reaction, dermal reactions and sometimes irregular menstruation and increasing hemorrhage. The drug has antagonist effect with barbiturates (14). MATERIALS AND METHODS In the present study the patients who suffered from body and groin tinea and referred to dermal clinic of Emam Khomeini hospital of Ardabil were examined. 80 subjects were understudied that were divided to two treatment and control groups of 40 people in each group. Sampling was done from any patient referred to clinic with body and groin tinea and had no external criteria such as pregnancy, breast-feeding, any previous disease like liver diseases and their history. The patients were divided to two identical groups based on prescribed drugs by nurse and the patients and physician didn't inform about the kind of drug and the way of its administration.
59

Scholars Research Library

Jafari Behboud et al

Annals of Biological Research, 2012, 3 (1):570-574

Randomizing and blinding of drugs prescription were such that the physician and the patient had not any interference in the kind of administrated drug. Before starting of the treatment all of patients were understudied; so 100 mg Itraconasole tablet was prescribed daily for 2 weeks for treatment group and 500 mg Grizeofolovin daily for 4 weeks for control group. The reason for using of these drugs is two-headed blinding study in which the patients must not know belong to th th which group. The patients referred on 4 and 6 week following drug administration completion for clinical, KOH smear and drug side effect. The information about any visiting sessions was recorded in patients' questionnaire. The results divided to four groups based on clinical examination: complete recovery, moderate recovery i.e. 50%, slight recovery i.e. 0-50% and without any changing. In the present study5 subjects didn't refer for treatment continuation that 3 of them were from treatment group and 2 of them were of control group. 75 remained patients were under complete follow up for 4 weeks and were studied 6 weeks following the treatment completion. Then the results gathered and analyzed by SPESS 16 statistical soft ware. Subjective statistical methods were used in order to data analysis. Fisher extract test and T test were used for comprising quantitative values. (x) test was used for comprising qualitative values and finally the data was divided to two groups based on confidence coefficient 95%. RESULTS With regard to table 1, the average of patients' age, there is no age difference between two groups based on independent test. With regard to table 2, the relative distribution of subjects based on the groups treated with Grizeofolovin and Itraconasole, there is no meaningful difference between two groups (P=0.35). Table 3 demonstrates the kind of problem in which 19 patients have groin infection and 56 patients have body infection.table 4 demonstrates the condition of second week follow up and table 5 demonstrates the condition of third week follow up and table 6 demonstrates the condition of fourth week follow up of the patients of two groups in which the recovery process in Itraconasole administrated ones was better than Grizeofolovin th administrated ones. Table 7 demonstrates the 6 week follow up condition following the treatment in two groups. In Griseofulvin administrated group 5 subjects (13.2%) have infection recurrence after 6 weeks but there is no recurrent in Itraconazole group.
Table1: Age mean of patients Group Itraconazole Griseofulvin Total Mean 26.6 27.5 27.1 Sig 0.15 -

Table 2: Different treatment groups Groups Itraconazole Griseofulvin Total Male No. % 21 55.5 23 62.2 44 58.7 Female No. % 17 44.7 14 37.8 31 41.3 Total No. % 38 100 37 100 75 100

Table 3: Type of diseases in different groups Groups Itraconazole Griseofulvin Total tinea corporis No. % 12 32,4 7 8.4 19 25.3 tinea crurist No. % 25 67.6 31 81.6 56 74.4 Total No. % 37 100 38 100 75 100

60

Scholars Research Library

Jafari Behboud et al

Annals of Biological Research, 2012, 3 (1):570-574

Table 4: Patients condition in different group after 2 week (P=0.001). Groups after 2 week Complete Average Moderate Without any change Griseofulvin No. % 9 23.7 21 55.3 8 21.1 0 0 Itraconazole No. % 27 73 4 10.8 6 16.2 0 0 Total No. % 36 48 25 33.3 14 18.7 0 0

Table 5: Patients condition in different group after 3 week (P=0.1) Groups after 3 week Complete Average Moderate Without any change Griseofulvin No. % 9 23.7 21 55.3 8 21.1 0 0 Itraconazole No. % 27 73 4 10.8 6 16.2 0 0 Total No. % 36 48 25 33.3 14 18.7 0 0

Table 6: Patients condition in different group after 4 week (p=0.2) Groups after 4 week Complete Average Moderate Griseofulvin No. % 26 68.4 9 23.7 3 7.9 Itraconazole No. % 34 91.9 1 2.7 2 5.4 Total No. % 60 80 10 13/3 5 6/7

Table 7: Patients condition in different group after 6 week Groups after 6 week Complete Average Moderate Griseofulvin No. % 33 86.8 0 0 5 13.2 Itraconazole No. % 36 97/3 1 2/7 0 0 Total No. % 69 92 1 1/3 5 6/7

CONCLUSION Body tinea applied to fungal infection of body skin with the exception of hairy regions (beard and groin), palm, foot and nail. Body tinea is seen in all ages and occurs rarely at first weeks of life. Various methods have been suggested for treatment this kind of infection. The aim of the present study is determining the rate of Itraconasole and Grozeofolovin effect on Groin and body treatment and comparison the effects of the drugs. 80 patients involved in the study and 75 of them completed the follow up visits. Understudied patients were patients with body and groin tinea that they were 12-48 years old. The average level of patients' age in Grizeofolovin group was 26.6 6.3 and in Itraconasole group was 27.5 8.2. The effect of the drugs was determined th by clinical examination by one to four weeks interval as well as 6 week after the clinical treatment completion. All of under-treatment subjects with Itraconasole and Grizeofolovin were unchanged at first follow up week. During the second week after the follow up, 5.3% of under treatment subjects had a moderate recovery. In Itraconasole group this rate was 43.2% and in Grizeofolovin group was 7.9%; so there was a meaningful statistical difference (P=0.001).During the third week after the follow up, 48% of under treatment subjects had a complete recovery. In Itraconasole group this rate was 73% and in Grizeofolovin group was 23.7%; so there was a meaningful statistical difference (P=0.001).At the end of fourth week after the follow up, 80% of under treatment subjects had a complete recovery. In Itraconasole group this rate was 91.9% and in Grizeofolovin group was 68.4%; so there was a meaningful statistical difference (P=0.02). the results demonstrated that the recovery process was in Itraconasole administrated group was
61

Scholars Research Library

Jafari Behboud et al

Annals of Biological Research, 2012, 3 (1):570-574

better than grizeofolovin administrated group. 6 weeks after the treatment completion, 92% of patients had complete recovery that the rate of recovery in Itraconasole group was 97.3% and in Grizeofolovin group was 86.8%; so there was no meaningful statistical difference between two groups (P=0.054). with regard to the obtained results, in the present study Itraconasole was more effective than Grizeofolovin in body and groin tinea treatment. REFERENCES [1] Simpson NB& Wj Conliffe, Labrie, C, Cusan L, Plante M, Dermatophytosis . Rook. Text th book of dermatology. 8 ed. Chapter 31.2004.pages: 31.19-31.24. [2] Faergemann J., Mork N.J., Haglund A., Odegard A. Br J Dermatol. 1997; 136:575-577. [3] Hay R.J., Moore M. Burton D.A. Breathnach Textbook of dermatology 6th edition 1998 Blackwell Science United Kingdom. 1277 1376. [4] Drake L. A., Dinehart S. M., Farmer E.R., J Am Acad Dermatol. 1996 ; 34: 282 - 286. [5] Sadri M.F., Farnaghi F. Danesh- Pazhooh M., et al. Mycoses J. 1998; 43: 41- 44. [6] Farag F., Taha M., Halim S.. B J Dermatol. 1994; 131: 684 - 686. [7] Pariser D. M., Pariser R. J., Ruoff G., et al. J Am Acad Dermatol. 1994 ; 31: 232-234 . [8] Georgopapadakou NH. Curr opin Microbiol. 1998; 1(5) : 547-57. [9] Gupta Ak, Alexis ME, Raboobee N, et al . Br J Dermatol. 1997 ; 137 (2) : 251-4. [10] Doncker PD, Gupta Ak, Marynissen G, et al . J Am Acad Dermatol. 1997; 37 (6): 969-74. [11] Oxford AE, Raistrick H, Simonart P, et al. J Mycoses. 2006, 49(3): 232-5. [12] Georgopapadakou NH. Curr opin Microbiol. 1998; 1(5) : 547-57. [13] Tanz RR, Herbert AA, Esterly NB. J Pediatr. 1988; 112(6) :987-91. [14] Bennett ML, Fleischer AB, Love less JW, et al. J Pediatr dermatol. 2000; 17(5): 3049.

62

Scholars Research Library