griseofulvin and Hand-Dermatoses

An economic analysis of the oral antifungal drugs griseofulvin (GRI), ketoconazole (KET), and terbinafine (TER), currently registered and used in treating onychomycosis of fingernails and toenails, was performed using a model that incorporates elements of both meta-analysis and pharmacoeconomics. The meta-analysis of published studies determined rates of success, relapse and side-effects. The perspective taken for the analysis was that of the government payer, with expected total cost and cost-effectiveness being calculated. A multiphase approach was used. The studies of onychomycosis of the fingernails showed that TER had a 95.0% success rate, KET 80.9%, and GRI 59.6%. GRI had the lowest acquisition costs. The success rates for onychomycosis of the toenails were: TER 78.3%, KET 40.8%, and GRI 17.5%. GRI had the lowest acquisition costs. However, expected cost comparison showed TER had the lowest cost because of shorter treatment duration. The expected cost of therapy with a 100% government payer perspective for fingernail onychomycosis was the lowest for TER ($439.83), followed by GRI ($480.80), then KET ($755.46). Toenail onychomycosis showed the same order for the comparators, with TER $1049.77, GRI $1388.54 and KET $1936.48. When compared with TER, fingernail cost-effectiveness ratios for GRI and KET were 1.51 and 2.00. Toenail cost-effectiveness ratios were 2.49 and 2.48, respectively. For both fingernail and toenail onychomycosis, TER had the greatest number of disease-free days (973 for fingernails; 1073 for toenails), followed by KET (837; 798), then GRI (702; 569).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Antifungal Agents; Canada; Cost-Benefit Analysis; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Due to increased interest in economic evaluation and the rapid international spread of new healthcare technologies across borders, there is a need to interpret economic evaluations on a worldwide basis. We conducted a multinational cost-effectiveness analysis, from a government payer perspective, comparing four primary oral treatment regimens for onychomycosis of the fingernails and toenails: griseofulvin, itraconazole, ketoconazole and terbinafine. We used a four-step pharmacoeconomic research model which includes all relevant factors affecting costs in 13 countries: Austria, Belgium, Canada, Finland, France, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and the U.K. A worldwide meta-analysis of published clinical data served as the statistical input for the pharmacoeconomic model, and demonstrated that terbinafine had the highest success rates (95.0% and 78.3%) of the clinical comparators for fingernails and toenails, respectively. We found that terbinafine was the most effective therapy in relation to cost (therefore giving it the lowest cost-effectiveness ratio) for both infections in all health-care systems analysed.

Topics: Antifungal Agents; Cost-Benefit Analysis; Decision Support Techniques; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Ketoconazole; Models, Econometric; Naphthalenes; Onychomycosis; State Medicine; Terbinafine

The management of onychomycosis has changed considerably in the past few years. The main trends have been improvement in the choice of evidence and cover of infections other than dermatophytosis, shortening of periods of oral therapy, and introduction of topical agents designed to treat nail disease. At present there have been almost no comparative studies of these different approaches, and choice is therefore largely based on enlightened guesswork coupled with personal experience. It is hoped that within the next few years such studies will be carried out to allow dermatologists to make an accurate choice based on appropriate scientific data.

Topics: Administration, Cutaneous; Administration, Oral; Antifungal Agents; Candidiasis, Cutaneous; Fluconazole; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

A parallel-group double-blind study was carried out which compared the efficacy of chemical avulsion of affected nail by urea 40% and bifonazole 1% cream alone with that of the same local therapy combined with short-term oral griseofulvin in onychomycosis. A total of 120 patients were included in the study. Patients' characteristics were comparable in both treatment groups. Of the 98 patients fully evaluated, 91 had toenail involvement and only seven had fingernail involvement. Forty-six of the patients were men and 51 were women. The mean age of the patients was 47.14 +/- 13.84 years (range 17-80 years). The duration of onychomycosis was for more than 1 year in 96 patients and for 3 months duration in only one patient, who was in the placebo group. Forty patients had received different previous therapies. All topical treatments were discontinued for at least 2 weeks and oral therapy for at least 2 months prior to the beginning of the study. The diagnosis was confirmed by positive mycologic cultures. Trychophyton rubrum was identified as the pathogen in 90 patients, 45 in each group, T. tonsurans in four patients, two in each group, and T. mentagrophytes in three patients, two in the griseofulvin treated group, and one in the placebo group. The first phase of treatment given to all patients consisted of occlusive dressing every 24 h with urea 40% and bifonazole 1% ointment until the infected nail became completely detached. Subsequently, in the second phase bifonazole 1% cream was applied to the nail ped every 24 h for 4 weeks. In addition, concomitantly with the bifonazole cream the patients were randomly allocated to a daily oral double-blind treatment with griseofulvin 500 mg or placebo, for 4 weeks. Clinical and mycologic evaluations were carried out at baseline, immediately after removal of the nail, and at 3 days, 4 weeks, and 4 months after the end of treatment with bifonazole cream and griseofulvin/placebo tablets. Mycologic examination included identification of fungi by KOH preparation and culture on potato dextrose agar. Positive cultures were transfered for identification on Sabouraud's. Criteria for evaluation of efficacy comprised: "cure" defined as clinical and mycologic cure (fresh specimen and culture negative) at both investigation times after the end of treatment; "late cure" defined as mycologic cure at both investigation times after the end of treatment, clinical clearing of the nail only 4 months after the end of treatment; "improvem

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Aged; Antifungal Agents; Double-Blind Method; Female; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Imidazoles; Male; Middle Aged; Onychomycosis; Urea

Topics: Antifungal Agents; Fingers; Griseofulvin; Hand Dermatoses; Humans; Naphthalenes; Onychomycosis; Terbinafine

To compare the efficacy and safety of itraconazole and griseofulvin in a double-blind parallel study of 20 patients with microscopically and/or culturally proven tinea pedis and/or tinea manus.. A 4 week study was undertaken with patients randomised to receive either itraconazole 100 mg or griseofulvin 500 mg once daily for 4 weeks. Microscopy and cultures were performed prior to and at the end of the treatment and 2 weeks posttreatment.. After 4 weeks therapy, 50% of itraconazole-treated patients and 30% of griseofulvin-treated patients had negative microscopy; 70% and 50% of these patients, respectively, had negative microscopy at follow up 2 weeks later. A combined score of all clinical assessments showed a statistically significant (p < 0.05) difference at the follow up visit in favour of itraconazole. There was no statistically significant difference with regard to haematological or biochemical measurements, or in urinalysis results, either within or between treatment groups. Six patients reported mild adverse effects (itraconazole = 5, griseofulvin = 1), none of which warranted treatment withdrawal.. The findings of this study suggest that itraconazole is more effective than griseofulvin in the symptomatic treatment of tinea pedis and/or manus.

Topics: Adult; Double-Blind Method; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Tinea; Tinea Pedis; Treatment Outcome

We conducted a double-blind comparative study of terbinafine, 250 mg twice daily, versus griseofulvin, 500 mg twice daily, for 6 weeks in chronic dermatophyte infections of the feet or hands. All but three patients (total 31) had Trichophyton rubrum infection. At 12-week follow-up, 100% of the terbinafine-treated group were free from infection compared with 45% of those treated with griseofulvin. Therapy in 75% of the terbinafine-treated group and in 35% of those given griseofulvin was rated as effective overall at long-term follow-up, although these differences were not statistically significant. Six months after treatment all nine patients whose skin had cleared with terbinafine therapy remained in remission versus only one of seven patients treated with griseofulvin. None of the patients in either group experienced serious adverse effects.

Topics: Antifungal Agents; Chronic Disease; Double-Blind Method; Female; Follow-Up Studies; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Male; Nail Diseases; Naphthalenes; Recurrence; Terbinafine; Tinea

Topics: Adolescent; Adult; Aged; Antifungal Agents; Double-Blind Method; Female; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Ketoconazole; Male; Middle Aged; Tinea; Tinea Pedis

Topics: Antifungal Agents; Child, Preschool; Dermatomycoses; Female; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Microsporum; Tinea Capitis

The "complete cure" of onychomycosis requires long-term treatment with a systemic antifungal agent. Therefore, to properly assess the effects of an antifungal agent on onychomycosis requires a long follow-up. We have conducted a retrospective analysis of the patients treated with griseofulvin (GRF) from 1962 to 1992 and a clinical study to compare the long-term effect of GRF with that of a new oral antifungal agent, itraconazole (ITCZ), for patients who received treatment from 1992 to 1995. For the retrospective study, 281 patients who were microscopically diagnosed as having onychomycosis at the Department of Dermatology, Faculty of Medicine, University of Tokyo, and received GRF administration in 1962, 1972, 1982, and 1992, were evaluated for cure rate and dropout rate. The total cure rate was 29.2%, but the cure rate was 68.8% for the patients who continued their medication for more than one year. For the comparative study, 139 patients who received the treatment at the same institution between 1992 and 1995 were evaluated. The cure rate and the dropout rate for GRF were found to be 23.8% (23/97) and 52.6% (51/97) respectively. The cure rate and the dropout rate for ITCZ were found to be 50.0% (21/42) and 38.1% (15/42). When the two treatment protocols were compared for their long-term effects, we found that most of the patients treated with ITCZ were cured within 3 years, and about 30% of the patients treated with GRF remained uncured even after long-term administration of the agent. Furthermore, from a multiple regression analysis, the GRF/ITCZ administration required to cure onychomycosis was estimated to be 3.92 + 0.161 [Age (years)] + 0.635 [Number of infected toenails] months. The results of this study suggest that the biggest problem associated with the treatment of onychomycosis with an oral antifungal agent is compliance in long-term therapy. Notably, the final cure rate of ITCZ therapy went over 90%, suggesting that the low dose continuous therapy, the standard treatment protocol in Japan, was a key contributing factor for the higher cure rate for ITCZ.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Child; Child, Preschool; Female; Follow-Up Studies; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Male; Middle Aged; Onychomycosis; Regression Analysis; Retrospective Studies; Treatment Outcome

Topics: Antifungal Agents; Child; Female; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Microsporum; Naphthalenes; Onychomycosis; Terbinafine; Tinea Capitis; Trichophyton

The neutrophilic phagocytic activity (absorption and enzymic bactericidal) is intensified in rubromycosis patients treated with nizoral vs. those administered griseofulvin. it is advisable to combine griseofulvin therapy with biogenic stimulants (pyrogenal, aloe, fiBS, vitreous body).

Topics: Biological Products; Blood Bactericidal Activity; Combined Modality Therapy; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Neutrophils; Onychomycosis; Phagocytosis; Tinea Pedis

This article summarizes the diseases of the nail caused by fungi. The clinical appearance of the diseases are the key to understanding their causes. Therapy is updated. Specifically discussed are distal subungual onychomycosis, white superficial onychomycosis, proximal subungual onychomycosis, and onychomycosis in chronic mucocutaneous candidiasis.

Topics: Adult; Candida albicans; Candidiasis, Chronic Mucocutaneous; Foot Dermatoses; Glutaral; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Middle Aged; Onychomycosis; Recurrence

Ketoconazole 200-400 mg was given once daily for a maximum period of 12 months to 31 patients with chronic (mean duration, 12 years) dermatophyte infections of the hands and/or feet. Griseofulvin had previously been withdrawn due to intolerance or lack of effect. All skin and nail infections improved clinically. Fifty percent of the patients with skin infections and 26% of those with nail infections became clinically clear and culture-negative. Six months later, relapses had occurred in 8 of 12 patients (67%) with cleared skin lesions, and in 2 of 5 (40%) with cleared nail infections. Ketoconazole was discontinued in one patient due to headache and in another due to asymptomatic transient elevation of hepatic laboratory tests. Ketoconazole is an alternative when a replacement for griseofulvin is required, provided the degree of disability justifies the risk of drug toxicity.

Topics: Female; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Male; Middle Aged; Onychomycosis; Recurrence; Time Factors; Tinea; Tinea Pedis

The authors report 13 cases of tinea manuum and emphasize that this condition is not commonly described in the Brazilian medical literature. Eight males and five females, aged 18 to 72 years, presented an infection ranging from 1 month to 20 years. The main clinical picture was of desquamating type on the palms without fingernails lesions. All patients had associated dermatophytosis of the feet. Trichophyton mentagrophytes, T. rubrum and Epidermophyton floccosum were the species isolated from the hands. The trichophytin test was positive in all cases and treatment with oral griseofulvin and topical clotrimazole and miconazole was rather effective. Clinical evaluation at the end of the treatment and afterwards did not show relapses.

Topics: Adolescent; Adult; Aged; Epidermophyton; Female; Griseofulvin; Hand Dermatoses; Humans; Intradermal Tests; Male; Middle Aged; Tinea; Tinea Pedis; Trichophytin; Trichophyton

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole

Topics: Antibody Formation; Dermatomycoses; Dimethyl Sulfoxide; Drug Therapy, Combination; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Immunity, Cellular; Immunity, Innate; Levamisole; Paraffin; Urea; Waxes

Topics: Adult; Drug Therapy, Combination; Female; Griseofulvin; Hand Dermatoses; Humans; Male; Middle Aged; Onychomycosis; Pentoxyl; Placental Extracts; Tinea Pedis; Trichophyton; Uracil

Described are three male patients showing bizarre manifestations of granulomatous dermatophytosis, all in the hand region. One had a small infiltrated nodular lesion near the thumb which was mistaken for a common insect bite. The second had a violaceous-yellowish plaque, also on the thumb, composed of 2-3 small subcutaneous nodules. The third case had five reddish intracutaneous nodules on the dorsum of the hand. Puncture of these nodules revealed the presence of fungal elements and culture yielded T. rubrum in all cases. Each patient was also found to have a fingernail affected by the same agent. Histologic sections in each case showed granulation tissue in the dermis and hypodermis, mainly in the vicinity of hair fragments with spores. These lesions appeared to be variants of Majocchi's granuloma trichophyticum.

Topics: Aged; Granuloma; Griseofulvin; Hand Dermatoses; Humans; Male; Middle Aged; Tinea

We describe a case of tinea unguis in a 20 year old female student from Caracas. The peri-ungual skin of a thumb appeared altered first and, since 6 months, the lamina was being progressively invaded and destroyed. At the direct mycologic examination numerous, regular and irregular, hyaline fungal hyphae were visible. Culture was performed 9 times: several molds did grow, among which, eight times, we got numerous colonies of a strain that has been identified to Nannizzia gypsea (+). Owing to the rarity of the observation the bases for the diagnosis are discussed and the pertinent literature is reviewed.

Topics: Adult; Female; Griseofulvin; Hand Dermatoses; Humans; Miconazole; Microsporum; Onychomycosis

Topics: Adult; Griseofulvin; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Male; Tinea; Tinea Pedis

Topics: Adolescent; Adult; Aged; Female; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Male; Middle Aged; Nails; Onychomycosis; Russia; Urban Population

The diagnosis and management of dermatophytic fungal infections depends upon a knowledge of the causative organism fungi, the morphological patterns which can be produced and the type, extent and duration of treatment necessary to effect cure.

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Humans; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Topics: Administration, Oral; Adult; Amphotericin B; Cautery; Cryosurgery; Curettage; Cytosine; Dermatomycoses; Evaluation Studies as Topic; Flucytosine; Griseofulvin; Hand Dermatoses; Humans; Imidazoles; Male; Miconazole; Potassium Iodide; Sporotrichosis

Topics: Arthrodermataceae; Griseofulvin; Hand Dermatoses; Humans; Tinea

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Humans; Onychomycosis; Quaternary Ammonium Compounds; Tinea

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Hospitals, Municipal; Humans; Netherlands; Onychomycosis

Topics: Folliculitis; Griseofulvin; Hand Dermatoses; Humans; Tinea; Trichophyton

Topics: Combined Modality Therapy; Griseofulvin; Hand Dermatoses; Humans; Leg Dermatoses; Manipulation, Osteopathic; Onychomycosis

Topics: Griseofulvin; Hand Dermatoses; Humans; Powders; Tinea Favosa

Topics: Griseofulvin; Hand Dermatoses; Humans; Tinea; Washington

Topics: Dermatitis; Griseofulvin; Hand Dermatoses; Tinea