In vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine against Scytalidium dimidiatum and Scytalidium hyalinum clinical isolates.

OBJECTIVES: The objective of this work was to evaluate the in vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafine against clinical isolates of Scytalidium dimidiatum and Scytalidium hyalinum. METHODS: Microdilution testing was performed in accordance with the CLSI M38-A method on 17 S. dimidiatum and 15 S. hyalinum clinical isolates. RESULTS: The MIC ranges of voriconazole, posaconazole, itraconazole, terbinafine, caspofungin and amphotericin B were <0.03 to 0.5 mg/L, 0.06-2 mg/L, <0.03 to >16 mg/L, 0.06-2 mg/L, 0.06-8 mg/L and 0.06-1 mg/L, respectively. CONCLUSIONS: Amphotericin B and voriconazole exhibit the lowest MICs for Scytalidium spp. Voriconazole could be a promising agent for the treatment of these refractory infections.

Novel, single-dose, topical treatment of tinea pedis using terbinafine: results of a dose-finding clinical trial.

Tinea pedis is the most common dermatophytosis requiring topical antifungals for at least 1-4 weeks. To determine the effectiveness of a novel topical single dose formulation of terbinafine (film forming solution-FFS) in the treatment of tinea pedis, 344 outpatients from 43 dermatological centres in France and Bulgaria suffering from tinea pedis with possible extension to soles confirmed by mycological examination (direct and culture) were evaluated for efficacy of terbinafine 1%, 5%, 10% FFS in a randomised double blind vehicle controlled parallel group dose finding study. Evaluations were carried out at baseline, 1 and 6 weeks after a single application of FFS. Effective treatment rate based on negative mycology (direct and culture) and minimal signs and symptoms (two or less with only mild recorded) was measured at week 6. Effective treatment rates at week 6 with terbinafine 1%, 5% and 10% FFS were 66%, 70%, 61% compared with 18% with placebo. All three active preparations were shown to be significantly superior to placebo (P < 0.001). Terbinafine 1% and 5% FFS were shown to be non-inferior to terbinafine 10% FFS. Terbinafine 1% FFS is an effective, safe dose for the treatment of tinea pedis. This novel product represents a significant advance with the enhanced compliance and convenience that it offers.

Scytalidiosis in Paris, France.

BACKGROUND: Scytalidium dimidiatum and S hyalinum are molds responsible for human skin and nail infections in tropical areas. OBJECTIVE: We sought to examine the epidemiology of cutaneous infections caused by Scytalidium species in a temperate country. METHODS: We conducted a retrospective study of patients with Scytalidium spp. infection diagnosed in our laboratory in Paris, France, from 1994 to 1999. RESULTS: Cutaneous Scytalidium infections were diagnosed in 332 patients, all of whom were from the tropics, especially the West Indies and Africa. S hyalinum and S dimidiatum were isolated in 53.6% and 43.9% of cases, respectively, and were associated with dermatophytes in 30 patients. Skin and nail lesions were found in, respectively, 65.3% and 34.7% of cases, and the feet were involved in 90.6% of cases. CONCLUSION: Cutaneous infections caused by Scytalidium species are far from rare in France, a temperate country, and must not be mistaken for dermatophytosis, given the resistance of S hyalinum and S dimidiatum to most antifungal drugs. Mycologic examination is, thus, required to identify Scytalidium spp in patients returning from or residing in tropical areas.