Terbinafine in Fixed Cutaneous Sporotrichosis: A Case Series

Sporotrichosis is a chronic granulomatous mycotic infection caused by thermally dimorphic fungus, Sporothrix schenckii. The disease is endemic in tropical and subtropical belts throughout the world. In India, it is commonly seen in the Himalayan belt, frequently encountered in gardeners. Infection generally occurs by traumatic inoculation of soil and plants contaminated with the fungus. In humans, the lesions are usually restricted to the skin, subcutaneous cellular tissue and adjacent lymphatic vessels. Disseminated disease occurs when the fungus spreads throughout the body. Itraconazole is regarded as the treatment of choice for patients with most forms of cutaneous as well as extracutaneous sporotrichosis and amphotericin B as the preferred treatment for patients who are severely ill in disseminated mycotic infections. Terbinafine is a synthetic allylamine used as the drug of choice in tinea infections. This article compiles three cases of fixed cutaneous sporotrichosis, proven histopathologically, who were treated with oral terbinafine due to poor response to itraconazole or because of cost factor, with dosage ranging from 250mg/day to 1g/ day, given upto six weeks after clinical resolution. The article also highlights the importance of terbinafine as an effective drug for sporotrichosis where there is poor response to itraconazole or affordability may be an issue.