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Biomedical subjects

J Faergemann

Publications and source records attributed to J Faergemann.

At least 37 records · Page 2Linked to original sources
PubMed1997

Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel.

Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck or upper arms. Terbinafine is an orally and topically active allylamine antifungal derivative with a broad antifungal spectrum. Several studies have documented the high activity of terbinafine (Lamisil) cream in the treatment of pityriasis versicolor, with cure rates of 79-100% after 2-4 weeks of treatment. Lamisil emulsion gel (Lamisil DermGel) is a new topical formulation that remains in the skin in high concentrations for several months after just 1 week of application. Recently, in a prospective, double-blind, placebo-controlled, randomised, parallel-group, comparative, multicentre study, we have treated patients with pityriasis versicolor with either terbinafine 1% emulsion gel (Lamisil DermGel) or placebo gel. Sixty-one patients were included, 31 in the Lamisil DermGel group and 30 in the placebo gel group. The gel was applied once daily for 7 days and the patients were followed up for 8 weeks. Twenty-eight patients in the active and 29 patients in the placebo group were evaluable for efficacy. Using the intent-to-treat efficacy analysis, 21/28 (75%) were cured in the Lamisil-DermGel-treated group compared to 4/29 (14%) in the placebo group. No side-effects were seen. In conclusion, Lamisil DermGel was well tolerated and superior to placebo in the treatment of pityriasis versicolor when applied once daily for 7 days.

Administration, Topical↗
PubMed1997

A multicentre (double-blind) comparative study to assess the safety and efficacy of fluconazole and griseofulvin in the treatment of tinea corporis and tinea cruris.

In a double-blind, parallel group study we compared fluconazole 150 mg once weekly with griseofulvin 500 mg once daily for 4-6 weeks in the treatment of tinea corporis or tinea cruris. Eighty-four of 114 patients (74%) (39% after 3 weeks) were clinically cured in the fluconazole group compared with 72 of 116 (62%) (39% after 3 weeks) in the griseofulvin group (P = 0.06). In the fluconazole group 78% were mycological cured compared with 80% in the griseofulvin group. In the fluconazole group nine patients (7.5%) had treatment related adverse events and in the griseofulvin group 15 patients (12.5%) had adverse events. Fluconazole 150 mg once weekly for 6 weeks is both clinically and mycologically effective in the treatment of tinea corporis and tinea cruris and few side-effects were reported.

Adolescent↗
PubMed1996

Pityrosporum ovale (Malassezia furfur) as the causative agent of seborrhoeic dermatitis: new treatment options.

Several studies indicate that Pityrosporum ovale plays an important role in seborrhoeic dermatitis. Many of these are treatment studies which describe the effectiveness of antimycotics, paralleled by a reduction in the number of P. ovale colonies and then recolonization, leading to a recurrence of seborrhoeic dermatitis. In this study 20 patients with seborrhoeic dermatitis of the scalp were treated with terbinafine (Lamisil) 1% solution once daily for 4 weeks. Eleven of 18 patients (61%) were cured and they were still free of lesions 2 weeks after stopping treatment. No side-effects related to treatment were seen. There was also a significant reduction in the number of P. ovale colonies. This may explain both the good clinical effect and the observation that all patients who were cleared of P. ovale were still free of lesions 2 weeks after stopping treatment.

Adolescent↗
PubMed1996

Levels of fluconazole in normal and diseased nails during and after treatment of onychomycoses in toe-nails with fluconazole 150 mg once weekly.

Thirty-six patients with onychomycoses of their toe-nails were included in a double-blind, parallel-group comparative study of fluconazole 150 mg once weekly and griseofulvin 1,000 mg once daily for 12 months, or earlier if cured. Every month during treatment and in cured patients 3 and 6 months after stop of treatment one toe-nail was clipped and serum samples were taken. In patients treated with fluconazole the concentration of fluconazole was measured in serum and nails. We found a very high concentration of fluconazole in nails (peak 8.54 micrograms/g) and the nail concentration was statistically significantly higher than serum concentrations (p < 0.001). In cured patients fluconazole was still present in high concentrations 3 (1.7 micrograms/g) and 6 (1.4 micrograms/g) months after stop of treatment. These results indicate that fluconazole should be effective in the treatment of onychomycosis in a dose of 150 mg once weekly. The results also indicate that the treatment period could be shortened because fluconazole is still present in high concentrations 6 months after stop of therapy. The concentration of fluconazole found in nails is much higher than that found in the case of terbinafine and itraconazole, indicating that fluconazole should be at least as effective as these drugs in the treatment of tinea unguium.

Antifungal Agents↗
PubMed1996

The in vitro effect of fluconazole on the filamentous form of Pityrosporum ovale.

The antimycotic activity of fluconazole against the filamentous form of Pityrosporum ovale was studied in vitro. P. ovale was grown on human stratum corneum in vitro with and without the addition of different concentrations of fluconazole. In control cultures hyphae were produced in 25% of the cells compared to only 4% after exposure to fluconazole 1 microgram/ml. In control cultures 16% of the fungal cells showed signs of necrosis, due to the normal turnover rate of the cells, compared to 65% of the fungal cells exposed to 1 microgram/ml of fluconazole. In the transmission electron microscope the typical thick-walled fungal cells with their characteristic budding were observed in control cultures. However, after exposure to 1 microgram/ml of fluconazole that P. ovale cells showed extensive signs of necrosis, with loss of internal organelles and disinterruption of the cell wall. The results obtained in this in vitro model mimic the in vivo situation in pityriasis versicolor. There is a parallel between the good results obtained in this system and the good clinical effect of fluconazole in Pityrosporum-related diseases.

Antifungal Agents↗
PubMed1995

Double-blind, parallel-group comparison of terbinafine and griseofulvin in the treatment of toenail onychomycosis.

BACKGROUND: Griseofulvin has been used in the treatment of toenail onychomycosis with limited success. Evidence suggests that terbinafine may be more effective. OBJECTIVE: In a double-blind, parallel-group study we compared 250 mg/day terbinafine for 16 weeks with 500 mg/day griseofulvin for 52 weeks (or for shorter periods in cured patients) in patients with toenail onychomycosis. METHODS: Eighty-nine patients with culture-proved tinea unguium were included, and 43 in the terbinafine group and 41 in the griseofulvin group were assessable for efficacy. Patients who had not improved after 16 weeks were entered into an open study and were given 250 mg/day terbinafine for 16 weeks with the study code still blinded and were then followed up for 20 weeks. RESULTS: Terbinafine was significantly more effective than griseofulvin, with 42% being completely cured and 84% mycologically cured compared with only 2% with total cure and 45% with mycologic cure in the griseofulvin-treated group. The number of side effects was significantly lower in the terbinafine group (11%) compared with the griseofulvin group (29%). CONCLUSION: Terbinafine is significantly more effective than griseofulvin in the treatment of toenail onychomycosis.

Adolescent↗
PubMed1995

An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in Sweden.

An epidemic of tinea corporis due to Trichophyton tonsurans among wrestlers in Sweden is described. Totally 19 patients, 14 patients from Malmö and 5 from Gothenburg, were found. The suspected source of this epidemic was from a wrestlers' team from the USA visiting Sweden in April, 1993. All patients were treated orally with either griseofulvin, fluconazole or terbinafine, and all were cured. To prevent spreading, epidemiological tracing of secondary cases is important.

Adolescent↗
PubMed1995

The effect of antiseptic solutions on microorganisms in venous leg ulcers.

The effect on the microbial ulcer flora of wet gauze dressings soaked in antiseptic solutions used for desloughing leg ulcers is not known. Quantitative cultures were therefore performed in 45 venous leg ulcers, before application and after 15 minutes' treatment with gauze dressings with four different antiseptic solutions: aluminium acetotartrate (Alsol) 1%, potassium permanganate 0.015%, acetic acid 0.25% and chloramine 0.25%. The percentage of ulcers with each type of microorganism did not differ before and after application of the antiseptic solutions. Staphylococcus aureus was found in 79% of the ulcers, gram-negative rods in 39%, S. epidermidis in 21%, Proteus spp in 21%, Pseudomonas spp in 14% and fungi in none. Potassium permanganate reduced the mean number of bacteria per ulcer from 4.4 x 10(6) to 0.9 x 10(6) (ns), chloramine from 2.7 x 10(6) to 2.2 x 10(6) (ns), Alsol from 1.2 x 10(7) to 3.5 x 10(6) (ns) and acetic acid from 6.3 x 10(6) to 2.6 x 10(5) (p = 0.007). S. aureus was reduced by acetic acid (p = 0.002), gram-negative rods by both chloramine (p = 0.03) and acetic acid (p = 0.03). The number of Pseudomonas, Proteus, S. epidermidis and Streptococcus haemolyticus group G was not reduced significantly (p > 0.05) by any of the solutions.

Acetates↗
PubMed1995

Topical antimycotic treatment of atopic dermatitis in the head/neck area. A double-blind randomised study.

In order for us to evaluate the effect of topical antimycotic treatment in patients with atopic dermatitis affecting the head and neck area, 60 patients (36 females and 24 males; median age 28 years; range 14-53 years) were included in a double-blind study during 6 weeks. Of the 53 evaluable patients, 55% had positive skin prick tests to Pityrosporum ovale. In addition to oral antibiotic treatment, patients in group A (n = 26) were given miconazole-hydrocortisone cream and ketoconazole shampoo, whereas patients in group B (n = 27) were given hydrocortisone cream and placebo shampoo. At the start of the study P. ovale cultures were positive in 83% of all patients (no significant difference between the groups). After 4 weeks of treatment, there was a decrease in P. ovale colonisation in group A (p < 0.001) but not in group B. Patients in both groups improved (p < 0.001). The decrease in eczema score did not differ between group A and group B after 4 weeks' treatment. A further decrease of the eczema score was seen in both groups at the end of the study, but no difference was found between the groups.

Administration, Cutaneous↗
PubMed1995

Intracutaneous transport of orally administered fluconazole to the stratum corneum.

Fluconazole administered at 150 mg/week for 1-5 weeks is effective orally against dermatophytes and yeast in stratum corneum. Clinical and mycological cure rates approach 90%, but the precise distribution of the drug within various layers of skin is uncertain. We administered fluconazole at 150 mg/week for 2 weeks to 5 volunteers. Distribution of fluconazole in biopsies of skin was imaged by energy dispersive analysis of X-rays (EDX) and transmission electron microscopy, and in cells by electron energy-loss spectroscopy (EELS). Eight hours after a second dose, EDX showed fluconazole highest and homogeneously distributed in stratum corneum, lower in the rest of the epidermis, and lowest in dermis. The highest fluconazole levels detected by EELS were in cytoplasmic inclusions of sweat and sebaceous glands and less in keratinocytes and dermal collagen. We conclude that fluconazole delivered to stratum corneum by direct diffusion from capillaries and in sweat is also in all likelihood transported in sebum.

Administration, Oral↗
PubMed1994

Pityrosporum infections.

Pityrosporum ovale is a lipophilic yeast that is part of the normal human adult cutaneous flora. It is both a saprophyte and an opportunistic pathogen associated with pityriasis versicolor, Pityrosporum folliculitis, seborrheic dermatitis, and some forms of atopic dermatitis. Systemic infections have also been described. In this article the diagnosis and management of pityriasis versicolor, Pityrosporum folliculitis, seborrheic dermatitis, and atopic dermatitis will be discussed.

Adult↗
PubMed1994

Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once daily for 7 and 14 days.

In earlier skin pharmacokinetic studies we have shown that terbinafine is rapidly delivered to the stratum corneum, nails and hair both through sebum and by direct diffusion through dermis-epidermis. In the present study the skin pharmacokinetic profile of terbinafine was studied in two groups of eight human male volunteers during and after 250 mg orally once daily for 7 and 14 days. In the 7-day study high terbinafine levels were found in sebum (19.0 micrograms/g) and stratum corneum (2.5 micrograms/g), and a concentration in stratum corneum above the minimal inhibitory concentration for most dermatophytes was still found 48 days after the last day of medication. Terbinafine was found in peripheral nail clippings after 7 days of medication and the concentration was, in the 7-day study, 0.5 microgram/g 1 day after stopping medication; it was still 0.2 microgram/g 90 days after stopping treatment. The results in the 14-day study were in parallel with, but higher than, in the 7-day study. The elimination of terbinafine from several compartments is biphasic, with a faster initial elimination followed by a slower secondary elimination. For nails, the elimination is slower compared with the other compartments. The results indicate that terbinafine may be effective in short-term treatment of several dermatophytoses. The concentration of 0.2 microgram/g of terbinafine found in nails 90 days after stopping medication, following 7 days of treatment, indicates that the duration of therapy, even in tinea ungium, may be shorter than is currently the case.

Administration, Oral↗
PubMed1993

Levels of fluconazole in serum, stratum corneum, epidermis-dermis (without stratum corneum) and eccrine sweat.

The distribution in the skin of orally active antifungals and other drugs claimed to be active in the treatment of skin diseases is of major importance, but to date has been studied only rarely. In the present study the distribution of fluconazole in stratum corneum, epidermis-dermis (without stratum corneum), eccrine sweat and serum was studied in human male volunteers after dosages of 50 mg daily for 12 days and 150 mg once weekly for 2 weeks. In the present study high levels of fluconazole were found especially in the stratum corneum. At a dose of 50 mg once daily the concentration of fluconazole after 12 days was 73.0 micrograms/g and 7 days after cessation of treatment the concentration was still 5.8 micrograms/g. At the 150 mg once a week dose the concentration 7 days after the second dose was still 7.1 micrograms/g in stratum corneum indicating that medication once a week may be effective in the treatment of dermatomycoses. High concentrations, all above the serum concentrations, were also seen in sweat and epidermis/dermis. These results indicate that fluconazole is delivered to the stratum corneum, where it is accumulated, through sweat and by direct diffusion through the dermis-epidermis. These pharmacokinetic results indicate that the drug should be very effective in the treatment of dermatomycoses. An extremely high concentration of the drug in the stratum corneum combined with concentrations from 2.93 to 4.62 micrograms/g in the rest of the epidermis and dermis is important in the treatment of these diseases.

Adult↗
PubMed1993

Levels of terbinafine in plasma, stratum corneum, dermis-epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once per day for four weeks.

The distribution of terbinafine in stratum corneum dermis-epidermis (without stratum corneum), sebum, hair, nails and plasma was studied in human male volunteers during and after 250 mg orally once daily for 28 days. The highest concentration was seen in sebum, 56.07 micrograms/g, after 14 days of therapy. The concentration was still 1.0 microgram/g 44 days after stop of medication. In stratum corneum the highest concentration, 14.4 micrograms/g, was seen 1 day after the last day of therapy, and it was 2.1 micrograms/g 44 days after stop of medication. The concentrations in hair and nails were lower with a maximum of 2.36 and 0.39 micrograms/g respectively, 1 day after stop of therapy, and still 0.21 microgram/g in hair and 0.09 microgram/g in nails 55 days after the last day of medication. With the exception of nails, all other tissue levels were at all times above the plasma concentrations. For nails, tissue levels exceeded that of plasma as early as 1 day after stop of medication, and this difference continued to increase until the last day of tissue sampling, 55 days after the last tablet. These results indicate that terbinafine is delivered to the stratum corneum through sebum and to a minor extent by direct diffusion through dermis-epidermis. Probably short-term therapy with terbinafine may be effective in the treatment of several dermatomycoses, due to the strong binding of terbinafine to stratum corneum for a long time after stop of medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1993

Dermatophytes and keratin in patients with hereditary palmoplantar keratoderma. A mycological study.

Fourteen patients with hereditary palmoplantar keratoderma of the Unna Thost variety were included in the study. Dermatophytosis was found in 7 of the 14 patients. Six were affected with T. rubrum and one with T. mentagrophytes. The growth pattern of dermatophytes in keratin from the patients did not differ from that of normal control individuals. Keratin from patients with hereditary palmoplantar keratoderma was sterilized with ethylene gas and placed in the center of culture plates, previously broad inoculated with control dermatophytes or dermatophytes isolated from patients. An inhibition zone around the keratin was found in 42.9% of the control dermatophytes and in 83.4% of the patient cultures. The inhibition zone was only seen in cultures with T. rubrum and not in those with T. mentagrophytes. No significant difference in minimal inhibitory concentration values against ketoconazole between control dermatophytes and dermatophytes from patients was demonstrated.

Adult↗