Comparative Evaluation of Efficacy & Safety of Oral Terbinafine versus Fluconazole in Patients with Tinea Corporis

Abstract

Background: Tinea corporis is among the most common dermatophyte infections in India and often requires systemic therapy when topical treatment fails. Terbinafine and fluconazole are widely used systemic antifungals with differing pharmacological profiles.

Objectives: To compare the efficacy and safety of oral terbinafine 250 mg once daily for 2 weeks versus oral fluconazole 150 mg once weekly for 4 weeks in adults with tinea corporis.

Methods: In this observational comparative study conducted at a tertiary care center (November 2020–October 2021), 30 KOH‑positive adults with Tinea corporis ≥10% body‑surface area involvement, recurrent disease and non‑response to topical therapy were randomized to receive either terbinafine or fluconazole. Patients were followed at weeks 0, 1, 2, 3, 4, 5 and 8 for clinical signs & symptoms (erythema, scaling, itching), adverse events and laboratory safety parameters. Compliance was assessed by pill counts. Primary endpoint was clinical cure at end of therapy; secondary endpoints included change in individual signs and relapse during follow‑up.

Results: Of 30 participants (93% male; mean age 31.6±10.6 vs 34.5±14.1 years in terbinafine and fluconazole groups), clinical cure rates were 100% with terbinafine versus 79% with fluconazole. Itching resolved completely with terbinafine and improved with fluconazole (post‑treatment mean 0.21±0.43). Erythema and scaling resolved in both groups. One patient in the fluconazole arm developed a maculopapular rash after the first dose and was withdrawn. Relapse occurred in 5/14 (36%) evaluated patients in the fluconazole arm within four months; none relapsed in the terbinafine arm. No clinically significant laboratory abnormalities were observed.

Conclusions: Short‑course oral terbinafine (250 mg daily for 2 weeks) achieved higher clinical cure with zero relapse compared with fluconazole (150 mg weekly for 4 weeks) in adults with extensive tinea corporis, with good overall tolerability. However, larger blinded trials with mycologic endpoints are warranted.