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  Issue 1 (2002)

Conversation with Dr Kresken:
Tinea Pedis Treatment: Advantages for topical Terbinafine

"Tinea pedis prophylaxis as important as personal hygiene". This is the title of a press release by which the GD Gesellschaft für Dermopharmazie informed the public about the widespread disease tinea pedis on the occasion of its 6th Annual Meeting in Hamburg between 20 and 22 March 2002. It has been shown in a major European study, the Achill Project, that this disease affects every third person in Germany. Recommendable for treatment are for example topical antimycotics on the basis of Terbinafine (Lamisil® cream and spray), which are reliably effective, and at the same time low in price. DermoTopics discussed this subject with the president of the GD, pharmacist Dr. Joachim Kresken. 

Dr. Kresken, to which fact do you attribute the spreading of the disease Tinea pedis?

Dr. Kresken:
An important cause lies in the incorrect behaviour of many people: if I do not dry my feet thoroughly after a visit to the swimming pool or sauna then I generate - especially when wearing occluding footwear - a "moist-warm chamber". This ensures dermatophytes optimal living conditions and increases thus the risk of a tinea pedis. Moreover, the disease is unrecognized by many affected or not taken seriously and accordingly not at all or inadequately treated.

Most topical antimycotics have to be applied at least three to four weeks at an infection of the toe interspace. In contrast, for topical Terbinafine an application duration of only seven days is subject to advertising. Is such a short treatment period in fact sufficient and how can this difference be explained?

Dr. Joachim Kresken

Dr. Kresken:
Several controlled clinical studies could undoubtedly prove and also authorization authorities have acknowledged that this short application duration is sufficient. This has been proven for the commercial Terbinafine cream as well as the spray newly introduced in the beginning of this year. The reason is the long retention time in the horny layer. Even three weeks after the last application, a sufficient high fungicidal active substance level can be found. Since moreover an application once a day suffices, a higher compliance than with antimycotics can be assumed which due to their swifter active substance decrease in the horny layer have to be used for a duration of three to four weeks. When employing these preparations, the treatment is often terminated too early because the subjective symptoms already disappear after a few days of treatment. This may cause a recidivation which is misinterpreted by many persons affected as reinfection.

In your lecture in the course of the 74th Annual Meeting at the North German Dermatological Society in Kiel in September of last year you emphasized the particular economic efficiency of topical Terbinafine. Does this only apply to the cream or also to the newly introduced spray and are there are reasons in favor of the new presentation?

Dr. Kresken:
Due to the lower product consumption cost benefits can also be established for the spray compared with other antimycotics. For the treatment of an infection in the forefoot area normally an original package at a price of 8,85 Euro is sufficient. In comparison, Clotrimazole-containing sprays are lower-priced, but the cost advantage is used up by an eight times as high consumption quantity. Normally two original packs are required in accordance with the correct application duration which amount to 10 to 12 Euros depending on the preparation. Terbinafine-spray is a little more expensive than the cream, has however some application-related benefits. For example I think of the easy spreadibility at diffuse infestation and also of the modern convenient form of application without the aid of fingers allowing an easy application also at limited agility.


Dr. Kresken, thank you for this conversation (jk).


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