Terbinafine exacerbates psoriasis: case report with a literature review

Oral terbinafine is a widely used antifungal agent. Adverse effects occur in about 11% of patients taking terbinafine. A rare case of the exacerbation of pre-existing psoriasis after oral terbinafine treatment is reported. A 63-year-old male patient with stable psoriasis vulgaris developed extensive tinea cruris. For this reason, he was treated with oral terbinafine 250 mg/day and topical 1% terbinafine cream. After 6 days of this therapy, a widespread flare-up of psoriasis developed. Oral terbinafine was discontinued, and the psoriasis was treated with topical corticosteroids and tacalcitol. Tinea cruris was cured with topical terbinafine. This case points out that terbinafine can influence the course of psoriasis. Moreover, the literature data indicate that terbinafine may not only exacerbate pre-existing psoriasis, but may also be responsible for de novo development of psoriasis. Therefore, oral terbinafine should not be considered the first line drug for superficial fungal infections in psoriatic individuals.