By S H Wakelin

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These include decreased HDL and, sometimes, increased LDL. The changes may be marked. • Virilization in women with deepening of the voice, hirsutism, acne, and clitoromegaly. Menstrual irregularity, flushing, sweating, vaginal dryness and emotional lability may also occur. To prevent irreversible change the drug should be discontinued, or the dosage significantly reduced when mild symptoms are first detected. • Gonadal effects in adult males include testicular atrophy, a modest reduction in spermatogenesis, impotence, priapism and bladder irritability.

4. Honig PK, Wortham DC, Zamani K et al. Terfenadine–ketoconazole interaction. Pharmacokinetic and electrographic consequences. JAMA 1993; 269: 1513–1518. Further reading Daneshmend TK, Warnock DW. Clinical pharmacokinetics of ketoconazole. Clin Pharmacokinet 1988; 14: 13–34. Van Tyle JH. Ketoconazole: mechanism of action, spectrum of activity, pharmacodynamics, drug interactions, adverse reactions and therapeutic use. Pharmacotherapy 1984; 4: 343–373. qxd:Final proofs 21/1/11 12:33 Page 60 GRISEOFULVIN ✚ Classification and mode of action Griseofulvin was the first drug to be effective orally against superficial fungal infections in man.

Overview of the use of terbinafine (Lamisil) in children. Br J Dermatol 1995; 132: 683–689. 3. Elewski BE. Tinea capitis: a current perspective. J Am Acad Dermatol 2000; 42: 1–20. 4. Cribier BJ, Paul C. Long-term efficacy of antifungals in toenail onychomycosis: a critical review. Br J Dermatol 2001; 145: 446–52. 5. Bell–Syer SEM, Hart R, Crawford F et al. A systematic review of oral treatments for fungal infections of the skin of the feet. J Dermatol Treat 2001; 12: 69–74. 6. Hamm H, Schwinn A, Brautigam M et al.

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