Efficacy of Four Different Topical Drugs in the Management of Tinea Corporis and Tinea Cruris
European Journal of Molecular & Clinical Medicine: Published
on 2020
Superficial infection caused by a
dermatophyte is termed dermatophytosis or ringworm. They are all moulds
belonging to three asexual genera: microsporum, trichophyton and
epidermophyton.
Depending upon the site of
infection, dermatophyte infection can be classified as tinea corporis (body),
tinea cruris (groin), tinea capitis (head), tinea pedis (feet), tinea manuum
(hand), tinea unguium (nail), tinea barbae (beard) etc.
The most common factors
predisposing to fungal infection still remain poor personal hygiene, immune
status and associated illness.
Topical
antifungal therapy is the mainstay in the treatment of dermatophytosis. Currently,
topical azoles and allylamines are used for the treatment of cutaneous mycoses
with disadvantages like long duration of therapy, which leads to poor
compliance and a high relapse rate.
This
report will summarize the studies evaluating new antifungal agents that are
approved by the US Food and Drug Administration.
TAKE HOME MESSAGE:
Newer
topical antifungals seem to have certain advantages over the older drugs. Some
of the newer agents require only once-daily application and shorter courses of
treatment, and are associated with lower relapse rates.
Current
epidemic of dermatophytosis is complicated by an increased number of chronic and
recurrent dermatophytosis. Topical steroid abuse also seems to be a major
contributor to the onslaught of extensive and treatment resistant cases.
There has
also been a shift in the dominant pathogen responsible for the infections
across India from Trichophyton rubrum to Trichophyton mentagrophytes.
Within
the past few years, new extended-spectrum triazoles and allylamines have been
introduced into market among such are Luliconazole, Sertaconazole, Eberconazole
which belong to Triazoles and Amorolfine which belong to Allyamine group.
Authors found that the topical antifungals were effective in majority of the patients, although variable response was seen. Best response at the end of 3 weeks of topical therapy was shown by Luliconazole.
CONCLUSION:
Authors
concluded that the Luliconazole may score over other 3 topical antifungals
(sertaconazole, amorolfine and terbinafine). Although it belongs to azole
class, it seems to exhibits fungicidal activity.
This
study also signifies the role of topical antifungal alone in treating limited
tinea corporis and cruris, thus boosting the confidence on topical therapy.
Doctors Liked to Read More
Aim:
Comparative assessment of efficacy
of topical amorolfine, luliconazole, sertaconazole, terbinafine in tinea
corporis and tinea cruris.
Material and methods:
This was a prospective, randomized
study was done in the Department of skin and VD, Vardhman Institute
of Medical Sciences, Pawapuri, Nalanda, Bihar, India for one year Total 100
divided into four groups with 25 patients in each category of antifungal were
considered. Consecutive eligible patients were prescribed topical amorolfine
(0.25%), luliconazole (1%), sertaconazole (2%) and terbinafine (1%) in a serial
order. We evaluated the improvement in the pruritus, erythema and scaling with
score 0 for no improvement, score 1 for partial improvement and score 2 for
complete improvement. Therapeutic response was statistically evaluated using
Kruskal Wallis test and Fishers exact test.
Results:
Among 100 patients 44 were
treatment naive, 25 were topical steroid (with or without antifungal) modified
cases, 23 were partially treated with antifungals and 8 had used home remedies
prior to the study. Luliconazole showed best improvement of pruritus
(mean-1.53), erythema (mean-1.48) and scaling (mean- 1.47). Terbinafine showed
the least improvement with mean being 0.62, 0.52, and 0.77 for pruritis,
erythema and scaling respectively. Difference in the mean values of improvement
of luliconazole as compared to the other three drugs was significant for
pruritus and highly significant for erythema and scaling. A total of 16
patients (64%) in luliconazole group showed good response as compared to the
other drugs. These differences in the improvement of patients were
statistically significant as compared to other drugs.
Conclusion:
Authors concluded that the
Luliconazole is better as compared to other antifungal.
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