A clinical double-blind trial of topical miconazole* and clotrimazole† against superficial fungal infections and erythrasma

A clinical double-blind trial of topical miconazole and clotrimazole creams was carried out against superficial fungal infections of the skin. The trial showed both compounds to be very effective against dermatophytes, pityriasis versicolor, Candida and erythrasma infections. Patient acceptability was equally good for both compounds.     

Topical agents in the treatment of superficial fungal infections

Such newer topical antifungal agents as tolnaftate, haloprogin, clotrimazole and miconazole are effective in the treatment of most superficial fungal infections.     

New topical agents for dermatophytosis.

Several new synthetic antifungal agents have recently become available for topical use. Reported experiences with haloprogin, miconazole and clotrimazole are reviewed. Topical preparations of these agents are nonirritating and effective in the treatment of superficial fungus infections. They are effective in the management of tinea versicolor and cutaneous candidiasis as well as dermatophytosis.     

Treatment of erythrasma with miconazole

Miconazole cream was compared with Whitfield's Ointment in a single blind trial for the treatment of erythrasma amongst patients in a hospital for the mentally subnormal. There was no significant difference in the effectiveness of the preparations when applied twice daily; more than 90% of all sites were cleared, although miconazole cream was much less irritating than Whitfield's Ointment.     

Double blind comparison of the efficacy of tioconazole and miconazole for the treatment of fungal infection of the skin or erythrasma

A total of ninety-nine patients, of whom eighty-six had fungal infections of the skin and thirteen erythrasma, took part in a double blind comparison of the efficacy and acceptability of tioconazole and miconazole creams applied twice daily. The duration of treatment was 4 weeks. Of the patients available for review upon completion of treatment, twenty-three of thirty-four patients (68%) treated with tioconazole and twenty-one of thirty-eight patients (55%) treated with miconazole were cured clinically and mycologically. Of the patients available for follow-up 4 weeks later, nineteen of twenty-one patients (90·5%) treated with tioconazole and twelve of fifteen patients (80%) treated with miconazole remained free from infection. Statistical analysis showed that tioconazole achieved a significantly higher mycological cure rate than miconazole. There was no significant difference between the two creams in clinical or overall cure rates.     

Comparison of clotrimazole cream, Whitfield''s ointment and Nystatin ointment for the topical treatment of ringworm infections, pityriasis versicolor, erythrasma and candidiasis

A double-blind trial was used to compare the efficacy and acceptability of topical treatment with clotrimazole cream or Whitfield's ointment for ringworm, pityriasis versicolor, and erythrasma infections, and that of clotrimazole cream or Nystatin ointment for Candida infections. Clotrimazole was found to be as effective and acceptable as Whitfield's ointment and Nystatin ointment.     

Human models for in vivo and in vitro assessment of topical antifungal compounds

Topical antifungal agents, 1% haloprogin solution (Halotex®), 1% tolnaftate solution (Tinactin®), 1% sodium omadine cream and 5% thiabendazole in dimethylacetamide have been investigated. They were tested for prophylactic effect against experimental human Trichophyton mentagrophytes infections. All the drugs were totally effective against experimental infection if the inoculation was immediate. However, after 48 h the effects of haloprogin and tolnaftate were greatly reduced, but the others were still very effective. Statum corneum may be stripped onto a tape, sterilized and then inoculated with T.mentagrophytes spores. Under controlled conditions the spores germinate in vitro in the stratum corneum. This method has been quantitated and adapted to the investigation of topical antifungal agents. Results show that tolnaftate has very title antifungal activity even at zero time, thiabendazole and sodium omadine retain excellent activity in the stratum corneum for 48 h and are readily detectable even 72 h after one application.     

Clotrimazole vs haloprogin treatment of tinea cruris

A study to compare the efficacy of clotrimazole 1% solution with that of haloprogin 1% solution for the treatment of tinea cruris was conducted among military personnel on active duty in a hot, humid climate. Eighty patients with documented dermatophyte infections were treated with the topical antifungal agents. Analysis of the response to treatment for 14 days demonstrated that clotrimazole was significantly more effective clinically and mycologically than haloprogin. With no further treatment, significantly more patients treated with clotrimazole remained free of the disease four weeks later.     

Infectious dermatoses in adult diabetic patients

Background The views about the increased prevalence of cutaneous infections in diabetic patients are in conflict. Objectives To study the prevalence of cutaneous infections in diabetic patients. Methods 100 non-insulin dependent diabetics and 100 controls were studied. Complete skin examination and routine dermatologic tests were used in the diagnosis of cutaneous infections. Results The overall prevalence of infections was higher in diabetic than non-diabetic patients. The toe webs were the most commonly affected sites. The frequency of erythrasma was significantly higher in diabetics, but not of candidosis, tinea versicolor, dermatophytosis and staphylococcal and viral infections. Conclusion In diabetics, erythrasma was the most frequently encountered skin infection.     

Eberconazole 1% cream is an effective and safe alternative for dermatophytosis treatment: multicenter, randomized, double-blind, comparative trial with miconazole 2% cream

BACKGROUND: Eberconazole is a topical, broad-spectrum imidazole derivative, effective in dermatophytoses, candidiasis, and pityriasis treatment. In previous trials, it showed a higher efficacy than clotrimazole in the treatment of dermatophytoses. The purpose of this trial was to evaluate the efficacy of eberconazole 1% cream compared with miconazole 2% cream in the treatment of dermatophytoses. METHODS: A multicenter, double-blind, randomized trial was performed in 653 patients with dermatophytoses, randomized to eberconazole 1% cream every 12 h or miconazole 2% cream every 12 h for 4 weeks. Treatment efficacy was assessed on the basis of the percentage of effective response after 4 weeks through mycologic and clinical assessment. RESULTS: Of the 653 patients included in the trial, 360 produced positive baseline mycologic cultures and were included in the efficacy assessment. Clinical efficacy was shown in 76.1% of patients receiving eberconazole and in 75.0% of patients receiving miconazole. The incidence of adverse events related to treatment was 0.91% for eberconazole and 0.92% for miconazole, none being serious, and all being local and transient. CONCLUSIONS: Eberconazole 1% cream is an effective treatment for fungal infections produced by dermatophytes, with a good safety and tolerability profile, and can be considered a good alternative for the treatment of dermatophytoses.     

Cutaneous candidiasis: treatment with miconazole nitrate.

In a well-controlled, double-blind, randomized study, 30 patients with cutaneous candidiasis were treated with a 2% miconazole nitrate lotion or its placebo control. By the 14th day, 13 of the 15 patients [87%] treated with miconazole nitrate achieved clinical and mycologic cures. Only a single patient treated with the placebo lotion would be classified as a therapeutic cure. In a second portion of the study those patients judged to be therapeutic failures were treated with the lotion containing 2% miconazole nitrate. By combining the results of both portions of the study we find that miconazole nitrate lotion produced both a clinical and mycologic cure in all patients receiving the active lotion. The miconazole lotion formula was well tolerated by all patients and no side effects were noted. The fact that miconazole nitrate acts rapidly in relieving symptoms, is well tolerated, and is highly effective against dermatophytes, yeasts and gram-positive bacteria, makes it a welcome addition to available topical therapy of skin infections.     

Concomitant erythrasma and dermatophytosis of the groin

Four patients are reported with concomitant erythrasma and trichophyton rubrum dermatophytosis of the groin. The recognition and diagnosis of these associated infections is emphasized.     

Clotrimazol therapy of skin mycoses]

Clinical evaluation of a 1% clotrimazole cream and solution on 236 in and out patients with different clinical manifestations of mycotic infections was done. Clotrimazole, both cream and solution, is an effective and well tolerated agent in the treatment of infections due to dermatophytes and yeasts. Best results were recorded with patients suffering from pityriasis versicolor and erythrasma, and interdigital erosion.     

Tinea pedis and erythrasma in Danish recruits: Clinical signs, prevalence, incidence, and correlation to atopy

Prior to military service, 665 recruits were examined clinically and microbiologically for tinea pedis and erythrasma and 546 of these were reexamined at the end of military service. The prevalence of clinical signs, erythrasma, and dermatophyte infection at the first investigation was 58.8%, 51.3%, and 6.2%, respectively, and at the second investigation, 81.1%, 77.1%, and 7.0%, respectively. The incidence of tinea pedis was 4.2% during the 9 months of military service. Of those infected at the first visit 41% had persistent infection mainly due to Trichophyton rubrum, whereas new infections were largely caused by Trichophyton mentagrophytes. Some of those persistently infected had signs of chronicity at the follow-up visit, indicating that chronic dermatophytosis may become established in the early twenties. The prevalence of atopy was 15.0% in all the recruits but was almost 50% in those with persistent tinea pedis.     

Diaper dermatitis: a therapeutic dilemma. Results of a double-blind placebo controlled trial of miconazole nitrate 0.25%

Diaper dermatitis, an acute inflammation of the skin in the diaper area, is the most common dermatologic disorder of infancy. This placebo-controlled, randomized, double-blind, parallel-group trial compared the efficacy and safety of miconazole nitrate 0.25% in a zinc oxide/petrolatum base with that of the ointment base alone in treating acute diaper dermatitis in infants and evaluated the role of Candida albicans in the response to treatment. Infants age 2-13 months with diaper rash were treated with either miconazole nitrate 0.25% (N = 101) or ointment base (N = 101) for 7 days. Although improvement in rash from baseline was seen in both treatment groups on days 3, 5, and 7, patients receiving miconazole nitrate 0.25% had significantly fewer rash sites and lower mean total rash scores on days 5 and 7 (p < 0.001). In the miconazole nitrate 0.25% group, improvement was most marked among those with moderate or severe diaper dermatitis at baseline and among patients whose baseline rashes were positive for C. albicans. Treatment with miconazole nitrate 0.25% was as safe as with ointment base alone. Miconazole nitrate 0.25% ointment is a safe and effective treatment for diaper dermatitis in infants.     

BEYTHRASMA IN A HOSPITAL FOR THE MENTALLY SUBNORMAL

Summary— An investigation of the incidence of erythrasma amongst patients in a psychiatric hospital for the mentally subnormal is described. The axillae, groins and toewebs were examined and clinical erythrasma, showing characteristic coral-red fluorescence under Wood's light, was found in 43% of the 874 patients examined. The incidence in the groins was 18%, in the axillae 4% and in the toewebs 30%. Fluorescence of other skin sites was also seen in a small proportion of the patients. Diphtheroids fluorescing on tissue culture medium No. 199 could be cultured from 35% of the fluorescent skin areas and from 25% of non-fluorescing sites. The incidence of erythrasma increased with age but was unaffected by state of personal hygiene, although fewer of the patients with a reasonable level of cleanliness carried fluorescent diphtheroids on non-fluorescent sites.     

The prevalence of interdigital erythrasma in southern region of Turkey

Background Erythrasma is a skin infection which is caused by Corynebacterium minutissimum. Interdigital erythrasma is the most common form. Objective The aim of this study was to detect the frequency and risk factors of interdigital erythrasma in patients with clinically suspected tinea pedis. Methods This study was conducted between June and December 2010 and included 122 patients who had interdigital foot lesions. All patients were examined using a Wood’s lamp. The smears were stained using Gram’s method. Direct examination was performed using 20% potassium hydroxide. Sabouraud dextrose agar and brain heart infusion agar were used for cultures. Moreover, the demographical characteristics of patients, concomitant diseases and clinical findings were also recorded. Cases that were found to be positive on Wood’s lamp examination and/or Gram staining/culture were considered as erythrasma. Results The rate of erythrasma was found to be 46.7%. The mean age was 43.6 years, and the disease was more prevalent in men. The most common clinical finding was desquamation. Mycological examination was found as positive in 40.35% of the patients. No growth was observed in bacteriological cultures. It was found that using only Wood’s lamp examination or Gram staining resulted in 11 (9%) and 19 positive patients (15.6%), respectively, whereas using both Wood’s lamp examination and Gram staining concurrently resulted in 27 positive patients (22.1%). Conclusion Interdigital erythrasma is a commonly seen condition and can clinically mimic tinea pedis. A Wood’s lamp is a good diagnostic tool, but Gram staining, particularly in those with a negative Wood’s lamp result, may be a useful method.     

Sertaconazole 2% cream vs. miconazole 2% cream for cutaneous mycoses: a double‐blind clinical trial

The efficacy of 2% creams of miconazole nitrate and sertaconazole were compared in a double‐blind clinical trial carried out on 100 patients with an established diagnosis of cutaneous dermatophytosis. Assessments were performed on days 0, 15, 29 and 43 in our dermatology clinic. Cure was defined according to clinical assessment confirmed by microscopical examination and culture. The groups were similar in age, gender, weight and clinical presentation. The reported side‐effects, most commonly pruritus, occurred in 22 (40.0%) and 15 (33.3%) patients in the sertaconazole and miconazole groups, respectively (P = 0.28), but were not serious enough to stop the treatment. The only significant difference between the groups was in per‐protocol cure rate by day 15, when patients in the sertaconazole group had a higher cure rate than the miconazole group (P < 0.01). In conclusion, sertaconazole was superior to miconazole in producing an early response in our patients. Given the higher price of sertaconazole and the ability of the considerably less expensive miconazole to produce equally good response after a month, the usefulness of sertaconazole as an alternative to miconazole in Iran requires further study.     

Preventive effects of topical washing with miconazole nitrate‐containing soap to diaper candidiasis in hospitalized elderly patients: A prospective,double‐blind,placebo‐controlled study

The objective of the present randomized, double‐blind trial was to evaluate the efficacy and safety of daily washing with miconazole nitrate‐containing soap for candidiasis at diaper‐covered sites in elderly subjects under long‐term inpatient care. To confirm the onset and disappearance of candidiasis, we microscopically evaluated the existence of the pseudohyphae and/or blastoconidia of Candida spp. We enrolled 75 elderly patients who wore diapers all day in the hospital or nursing home. Patients were randomly assigned to receive treatment with either miconazole soap or miconazole‐free placebo soap, and 28 patients in the miconazole group and 27 patients in the placebo group were followed for 4 weeks. Although washing with miconazole soap did not affect the frequency of pseudohyphae/blastoconidia‐positive patients, it significantly inhibited the positive conversion of pseudohyphae/blastoconidia compared with the placebo group. As a result, the frequency of patients positive for pseudohyphae/blastoconidia was significantly lower in the miconazole group than in the control group at 4 weeks (17.9% vs 44.4%). Clinically apparent diaper candidiasis did not develop in either group. Washing with miconazole soap was a significant independent factor for reducing the cases positive for pseudohyphae/blastoconidia, while diarrhea and heart failure were significant factors associated with an increase in the positive rate at the end‐point. Severe adverse effects were not found in any patients. Thus, washing with miconazole soap is well‐tolerated and can inhibit the positive conversion of Candida in patients wearing diapers. Therefore, maintenance of genital hygiene using this soap may prophylactically decrease the overall prevalence of patients with diaper candidiasis.     

Butoconazole and miconazole in treating vaginal candidiasis.

In a single blind trial, a three day course of butoconazole nitrate cream was compared with a seven day course of miconazole nitrate cream, both applied intravaginally, in treating vaginal candidiasis. They were equally effective. The cure rate for patients treated with butoconazole was 82.8% at the first follow up (a mean of 18.4 days from the beginning of the treatment) and 76.7% at second follow up (a mean of 40.4 days). Cure rates for patients treated with miconazole were 84.4% and 75.8% respectively. The differences between these cure rates were not significant.