Clinical Efficacy of Topical Clotrimazole Versus Combination of Isoconazole Nitrate with Diflucortolone Valerate in Tinea Corporis

Abstract

Introduction: Tinea corporis also known as ‘ringworm’ is dermatophytosis of the trunk. It usually presents as an annular plaque with a slightly raised and often scaly, advancing border. Topical azoles in combination with steroids are commonly prescribed. But it is unclear whether they are superior to topical azoles alone or not.

Objective: To compare the clinical efficacy of 1% topical clotrimazole cream vs combination of 1% isoconazolenitrate (ISN)with 0.1%diflucortolone valerate (DFV) cream in patients of tinea corporis.

Methods        : A randomized controlled trial was performedon 380 patients of outdoor dermatology unit of Pakistan Institute of Medical Sciences, Islamabad. They were randomly allocated to two groups by lottery method named Group A  who were given topical 1% clotrimazole cream (an antifungal) and Group B who were given topical 1% isoconazole nitrate (an antifungal) and 0.1% diflucortolone valerate cream (a corticosteroid). Both groups were asked to apply respective cream twice daily for two weeks.

Results: Among 190 patients of study group A, where 123 (64.70%) patients showed complete clinical cure, 67 (35.3%) still had existent any of the three signs of tinea corporis, hence had negative clinical efficacy. Comparatively in group B, 126 (66.3%) patients showed complete clinical cureand 64 (34.70%) showed persistence of either of the clinical signs of tinea corporis after treatment. Even though the clinical efficacy showed slightly better results with ISN and DFV group, the difference was also not statistically significant. (d.f. 1, χ statistic 0.10, p- value 0.74)

Conclusion: There is no significant difference in clinical efficacy of clotrimazole vs isoconazole nitrate and diflucortolone valerate cream and both are effective treatments for tinea corporis. Azole monotherapy being cheaper should be preferred over combination treatment.