Isoconazole Nitrate vs Isoconazole Nitrate and Diflucortolone Valerate in the Treatment of Tinea Inguinalis: Results of a Multicenter Retrospective Study
November 2012 | Volume 11 | Issue 11 | Original Article | 70 | Copyright © November 2012
AbstractBackground and Objective:
Many tinea inguinalis infections are characterized by pronounced inflammatory lesions and pruritus.
Therefore, a therapy with a topical corticosteroid in addition to a topical antimycotic agent might be beneficial. In this multicenter,
retrospective study, we compared the mycological and clinical efficacy and tolerability of isoconazole nitrate alone vs isoconazole
nitrate and diflucortolone valerate in 58 adult patients with tinea inguinalis.
Patients and Methods:
Treatment duration was three weeks. The efficacy of the treatment was based on the assessment of
several signs and symptoms, which were collected on a 4-point scale. All patients were examined clinically before the beginning
of the treatment, one week later, two weeks later, and at the end of the treatment. Mycological examinations were performed
before the beginning of the treatment and at the end of the study.
Treatment results with the combination of isoconazole nitrate and diflucortolone valerate were superior regarding erythema
and pruritus. Both erythema and pruritus resolved in a larger percentage of patients and more quickly. Both regimens were
well tolerated. Mycological cure rates were similar in both groups of patients.
Combination therapy with isoconazole nitrate and diflucortolone valerate is an effective and well-tolerated regimen
in adult patients with tinea inguinalis.
J Drugs Dermatol.
Tinea inguinalis is a mycotic infection of the inguinal
folds that usually occurs in young men living in warm,
humid climates. Trichophyton rubrum, Epidermophyton
floccosum, and Trichophyton mentagrophytes are the
most frequently involved species. Tinea inguinalis is characterized
clinically by erythematous lesions with an inner scaling
area and vesicular-pustular, well-defined borders. Typical
symptoms of tinea inguinalis are more or less severe pruritus
and burning sensation. Topical corticosteroids can be useful in
the management of inflammatory tinea inguinalis. However,
there is concern that these drugs can induce skin atrophy, and,
in addition, they can increase skin susceptibility to bacterial
superinfections. On the other hand, combination therapy with
an antimycotic agent and a topical corticosteroid can be useful
because the steroid component provides rapid symptomatic
relief, while the antimycotic agent eradicates causative organisms.
The efficacy of this combination has been demonstrated
in some clinical studies.1-4 The aim of this multicenter, retrospective
study was to assess the mycological and clinical efficacy
and tolerability in adult patients with tinea inguinalis of
a combination therapy with an antimycotic agent (isoconazole
nitrate) and a corticosteroid (diflucortolone valerate) compared
with a monotherapy with isoconazole nitrate alone.
PATIENTS AND METHODS
Adult patients with mycologically proven inflammatory tinea
inguinalis were enrolled in this retrospective study. Patients
were assigned to be treated either with a cream containing
1% isoconazole nitrate (group 1, monotherapy group) or a
cream containing 1% isoconazole nitrate and 0.1% diflucortolone
valerate (group 2, combination group). Patients in group
1 were treated with isoconazole nitrate twice daily for three
weeks. Patients in group 2 were treated with the combination
of isoconazole nitrate and diflucortolone valerate (Travocort;
Intendis GmbH, Berlin, Germany) twice daily for one week, followed
by isoconazole nitrate alone (twice daily for two weeks).
All patients were examined clinically before the beginning of the
treatment (T0), one week later (T1), two weeks later (T2), and at
the end of the treatment (T3). The efficacy of the treatment was
based on assessing seven signs (erythema, swelling, scaling,
papules, vesicles, pustules, and exudation) and two symp-