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

Stefano Veraldi MD PhD,a Maria Chiara Persico MD,a and Rossana Schianchi MDb

aDepartment of Anesthesiology, Intensive Care and Dermatological Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy bEuropean Institute of Dermatology, Milan, Italy

Abstract
Background 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.
Results: 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.
Conclusions: Combination therapy with isoconazole nitrate and diflucortolone valerate is an effective and well-tolerated regimen in adult patients with tinea inguinalis.

J Drugs Dermatol. 2012;11(11)e70-e73.

INTRODUCTION

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-