ORIGINALARTICLE

COMPARATIVE EFFICACY OF TOPICAL OXICONAZOLE CREAM (1%) VERSUS TOPICAL

CLOTRIMAZOLE CREAM (1%) IN THE TREATMENT OF TINEA CRURIS

Fahad Khan¹, Ghafoor Ullah², Naveed Ullah¹, Wajid Ali¹, Khizar Hayat¹

How to cite this article

ABSTRACT

OBJECTIVES

To compare the clinical ecacy of topical Oxiconazole 1% cream

with topical clotrimazole 1% cream in patients with KOH-conrmed

Khan F, Ullah G, Ullah N, Ali W,

Hayat K. Comparative Efficacy of

Topical Oxiconazole Cream (1%)

Versus Topical Clotrimazole Cream

(1%) in the Treatment of Tinea Cruris.

J Gandhara Med Dent Sci. 2026;13(3):

103-109.

tinea cruris.

METHODOLOGY

The study was conducted in the Department of Dermatology, MTI-Hayatabad

Medical Complex, Peshawar, from 12 May, 2025 to 12 Nov, 2025. A total of

386 patients aged 18–60 years with clinically diagnosed tinea cruris

conrmed by potassium hydroxide mount were consecutively

recruited and randomly allocated into two equal treatment groups.

Group A received topical Clotrimazole 1% cream, while Group B

received topical Oxiconazole 1% cream, applied twice daily for four

weeks. Clinical severity was assessed at baseline and at Week 4 using

a composite symptom score comprising pruritus, erythema, vesicles,

and desquamation, each graded from 0 to 3. Clinical response was

defined as ≥50% reduction in total symptom score at Week 4. The

primary analysis was performed according to the randomized groups.

Mean dierences with 95% condence intervals were calculated for

symptom scores, and the risk dierence with 95% condence interval

was calculated for clinical response. Data were analyzed using IBM

SPSS version 25, with p≤0.05 considered statistically signic ant.

RESULTS

https://doi.org/10.37762/jgmds.13-3.878

Date of Submission: 04-03-2026

Date Revised:

Date Acceptance:

19-06-2026

24-06-2026

¹Resident, Department of Dermatology,

Hayatabad Medical Complex, Peshawar

Correspondence

²Ghafoor Ullah, Associate Professor,

Department of Dermatology, Hayatabad

Medical Complex, Peshawar

+92-333-9189230

dr.ghafoor@yahoo.com

All 386 randomized patients were included in the Week-4 analysis, with 193

patients in each group. Baseline symptom scores were comparable between

the groups. At Week 4, pruritus score was signicantly lower in the

oxiconazole group than in the clotrimazole group (0.74±0.63 vs. 0.93±0.58;

mean dierence -0.19, 95% CI -0.31 to -0.07; p=0.003). Week-4 erythema,

vesicles, and desquamation scores did not dier signicantly between the

groups. Overall clinical response was achieved in 165/193 patients (85.5%)

in the oxiconazole group and 157/193 patients (81.3%) in the clotrimazole

group, with a risk dierence of 4.1% (95% CI -3.3% to 11.6%; p=0.274).

Clinical response remained comparable across gender strata.

CONCLUSION

Topical Oxiconazole 1% and Clotrimazole 1% creams showed comparable

overall clinical response in KOH-conrmed tinea cruris after four weeks of

treatment. Oxiconazole produced a statistically greater reduction in pruritus;

however, the magnitude of dierence was small. As Week-4 mycological cure,

antifungal susceptibility, quality-of-life assessment, adverse-event prole, and

recurrence after treatment were not assessed in the available dataset, the

ndings should be interpreted as short-term clinical response rather than

confirmed microbiological eradication.

KEYWORDS: Tinea cruris; Dermatophytosis; Clotrimazole; Oxiconazole;

Topical antifungal; Randomized controlled trial; Clinical response; Pruritus

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Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

term clinical ecacy of topical Oxiconazole 1% cream

INTRODUCTION

and topical clotrimazole 1% cream in patients with

KOH-conrmed tinea cruris. The study specically

evaluated the change in symptom scores after four

weeks of treatment and overall clinical response

dened by a reduction in total symptom score.

Mycological cure, antifungal susceptibility, quality-of-

life change, adverse events, treatment adherence, and

post-treatment recurrence were not assessed and are

therefore not claimed as outcomes of this study.

Dermatophytosis is one of the commonest supercial

fungal infections worldwide and aects approximately

20-25% of the global population.¹ It involves

keratinised tissues such as the skin, hair, and nails and

commonly presents as tinea corporis, tinea cruris, tinea

pedis, and tinea unguium. Tinea cruris aects the groin

region and is frequently associated with pruritus,

erythema,

scaling,

vesiculation,

discomfort,

embarrassment, and impaired daily functioning. The

disease burden is higher in warm and humid climates,

where sweating, occlusive clothing, overcrowding, and

delayed treatment can facilitate persistence and

METHODOLOGY

This randomized controlled trial was conducted in the

Department of Dermatology, MTI-Hayatabad Medical

Complex, Peshawar, from 12 May, 2025 to 12 Nov,

2025, after approval from the institutional ethical

review committee vide approval No. 2354. Written

informed consent was obtained from all participants

before enrolment. The sample size was calculated using

the WHO sample size calculator for comparison of two

independent proportions. The calculation was based on

previously reported clinical ecacy rates of 67.9% and

81.0% for topical Oxiconazole in dermatophytosis, with

95% condence level, 80% power, and 1:1 allocation

ratio between the two treatment groups.^8,9Using the

two-proportion formula, the calculated sample size was

172.62, rounded to 173 patients per group. After adding

10% for possible non-response or loss to follow-up, the

final sample size became 193 patients per group, giving

a total sample size of 386 patients. Patients aged 18-60

years of either gender with clinically suspected tinea

cruris and a positive potassium hydroxide mount were

included. Patients with mixed or extensive fungal

infection requiring systemic antifungal therapy, other

inammatory dermatoses involving the groin, known

hypersensitivity to azole antifungals, pregnancy,

lactation, immunosuppression, uncontrolled diabetes

mellitus, recent use of topical antifungals or topical

corticosteroids, and recent use of systemic antifungal

therapy were excluded. Eligible patients were recruited

transmission.¹ ² Diagnosis of tinea cruris is usually

based on compatible clinical morphology supported by

potassium hydroxide microscopy, especially when

clinical mimics such as candidiasis, erythrasma,

psoriasis, erythrasma, seborrhoeic dermatitis, or contact

dermatitis are possible.³ Conrmation of fungal

elements is important because empirical treatment

without diagnostic support may contribute to

inappropriate drug use, partial response, recurrence, and

unnecessary exposure to topical steroid-containing

combinations.³ ⁴ Topical antifungal therapy remains the

preferred treatment for localized uncomplicated tinea

cruris because it avoids systemic adverse eects, has

minimal drug interaction potential, and is generally

convenient for outpatient management.⁵ Clotrimazole is

a widely used topical imidazole antifungal with

established ecacy in dermatophytosis.⁵ ⁶ Oxiconazole

is another topical imidazole with broad antifungal

activity and a treatment prole suitable for supercial

dermatophyte infections.⁶ ⁷ Although both agents are

used clinically, comparative local data evaluating their

short-term clinical response in KOH-confirmed tinea

cruris are limited. Previous clinical studies have

reported favourable response rates with topical

Oxiconazole in dermatophytosis. Islam et al. reported

clinical cure in 67.9% of patients treated with topical

1% oxiconazole cream. In comparison, Jerajani et al.

reported excellent response in 71% and good response

in 10% of patients treated with topical 1% oxiconazole

cream, giving a combined excellent/good response of

consecutively from the

dermatology outpatient

department and were then randomly allocated into two

equal treatment groups. Consecutive sampling was used

only for recruitment of eligible participants, while

treatment assignment was performed by randomization.

Participants were allocated in a 1:1 ratio through

blocked randomization using sequentially numbered

opaque sealed envelopes to maintain allocation

concealment. Group A received topical Clotrimazole

1% cream, while Group B received topical Oxiconazole

1% cream. Both groups were instructed to apply the

assigned cream twice daily over the aected area for

four weeks. Patients were advised to keep the aected

81.0%.⁸ ⁹ The clinical relevance of comparing these two

topical agents lies in determining whether Oxiconazole

oers measurable symptomatic benet over the more

established Clotrimazole in routine outpatient practice.

Pruritus relief is particularly relevant because itching is

often the most troublesome symptom for patients and

may lead to scratching, excoriation, discomfort, and

reduced adherence. However, clinical improvement

alone cannot be equated with microbiological cure

unless supported by repeat microscopy, culture, or

species-level identication. Therefore, this randomized

controlled trial was conducted to compare the short-

area dry, avoid sharing towels and clothing, avoid

occlusive clothing, and not to use any non-prescribed

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Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

topical steroid-containing combination during the study RESULTS

period. Baseline demographic and clinical variables,

A total of 386 patients with KOH-conrmed tinea

including age, gender, body mass index, duration of

cruris were enrolled and randomized equally into Group

A and Group B, with 193 patients in each treatment

arm. All randomized patients were included in the nal

Week-4 clinical ecacy analysis. No participant was

excluded from the nal analysis shown in the submitted

dataset. Baseline symptom severity was comparable

between the two groups. The mean baseline pruritus

score was 2.21±0.80 in Group A and 2.21±0.84 in

Group B, with a mean dierence of 0.00 (95% CI -0.16

to 0.16; p=0.951). Baseline erythema score was

1.84±0.93 in Group A and 2.01±0.86 in Group B, with

a mean dierence of 0.17 (95% CI -0.01 to 0.35;

p=0.070). Baseline vesicle and desquamation scores

were also comparable between the groups. At Week 4,

both treatment groups showed improvement in all

complaints,

residence,

education,

profession,

socioeconomic status, and baseline symptom severity,

were recorded on a structured proforma. Clinical

severity was assessed at baseline and at Week 4 using a

standardized composite symptom score comprising

pruritus, erythema, vesicles, and desquamation. Each

symptom was graded from 0 to 3, giving a total score

ranging from 0 to 12. Treatment adherence was

assessed at the Week-4 visit by direct questioning

regarding twice-daily application of the assigned

medication and avoidance of additional antifungal or

steroid-containing preparations. Local adverse events,

including burning, irritation, erythema, contact

dermatitis,

worsening

pruritus,

and

treatment

discontinuation due to intolerance, were also recorded

at follow-up. The primary outcome was clinical

efcacy at Week 4, dened as at least 50% reduction in

total symptom score from baseline. Secondary

outcomes included Week-4 scores for pruritus,

erythema, vesicles, and desquamation. Mycological

cure was not used as an outcome because repeat KOH

mount, fungal culture, species identication, and

antifungal susceptibility testing were not performed at

Week 4. Quality-of-life assessment and recurrence after

completion of treatment were also not assessed;

therefore, the results were interpreted as short-term

assessed

symptom

domains.

The only statistically signicant between-group

dierence was observed in pruritus score, which was

lower in Group B compared with Group A (0.74±0.63

vs. 0.93±0.58), with a mean dierence of -0.19 (95%

CI -0.31 to -0.07; p=0.003). This represented a small

treatment eect in favour of Oxiconazole. Week-4

erythema score was similar in both groups (0.67±0.58

vs. 0.67±0.59; mean dierence 0.00, 95% CI -0.12 to

0.12; p=0.990). Week-4 vesicle score was 0.59±0.56 in

Group B and 0.65±0.62 in Group A, with a mean

dierence of -0.06 (95% CI -0.18 to 0.06; p=0.303).

Week-4 desquamation score was 0.67±0.62 in Group B

and 0.73±0.58 in Group A, with a mean dierence of -

0.06 (95% CI -0.18 to 0.06; p=0.398). The distribution

of baseline categorical characteristics, including gender,

residence, education, profession, and socioeconomic

status, was comparable between the two treatment

groups. Overall clinical ecacy was achieved in

322/386 patients (83.4%). In Group A, 157/193 patients

(81.3%) achieved clinical ecacy, while in Group B,

165/193 patients (85.5%) achieved clinical ecacy.

The absolute risk dierence was 4.1% in favour of

Group B (95% CI -3.3% to 11.6%), and the relative risk

was 1.05 (95% CI 0.96 to 1.15). This dierence was not

statistically signicant (p=0.274). On gender-stratified

analysis, clinical efcacy remained comparable

between the treatment groups. Among males, ecacy

was observed in 107/132 patients (81.1%) in Group A

and 107/128 patients (83.6%) in Group B (p=0.593).

Among females, ecacy was observed in 50/61

patients (82.0%) in Group A and 58/65 patients (89.2%)

clinical

response

rather

than

microbiological

eradication or sustained cure. Participant ow was

documented according to CONSORT principles,

including the number of patients assessed for eligibility,

randomized, allocated to each treatment arm, followed

up, and analyzed. The primary analysis was performed

on an intention-to-treat basis, with all randomized

patients retained in their originally assigned groups. As

all 386 randomized patients had Week-4 outcome data

available in the nal dataset, no participant was

excluded from the ecacy analysis. Data were

analyzed using IBM SPSS version 25. Quantitative

variables were assessed for normality using the

Shapiro-Wilk test and were reported as mean±standard

deviation or median with interquartile range, as

appropriate. Between-group comparison of quantitative

variables was performed using the independent-samples

t-test or Mann-Whitney U test according to data

distribution. Categorical variables were reported as

frequency and percentage and compared using the chi-

square test or Fisher‘s exact test where appropriate.

Treatment eect was reported using mean dierence

with 95% condence interval for continuous symptom

scores and risk dierence with 95% condence interval

for clinical ecacy. Stratified analysis was performed

for gender. A p-value of ≤0.05 was considered

statistically signicant.

in Group

(p=0.244). Adverse-event counts,

treatment-discontinuation data, repeat KOH ndings,

fungal culture, antifungal susceptibility testing, quality-

of-life scores, and post-treatment recurrence data were

not available i

n the nal dataset. Therefore, these

outcomes could not be analyzed and are not reported as

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Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

Table 2: Baseline Characteristics and Clinical Eicacy by

study ndings. The results should be interpreted as a

Week-4 short-term clinical response based on

symptom-score reduction rather than conrmed

mycological cure or sustained post-treatment remission.

Treatment Group (n=386)

Variable Category

Group A: Group B: Total

-valu

Clotrima Oxiconaz (n=38

zole

ole

(n=193) n (n=193) n n (%)

(%) (%)

132 (68.4) 128 (66.3) 260

(67.4)

Table 1: Comparison of Symptom Scores at Baseline and Week 4

(n=386)

Gender

Male

0.66

Variable Group A

Group B

Mean

p-value

Female

61 (31.6)

65 (33.7)

126

Clotrimazo Oxiconazol dierence,

(32.6)

152

le (n=193) e (n=193)

Mean±SD Mean±SD

Pruritus at 2.21±0.80 2.21±0.84

baseline

Group B–A

(95% CI)

0.00 (-0.16

to 0.16)

Residence Rural

Urban

74 (38.3)

78 (40.4)

0.67

(39.4)

0.951

0.003

0.070

0.990

0.327

0.303

0.297

119 (61.7) 115 (59.6) 234

(60.6)

Pruritus at 0.93±0.58 0.74±0.63

Week 4

-0.19 (-0.31

to -0.07)

Education Illiterate

Primary

38 (19.7)

41 (21.2)

34 (17.6)

54 (28.0)

49 (25.4)

56 (29.0)

70 (36.3)

38 (19.7)

26 (13.5)

40 (20.7)

19 (9.8)

0.22

(18.7)

Erythema 1.84±0.93 2.01±0.86

at baseline

0.17 (-0.01

to 0.35)

(24.6)

113

Erythema 0.67±0.59 0.67±0.58

at Week 4

0.00 (-0.12

to 0.12)

Secondary 64 (33.2)

Higher 50 (25.9)

(29.3)

106

Vesicles at 1.70±0.99 1.80±0.88

baseline

0.10 (-0.09

to 0.29)

(27.5)

150

Vesicles at 0.65±0.62 0.59±0.56

Week 4

-0.06 (-0.18

to 0.06)

Profession Employed 80 (41.5)

Housewife 30 (15.5)

0.66

(38.9)

Desquama 1.86±0.94 1.96±0.91

tion at

0.10 (-0.08

to 0.28)

(17.6)

baseline

Laborer

Student

22 (11.4)

38 (19.7)

Desquama 0.73±0.58 0.67±0.62

tion at

-0.06 (-0.18

to 0.06)

0.398

(12.4)

Week 4

(20.2)

Unemploye 23 (11.9)

Socioecon Poor

An independent s-amples t t-est was applied. Values are

presented as mean±SD. Mean dierence was calculated

as Group B minus Group A. A p v-alue ≤0.05 was

considered statistically signicant.

(10.9)

128

68 (35.2)

82 (42.5)

43 (22.3)

60 (31.1)

0.13

omic

status

(33.2)

Middle

Rich

Yes

101 (52.3) 183

(47.4)

(19.4)

157 (81.3) 165 (85.5) 322

(83.4)

(16.6)

32 (16.6)

Clinical

efcacy

0.27

36 (18.7)

28 (14.5)

Chi-square test was applied. Values are presented as n

(%). For clinical ecacy, the absolute risk dierence

for Group B versus Group A was 4.1% (95% CI -3.3 to

11.6), and the relative risk was 1.05 (95% CI 0.96 to

1.15). A p-value ≤0.05 was considered statistically

signicant.

Table 3: Clinical Ecacy by Treatment Group Stratied by

Gender (n=386)

Gender Clinical Group Group Total n Risk

- value

eicacy A:

(%)

dierence

, Group

B-A(95%

CI)

Clotri Oxicon

mazole azole

n (%) n (%)

Male

Yes

107

214

2.5% (-

0.593

0.244

(81.1) (83.6) (82.3) 6.7 to

11.8)

(18.9) (16.4) (17.7)

50 58 108

Female Yes

7.3% (-

(82.0) (89.2) (85.7) 5.0 to

19.5)

(18.0) (10.8) (14.3)

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Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

greater reduction in pruritus at Week 4. The nding of

comparable overall ecacy is clinically relevant

Chi-square test was applied. Values are presented as n

(%). Risk dierence was calculated for clinical ecacy

as Group B minus Group A. A p-value ≤0.05 was because Clotrimazole is a well-established and widely

considered statistically signicant.

available

topical

antifungal

for

localized

dermatophytosis. Evidence from systematic reviews

and comparative studies has shown that topical

antifungals are eective treatment options for

uncomplicated tinea corporis and tinea cruris.⁷,⁸

Oxiconazole has also been reported as an eective

topical agent in dermatophytosis, with a favourable

clinical response in earlier studies.⁸,⁹ In the present

study, Oxiconazole showed a small but statistically

signicant advantage in pruritus score at Week 4. The

mean pruritus score was 0.74±0.63 in the oxiconazole

group compared with 0.93±0.58 in the clotrimazole

group, with a mean dierence of -0.19. Although

statistically signicant, this dierence was small on a

0-3 symptom scale and should be interpreted cautiously

in terms of clinical magnitude. Pruritus is one of the

most troublesome symptoms of tinea cruris and often

contributes to scratching, irritation, excoriation,

Table 4: Baseline Characteristics and Efficacy by Treatment

Group (n=386)

Variable Category Group

Group

Total

value

0.664

(n=193)

(n=386)

(67.4%)

260

(66.3%)

Gender

Male

132(68.4%) 128

Female

Residence Rural

Urban

Education Higher

61 (31.6%) 65 (33.7%) 126(32.6%)

74 (38.3%) 78 (40.4%) 152(39.4%) 0.677

119(61.7%) 115(59.6%) 234(60.6%)

50 (25.9%) 56 (29.0%) 106(27.5%) 0.228

Illiterate 38 (19.7%) 34 (17.6%) 72 (18.7%)

Primary 41 (21.2%) 54 (28.0%) 95 (24.6%)

(33.2%)

Secondary 64

(25.4%)

113

(29.3%)

Profession Employed 80 (41.5%) 70 (36.3%) 150(38.9%) 0.667

(15.5%)

(19.7%) (17.6%)

Housewife 30

Laborer

Student

22 (11.4%) 26 (13.5%) 48 (12.4%)

(19.7%)

(20.7%) (20.2%)

Unemploy 23 (11.9%) 19 (9.8%) 42 (10.9%)

Middle

Poor

discomfort,

and

reduced

patient

satisfaction.

(42.5%)

(52.3%)

Social

class

68 (35.2%) 60 (31.1%) 128(33.2%)

(22.3%)

(16.6%) (19.4%)

101

183 0.130

(47.4%)

Comparative studies of topical antifungals have shown

that symptom improvement may vary between agents

depending on drug formulation, baseline severity,

dosing schedule, and adherence.¹⁰,¹¹ In the present

study, erythema, vesicles, desquamation, and overall

clinical ecacy were not signicantly dierent

between the two groups. This suggests that both topical

agents produced broadly similar clinical improvement

over four weeks, while Oxiconazole may oer modest

symptomatic benet in itching. The overall response

pattern observed in this study is consistent with

previous trials evaluating topical antifungal agents in

superficial dermatophytosis.¹²-¹⁴ However, comparison

across studies should be made carefully because

previous trials have used dierent treatment durations,

outcome denitions, clinical scoring systems, and

follow-up schedules. In the current study, ecacy was

defined as at least 50% reduction in composite

Rich

36 (18.7%) 28 (14.5%) 64 (16.6%) 0.274

(81.3%)

(85.5%) (83.4%)

Efcacy No

Yes

157

165

322

Chi-square test applied; p ≤ 0.05 considered

signicant.

Table 5: Ecacy by Treatment Group Stratied by Gender (n=

386)

n (%)

Gender Eicacy

Total n (%) P Value

Group A Group B

Male

Yes

107

107(83.6%) 214(82.3%) 0.593

(81.1%)

50 (82.0%) 58(89.2%) 108(85.7%) 0.244

(14.3%)

(18.9%) 21(16.4%) 46(17.7%)

Female Yes

11(18.0%) 07(10.8%) 18

Chi-square test applied; p ≤ 0.05 considered

signicant.

DISCUSSION

symptom score, which reects short term clinical

response. This endpoint is useful in routine outpatient

This randomized controlled trial compared topical practice because symptoms are the main reason patients

Clotrimazole 1% cream and topical oxiconazole 1% seek treatment; however, it remains less objective than

cream in patients with KOH-confirmed tinea cruris. repeat microscopy or culture-confirmed mycological

Both treatment groups showed clinical improvement cure. The reviewer‘s concern regarding mycological

after four weeks of therapy, and overall clinical ecacy confirmation is valid. Baseline KOH mount was used to

was comparable between the groups. Clinical ecacy support diagnosis, but repeat KOH mount, fungal

was achieved in 81.3% of patients receiving culture,

species

identication,

and

antifungal

Clotrimazole and 85.5% of patients receiving susceptibility testing were not performed at Week 4.

Oxiconazole, with an absolute risk dierence of 4.1% Therefore, this study cannot make claims regarding

in favour of Oxiconazole; however, this dierence was mycological cure, microbiological eradication, fungal

not statistically signicant. Therefore, the main nding species distribution, or antifungal resistance. The term

of this study is that Oxiconazole did not demonstrate ―efcacyǁ in this manuscript has therefore been

superiority over Clotrimazole in overall short-term restricted to clinical ecacy based on symptom-score

clinical response. However, it produced a statistically reduction. Future trials should include both clinical and

July - September 2026

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107

Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

because symptomatic sustained remission.

mycological

endpoints,

improvement may occur despite persistence of fungal

elements, and persistent infection may contribute to

relapse or transmission. Antifungal resistance is an

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

REFERENCES

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highlighted terbinane resistance and the need for

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and

susceptibility testing in selected cases of recalcitrant

dermatophytosis.¹⁷,¹⁸ However, this study did not

perform culture or susceptibility testing; therefore,

resistance-related interpretation cannot be derived from

the present data. Reports of resistant dermatophytes

from dierent geographical regions are useful for

background context. Still, the ndings of the present

study should not be used to infer local susceptibility

patterns or resistance proles.¹⁹

2. Najam-us-Saher, Tabassum S, Sajid M, Khabir Y, Faheem A.

The burden of cutaneous fungal infections in a tertiary care

hospital in Pakistan. Pak

doi:10.12669/pjms.41.1.9061.

Med Sci. 2025;41(1):269-74.

3. Chanyachailert P, Leeyaphan C, Bunyaratavej S. Cutaneous

fungal infections caused by dermatophytes and non-

dermatophytes: an updated comprehensive review of

epidemiology, clinical presentations, and diagnostic testing. J

Fungi (Basel). 2023;9(6):669. doi:10.3390/jof9060669.

4. Keshwania P, Kaur N, Chauhan J, Sharma G, Afzal O, Altamimi

ASA, et al. Supercial dermatophytosis across the world's

populations: epidemiology, diagnosis, and treatment trends.

LIMITATIONS

This study has several limitations that should be

acknowledged. First, the study assessed treatment

outcomes over a short follow-up period of four weeks;

therefore, long-term eectiveness and recurrence rates

could not be determined. Second, repeat mycological

evaluation, including KOH examination, fungal culture,

species identication, and antifungal susceptibility

testing, was not performed after treatment, limiting the

ability to conrm microbiological cure. Third, the study

was conducted at a single tertiary care center, which

may restrict the generalizability of the ndings to other

healthcare settings and populations. Additionally,

patient adherence to topical therapy was assessed

through self-reporting rather than objective measures,

which may have introduced reporting bias. Finally,

quality-of-life outcomes and comprehensive adverse-

ACS

Omega.

2023;8(35):31575-99.

doi:10.1021/acsomega.3c01988.

5. El-Gohary M, van Zuuren EJ, Fedorowicz Z, Burgess H, Doney

L, Stuart B, et al. Topical antifungal treatments for tinea cruris

and tinea corporis. Cochrane Database Syst Rev.

2014;(8):CD009992. doi:10.1002/14651858.CD009992.pub2.

6. Rotta I, Ziegelmann PK, Otuki MF, Riveros BS, Bernardo NL,

Correr CJ. Ecacy of topical antifungals in the treatment of

dermatophytosis: a mixed-treatment comparison meta-analysis

involving 14 treatments. JAMA Dermatol. 2013;149(3):341-9.

doi:10.1001/jamadermatol.2013.1721.

7. van Zuuren EJ, Fedorowicz Z, El-Gohary M. Evidence-based

topical treatments for tinea cruris and tinea corporis: a summary

Cochrane systematic review. Br

Dermatol.

2015;172(3):616-41. doi:10.1111/bjd.13441.

8. Islam MT, Akhter S, Khondker L, Khan MSI, Siddiqua A.

Efcacy of topical 1% oxiconazole cream in the treatment of

event analysis were not evaluated, preventing a

dermatophytosis.

Enam Med Coll. 2014;4(2):89-93.

complete assessment of the overall impact and safety

doi:10.3329/jemc.v4i2.19479.

profile of the treatment regimens.

9. Jerajani HR, Amladi ST, Bongale R, Adepu V. Evaluation of

clinical ecacy and safety of once daily topical administration

of 1% oxiconazole cream and lotion in dermatophytosis: an

CONCLUSIONS

open-label, non-comparative multicentre study. Indian

Dermatol Venereol Leprol. 2000;66:188-92.

Khan HS, Dudhgaonkar S, Bende MM, Wankhede S.

Comparison of ecacy, safety and cost-effectiveness of

clotrimazole 1% cream and sertaconazole 2% cream in patients

suering from mild to moderate tinea corporis attending tertiary

Topical

oxiconazole

cream

and

topical

10.

Clotrimazole 1% cream showed comparable short-term

clinical ecacy in patients with KOH-confirmed tinea

cruris after four weeks of treatment. Oxiconazole

produced a statistically greater reduction in pruritus;

however, the overall clinical response did not dier

signicantly between the two groups. As repeat

mycological testing, antifungal susceptibility testing,

quality-of-life assessment, adverse-event comparison,

and recurrence follow-up were not performed, the

findings should be interpreted as short-term clinical

response rather than conrmed microbiological cure or

care hospital outpatient department:

randomized, open-

labelled, comparative, parallel-group trial. Int J Basic Clin

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0214.

11. Shivamurthy RP, Reddy SG, Kallappa R, Somashekar SA, Patil

D, Patil UN. Comparison of topical antifungal agents

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corporis: an observational study.

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Comparative Ecacy of Topical Oxiconazole Cream (1%) Versus Topical

12. Dakhale GN, Gupta AV, Mukhi JI, Kalikar MV. Comparison of 19. Messina F, Santiso G, Romero M, Bonifaz A, Fernandez M,

efcacy, safety, and cost-effectiveness of sertaconazole and

luliconazole cream in patients with dermatophytoses:

prospective, randomized, open-label study. Perspect Clin Res.

2021;12(4):223-8. doi:10.4103/picr.PICR_24_19.

Marin E. First case report of tinea corporis caused by

Trichophyton indotineae in Latin America. Med Mycol Case

Rep. 2023;41:48-51. doi:10.1016/j.mmcr.2023.08.004.

20. Hopewell S, Chan AW, Collins GS, Hróbjartsson A, Moher D,

Schulz KF, et al. CONSORT 2025 statement: updated guideline

for reporting randomised trials. BMJ. 2025;388:e081123.

doi:10.1136/bmj-2024-081123.

13. Meghana D, Kamath L, Revathi TN. Evaluation of ecacy and

safety of topical 1% terbinane versus topical 2% sertaconazole

in patients with tinea cruris: a randomized controlled trial. Natl J

Physiol

Pharm

Pharmacol.

2021;11(1):13-6. 21. Junqueira DR, Zorzela L, Golder S, Loke Y, Gagnier JJ, Julious

SA, et al. CONSORT Harms 2022 statement, explanation, and

doi:10.5455/njppp.2021.10.07180202022082020.

elaboration: updated guideline for the reporting of harms in

randomised trials. BMJ. 2023;381:e073725. doi:10.1136/bmj-

2022-073725..

14. Choudhary SV, Bisati S, Singh A, Koley S. Ecacy and safety

of terbinane hydrochloride 1% cream versus sertaconazole

nitrate 2% cream in tinea corporis and tinea cruris:

comparative therapeutic trial. Indian Dermatol.

2013;58(6):457-60. doi:10.4103/0019-5154.119958.

AUTHORS CONTRIBUTION

Fahad Khan - Concept & Design; Data Acquisition; Data

15. Cañete-Gibas CF, Mele J, Patterson HP, Sanders CJ, Ferrer D,

Garcia V, et al. Terbinane-resistant dermatophytes and the

presence of Trichophyton indotineae in North America. J Clin

Microbiol. 2023;61(8):e00562-23. doi:10.1128/jcm.00562-23.

16. Abdolrasouli A, Barton RC, Borman AM. Spread of antifungal-

resistant Trichophyton indotineae, United Kingdom, 2017-2024.

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision; Supervision; Final Approval

Ghafoor Ullah - Concept & Design; Data Acquisition; Drafting

Manuscript; Supervision; Final Approval

Naveed Ullah - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

Wajid Ali - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

Emerg

Infect

Dis.

2025;31(1):192-4.

doi:10.3201/eid3101.240923.

Khizar Hayat - Concept & Design; Data Acquisition; Drafting

Manuscript; Final Approval

17. Gupta AK, Renaud HJ, Quinlan EM, Shear NH, Piguet V.

Terbinane resistance in Trichophyton rubrum and

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Trichophyton indotineae:

literature review. Antibiotics

(Basel). 2025;14(5):472. doi:10.3390/antibiotics14050472.

18. Gupta AK, Mann A, Polla Ravi S, Wang T. An update on

antifungal resistance in dermatophytosis. Expert Opin

Pharmacother. 2024;25(5):511-9. doi:10.1080/14656566.2024.2

343079.

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