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Comparative Study of Topical Oxiconazole Cream (1%) Versus Ketoconazole Cream (2%) in the Treatment of Inguinocrural Dermatophyt

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Comparative Study of Topical Oxiconazole Cream (1%) Versus Ketoconazole Cream (2%) in the Treatment of Inguinocrural Dermatophyt Original Article Comparative Study of Topical Oxiconazole Cream (1%) Versus Ketoconazole Cream (2%) in the Treatment of Inguinocrural Dermatophytoses 1 2 3 4 5 6 Afroz F , Shahidullah M , Alam MN , Afreen H , Sultana T , Shahriar R Abstract (46.7%) cases respectively.The mean age with SD in group A and group B were 28.93 ± 8.29 years and 31.36 A clinical trial was carried out for the duration of six ± 8.36 years respectively. The mean scoring with SD in months from September' 2012 to February' 2013 in the group A and group B were 6.26 ± 2.22 minutes and 6.53 Department of Dermatology and Venereology, Shaheed ± 1.81 minutes respectively at the time of observation Monsur Ali Medical College, Uttara Dhaka and patients and 4.23 ± 1.50 minutes and 5.13 ± 1.45 minutes attending private clinical chamber. To evaluate the respectively after 1 week and 2.00 ± 1.22 minutes and effectiveness of oxiconazole cream in comparison to the 3.25 ± 1.07 minutes respectively after 2 weeks. The ketoconazole cream for the treatment of inguinocrural difference between the mean score of the two group is dermatophytoses.A total number of 60 patients with significant (p=0.006). The mean scoring with SD in inguinocrural dermatophytoses were included in the group A and group B were 0.00 ± 0.00 minutes and 1.75 study of which 30 patients were treated with oxiconazole ± 0.95 respectively after 3 weeks.Sotopical treatment (Group A) and the rest 30 patients were treated with oxiconazole has revealed itself to be as efficient as ketoconazole (Group B)once daily for 21 days and ketoconazole and it seems more effective and better weekly the outcome of lesions were clinically evaluated tolerated than ketoconazole. and recorded.In group A, male and female were 17 (56.7%) cases and 13 (43.3%) cases respectively. In Key words : Inguinocrural dermatophytoses, group B, male and female were 16 (53.3%) cases and 14 Oxiconazole, Ketoconazole. Introduction 1. Dr. Farzana Afroz Dermatomycoses is the most common mycotic infections Assistant Professor caused by dermatophyte infecting humans across the Department of Dermatology&Venereology 1 world, with widely varying frequency and epidemiology. Nightingale Medical College, Dhaka. Although not life threatening, they may produce 2. Dr. Md.Shahidullah significant symptoms which interfere with the quality of 2 Professor, Department of Dermatology &Venereology life. They are particularly widespread in tropical countries Bangabandhu Sheikh Mujib Medical University, Dhaka. because of warm and humid climate, crowded living 3 3. Corresponding Author: Dr. Mohd. Nurul Alam conditions, and other socio-economic factors. There has Assistant Professor been a steady rise in the incidence of cutaneous fungal Department of Dermatology & Venereology infections and an increasing rate of treatment failure or 2 Ibn-Sina Medical College, Dhaka. relapse among mycotic patients undergoing treatment. email: [email protected] Many factors are responsible for this development. Certain 4. Dr. Humaira Afreen conditions and habits closely related to the modern way of life together with some endogenous predisposing Assistant Registrar 4 Department of Dermatology & Venereology influences play a major role in raising the incidence rate. Nonetheless, treatment methods are similar across the Dhaka Medical College, Dhaka. world, and modern antifungal medications can provide 5. Dr. Tahmina Sultana effective treatment for most presentations of Medical Officer dermatophytosis.A wide variety of topical agents is Department of Dermatology & Venereology available, in cream, gel, lotion, and shampoo formulations 1 Sir Salimullah Medical College, Dhaka. for dermatophyte infection. Most agents remain within 6. Dr. Rajib Shahriar the two main antifungal drug families like the azoles and Graded Specialist the allylamines; another class, the echinocandins, is used 5 Department of Surgery Combined Military Hospital, only for systemic Candida or Aspergillus infection. A Dhaka. majority of the agents are of the 'azole' antifungal family like clotrimazole, miconazole, econazole, oxiconazole, 57 2016 Volume 28 Number 02 ORIGINAL ARTICLE tioconazole. Terbinafine and naftifine represent the excluded from the study. All inguinocrural 'allylamine' family of agents. Innovation in dermatophyte dermatophytoses patients were recruited as per inclusion treatment has involved marketing of wide-spectrum topical criteria which were divided into two groups. Group A agents, use of topical agents with anti-inflammatory as were treated with oxiconazole and Group B were treated well as antifungal actions, and use of a combination of with ketoconazole once daily for 21 days and weekly the existing oral antifungal agents, or oral/topical anti-fungal out come of lesions were clinically evaluated and agents, in attempts to improve on monotherapy cure recorded. 6 rates . Both families of drugs are known for their high All the relevant collected data were compiled on a master efficacy against the dermatophytes. In addition, amorolfine chart first and then statistical analysis of the results were and butenafine are popular antifungals classed as obtained by using window based computer software morpholine derivatives. Cure rates of tinea corporis, tinea devised with Statistical Packages for Social Sciences cruris and tinea pedis are high, with infections resolving (SPSS-17) (SPSS Inc, Chicago, IL, USA). The data was with 2-4 weeks of topical therapy. Safety of therapy is less analyzed using Chi square test and paired 't' test. The of a concern for topical medications than oral medications, results have been presented in tables, figures, diagrams. as serum absorption tends to be minimal with topical 1 Significant value of 'p' was decided to be at a level of 0.05 dermatophytosistherapy . In India, superficial infections of in two tailed tests. the skin, nails and hair account for 8-10% of all skin Results 7 outpatient attendance . Tinea cruris and corporis are the Table I shows the distribution of patients according to sex. commonest varieties seen in India, followed by tinea In group A male was predominant than female which was pedis, capitis, barbae, unguium and manum in 2 17 (56.7%) cases and 13 (43.3%) cases respectively. In adescending order of frequency . Several antimycotic group B male was predominant than female which was 16 agents, including the imidazoles and triazoles, have been (53.3%) cases and 14 (46.7%) cases respectively. The used for topical treatment of dermatomycoses. difference between these two group was not statistically Oxiconazole nitrate is an imidazole antifungal agent significant (p=0.795) intended for topical treatment of superficial fungal infections. Results of in-vitro and in -vivo studies have Table-I: Distribution of patients according to sex indicated that oxiconazole nitrate has a broad spectrum of activity against infections caused by dermatophytes, yeast Group Sex Group A Group B p value like fungi, moulds and mixed infections due to fungi and 8,7 (Oxiconazole) (Ketoconazole) Gram-positive bacteria . The aim of the present study, therefore, will attempt to evaluate the efficacy and safety Male 17 (56.7) 16 (53.3) 0.795 of oxiconazole cream over Ketoconazole cream in the Female 13 (43.3) 14 (46.7) treatment of inguinocrural dermatophytoses. Total 30 (100.0) 30 (100.0) Materials and Methods Chi-square test was done to measure the level of This clinical trial was conducted in the Department of significance Dermatology and Venereology, Shaheed Monsur Ali Figure within parentheses indicates in percentage Medical College, Uttara, Dhaka and patients attending Table II shows the distribution of patients according to age private clinical chamber. Study was conducted between group. In group A majority of the patients were in the age the periods of September' 2012 to February 2013 for group of 21 - 30 years which was 13 (43.3%) cases duration of 6 months. Patients of inguinocrural followed by >30 years and <21 years which were 11 dermatophytoses with no identifiable cause who attended (36.7%) cases and 6 (20.0%) cases respectively. In group in the outpatient department of Dermatology & B majority of the patients are in the age group of >30 Venereology at Shaheed Monsur Ali Medical College, years which was 15 (50.0%) cases followed by 21 - 30 Uttara Dhaka and private clinical chamber were years and <20 years which were 12 (40.0%) cases and 3 undertaken as study population. (10.0%) cases respectively. The mean age with SD in A total number of 60 patients with inguinocrural group A and group B were 28.93 ± 8.29 years and 31.36 ± dermatophytoses were recruited of which 30 patients were 8.36 years respectively. The difference between the age of treated with oxiconazole and the rest 30 patients with the two group was not significant (p=0.262). inguinocrural dermatophytoses were treated with ketoconazole. The preliminary screening for each patient Table-II: Distribution of patients according to age group Group was done by taking complete history and physical p value Age Group A GroupB examination. The skin scraping for dermatophytes was (Oxiconazole) (Ketoconazole) examined by wet mount microscopy with 10% KOH to <21 06(20.0) 03(10.0) confirm the diagnosis. All patients presented with 21 - 30 13(43.3) 12(40.0) inguinocrural dermatophytoses who gave the consent and >30 11(36.7) 15(50.0) Total 30(100.0) 30(100.0) wanted to comply with the study, were included in the Mean ± SD 28.93 ± 8.29 31.36± 8.36 0.262 study. Pregnant women, severely ill patients and Patients 2016 Volume 28 Number 02 58 ORIGINAL ARTICLE T test was done to measure the level of significance *Chi-square test was done to measure the level of significance Figure within parentheses indicates in percentage. #Figure within parentheses indicates in percentage Table-III shows the distribution of patients according to occupation. In group A and group B service was the most Table-V shows the distribution of patients according to common occupation which were 13 (43.3%) cases and 10 side effect.
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