Tinea cruris and tinea corporis are common fungal infections seen by both general practitioners and dermatologists. Most of these can be treated with a variety of topical antifungals agents. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS, and ongoing trials registries (August 2013). 129 randomised controlled trials (RCTs) with 18,086 participants evaluated a range of interventions; mostly azoles. Pooling of data for several outcomes was only possible for two individual treatments. Terbinafine in 5 studies showed a statistically significant higher clinical cure rate compared to placebo (RR 4.51, 95% CI 3.10 to 6.56). Data for mycological cure could not be pooled due to substantial heterogeneity. Mycological cure rates favoured naftifine (1%) compared to placebo across three studies (RR 2.38, 95% CI 1.80 to 3.14) but the quality of the evidence was graded low. Combinations of azoles with corticosteroids were slightly more effective than azoles for clinical cure, but there was no statistically significant difference with regard to mycological cure. 65 studies were assessed at 'unclear' and 64 at 'high risk' of bias; many were over 20 years old and most were poorly designed and inadequately reported. Although most active interventions showed sufficient therapeutic effect, this review highlights the need for further, high quality, adequately powered RCTs to evaluate the effects of these interventions which can ultimately provide reliable evidence to inform clinical decision making.
EJ van Zuuren, Z Fedorowicz, M El-Gohary
Evidence Based Topical Treatments for Tinea Cruris and Tinea Corporis: A Summary of a Cochrane Systematic Review
Br J Dermatol 2014 Oct 07;[EPub Ahead of Print]