What is the best way to treat tinea cruris?

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Clinical Inquiries

What is the best way to treat tinea cruris?

J Fam Pract. 2006 March;55(3):256-258

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References

1. Gupta AK, Chaudhry M, Elewski BE. Tinea corporis, tinea cruris, tinea nigra, and piedra. Dermatol Clin 2003;21:395-400.

2. Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol 2004;30:748-752.

3. van Heerden JS, Vismer HF. Tinea corporis/cruris: new treatment options. Dermatology 1997;194(Suppl 1):14-18.

4. Zaias N, Berman B, Cordero CN, et al. Efficacy of a 1-week, once daily regimen of terbinafine 1% cream in the treatment of tinea cruris and tinea corporis. J Am Acad Dermatol 1993;29:646-648.

5. Lebwohl M, Elewski B, Eisen D, Savin RC. Efficacy and safety of terbinafine 1% solution in the treatment of interdigital tinea pedis and tinea corporis or tinea cruris. Cutis 2001;67:261-266.

6. Budimulja U. Terbinafine 1% cream vs. bifonazole 1% cream in the treatment of tinea cruris. Int J Dermatol 1998;37:871-873.

7. Millikan LE, Galen WK, Gewirtzman GB, et al. Naftifine cream 1% versus econazole cream 1% in the treatment of tinea cruris and tinea corporis. J Am Acad Dermatol 1988;18(1 Pt 1):52-56.

8. Jordan RE, Rapini RP, Rex IH, Jr, et al. Once-daily naftine cream 1% in the treatment of tinea cruris and tinea corporis. Int J Dermatol 1990;29:441-442.

9. Saple DG, Amar AK, Ravichandran G, Korde KM, Desai A. Efficacy and safety of butenafine in superficial dermatophytoses (tinea pedis, tinea cruris, tinea corporis). J Indian Med Assoc 2001;99:274-275.

10. Lescher JL, Babel DE, Stewart DM, et al. Butenafine 1% cream in the treatment of tinea cruris: A multicenter, vehicle-controlled, double-blind trial. J Am Acad Dermatol 1997;36:S20-S24.

11. Bogaert H, Cordero C, Ollague W, Savin RC, Shalita AR, Zaias N. Multicentre double-blind clinical trials of ciclopirox olamine cream 1% in the treatment of tinea corporis and tinea cruris. J Int Med Res 1986;14:210-216.

12. Fulton JE, Jr. Miconazole therapy for endemic fungal disease. Srch Dermatology 1975;111:596-598.

13. Ledezma E, Lopez JC, Marin P, et al. Ajoene in the topical short-term treatment of tinea cruris and tinea corporis in humans. Randomized comparative study with terbinafine. Arzneimittelforschung 1999;49:544-547.

14. Al-Waili NS. An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study. Complement Ther Med 2004;12:45-47.

15. The Sanford Guide to Antimicrobial Therapy. 35th ed. Hyde Park, Vt: Antimicrobial Therapy; 2005.

16. Noble S, Forbes R, Stamm P. Diagnosis and management of common tinea infections. Am Fam Physician 1998;58:163-178.Available at: www.aafp.org/afp/980700ap/noble.html. Accessed on February 9, 2006.

17. Crawford F, Hart R, Bell-Syer S, Togerson D, Young P, Russell I. Topical treatments for fungal infections of the skin and nails of the foot. Cochrane Database Syst Rev 1999;(3):CD001434.

Azoles. Azoles are less expensive than allylamines, but require longer treatment periods, theoretically compromising patient adherence to therapy. One of the more popular azoles is clotrimazole (Lotrimin, Mycelex), one of the oldest antifungal treatments. One RCT compared cure rates for 139 patients for clotrimazole 1% cream compared with ciclopirox olamine 1% cream when both were applied twice daily for 28 days. By the end of the 4-week period, 69% of the clotrimazole group was clinically and mycologically cured compared with 64% of the ciclopirox group.¹¹

Miconazole 2% cream (Micatin, Monistat) (used twice daily for 2 weeks by inmates in a Florida prison) demonstrated 75.5% clinical clearing (against tinea cruris, pedis, or corporis, or Candida cutaneous infections) when compared with placebo (NNT=1.57). Of the 99 patients evaluated, 48 were diagnosed with tinea cruris; however, results were not broken down into diagnostic category. The length of follow-up for these patients was not disclosed.¹²

Alternative therapy. Ajoene 0.6% gel (isolated from garlic), was as effective as terbinafine 1% cream (both applied twice daily for 2 weeks) in a RCT of 60 Venezuelan Army soldiers.¹³ Sixty days after treatment, 73% of the Ajoene-treated patients and 71% in the terbinafine group were asymptomatic. An open-pilot study of 14 patients with tinea cruris demonstrated 71% mycological cure with a honey, olive oil, and beeswax (1:1:1) mixture, applied 3 times daily up to 3 weeks, likely due to honey’s inhibitory effect on fungus and beeswax’s anti-inflammatory properties.¹⁴

FAST TRACK

Use of an allylamine or azole antifungal depends on patient compliance and cost—allylamines are more costly but allow for shorter treatments

Recommendations from others

The Sanford Guide to Antimicrobial Therapy (2005) recommends topical butenafine and terbinafine as primary agents of choice for tinea cruris due to their fungicidal activity.¹⁵ The American Academy of Family Physicians recommends any of the topical antifungal treatments as first-line treatment for tinea cruris.¹⁶ A systematic review on tinea pedis topical therapy acknowledges the higher cure rates by allylamines, compared with azoles, but concludes that azoles remain the most costeffective in the treatment of tinea pedis.¹⁷ No recent guidelines from the American Academy of Dermatology are available.

Evidence-based answers from the Family Physicians Inquiries Network