Tinea infections are the widely prevalent superficial fungal infections. Of these, the most common ones are tinea corporis, tinea cruris and tinea pedis. These infections are caused by organisms known as dermatophytes, with Trichophyton rubrum accounting for a majority of dermatophytosis, including tinea pedis, tinea corporis and tinea cruris.1
Several studies pertaining to the treatment of tinea corporis and tinea cruris have unravelled the effectiveness of topical antifungals.2 The current case also shows the efficacy of a topical antifungal, eberconazole in treating a patient with tinea corporis and tinea cruris.
A 42-year-old married female presented with the chief complaint of itchy rashes in the groin and on the right thigh since 3 to 4 weeks.
The patient had been diagnosed with relapsing polychondritis in the past and was treated with oral prednisolone 40 mg daily for 3 weeks, which was tapered slowly over a period of 3 months. She was also given tablet cyclophosphamide 50 mg once daily in the morning with instructions to have plenty of fluids. In addition, oral chymotrypsin and diclofenac tablets were given in the initial 2 weeks to relieve her pain and swelling of the ears. Moreover, adjunctive treatment with calcium and vitamin D tablets was also prescribed. About a month into her treatment for relapsing polychondritis, she complained of an itchy rash in her groin and on her right thigh.
On examination, there were patches with circinate configuration and superficial scaling in her groin and on her right thigh (Fig. 1). The patch on right thigh was markedly erythematous.
Figure 1. Circinate scaly patches in groin and on right thigh.
Figure 2. Healed lesions with post-inflammatory changes.
The lesions were diagnosed to be tinea cruris and tinea corporis.
The patient was prescribed miconazole 2% cream to be applied twice daily for 2 weeks; however, there was no improvement in the lesions. She was then prescribed topical eberconazole 1% cream which had to be applied twice daily for 2 weeks in view of the fact that she was on oral prednisolone and cyclophosphamide, a nonsteroidal immunosuppressant.
At follow-up visit, the lesion in her groin had healed with post-inflammatory hyperpigmentation. The lesion on her thigh had healed with post-inflammatory hypopigmentation (Fig. 2). Considering the current scenario of frequently relapsing/recurring dermatophytic infections and the fact that she was on immunosuppressant therapy, she was asked to continue applying eberconazole 1% cream for another 6 weeks on the post-inflammatory changes. After 2 months, the patient did not have any new lesions.
Eberconazole, a drug belonging to the class of imidazole displays a wide-spectrum of antifungal activity. An added advantage of this drug is its anti-inflammatory action that makes it different from other agents of its class. Its mechanism of action involves inhibition of fungal lanosterol 14a-demethylase.3
A wealth of data suggests the efficacy of this agent in the treatment of dermatophytic infections including tinea corporis and tinea cruris.3,4 According to a comparative study that assessed the in vitro activities of 4 topical antifungal drugs, eberconazole, clotrimazole, ketoconazole and miconazole against 200 strains of dermatophytes, eberconazole was found to be more active than the other three drugs against most of the species tested.4 Effectiveness of eberconazole 1% cream was further supported by the findings of another study that compared it with miconazole 2% cream. In this double-blind study, use of eberconazole 1% cream for 4 weeks helped in achieving effective response in 76.09% patients, while the figure was 75% in the miconazole-treated group.3
On the basis of the above-mentioned data, it can be suggested that eberconazole appears to be a suitable drug for treating dermatophytosis. In this patient, its use proved to be beneficial for obtaining favorable outcomes.
- Weinstein A, Berman B. Topical treatment of common superficial tinea infections. Am Fam Physician. 2002;65(10):2095-102.
- Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J. 2016;7(2):77-86.
- Moodahadu-Bangera LS, Martis J, Mittal R, et al. Eberconazole - pharmacological and clinical review. Indian J Dermatol Venereol Leprol. 2012;78(2):217-22.
- Fernández-Torres B, Inza I, Guarro J. In vitro activities of the new antifungal drug eberconazole and three other topical agents against 200 strains of dermatophytes. J Clin Microbiol. 2003;41(11):5209-11.