Comparison of topical anti- fungal agents sertaconazole and clotrimazole in the treatment of tinea corporis-an observational study

Microneedle-based arrays - Breakthrough strategy for the treatment of bacterial and fungal skin infections

Currently, fungal and bacterial skin infections rank among the most challenging public health problems due to the increasing prevalence of microorganisms and the development of resistance to available drugs. A major issue in treating these infections with conventional topical medications is the poor penetration through the stratum corneum, the outermost layer of the skin. The concept of microneedles seems to be a future-proof approach for delivering drugs directly into deeper tissues. By bypassing the skin barrier, microneedle systems allow therapeutic substances to reach deeper layers more efficiently, significantly improving treatment outcomes. Nonetheless, the primary challenges regarding the effectiveness of microneedles involve selecting the appropriate size and shape, along with polymer composition and fabrication technology, to enable controlled and efficient drug release. This review offers a comprehensive overview of the latest knowledge on microneedle types and manufacturing techniques, highlighting their potential effectiveness in treating bacterial and fungal skin infections. It includes updated statistics on infection prevalence and provides a detailed examination of common bacterial and fungal diseases, focusing on their symptoms, causative species, and treatment methods. Additionally, the review addresses safety considerations, regulatory aspects, and future perspectives for microneedle-based therapeutic systems. It also underscores the importance of industrialization and clinical translation efforts, emphasizing the significant potential of microneedle technology for advancing medical applications.

Comparison of efficacy, safety, and cost-effectiveness of sertaconazole and luliconazole cream in patients with dermatophytoses: A prospective, randomized, open-label study

Objective:

To compare efficacy, safety, and cost-effectiveness of sertaconazole (2%) and luliconazole (1%) cream in patients with dermatophytoses.

Materials and Methods:

Sixty-four patients with tinea corporis and tinea cruris infections were enrolled in this single-center, randomized, open–label, parallel study. Following inclusion and exclusion criteria, patients were randomly divided into two treatment groups and received either sertaconazole 2% cream applied topically twice daily for 4 weeks and luliconazole 1% cream once daily for 2 weeks. At follow-up, efficacy was assessed clinically using 4-point physician global assessment (PGA) scale, composite score, and mycologically by KOH mount. Safety was assessed by monitoring adverse drug events at each visit.

Results:

The primary efficacy variables including changes in pruritus, erythema, vesicle, and desquamation (4-point PGA) were significantly (P < 0.0001) improved in both the groups, at the end of treatment. There was a significant reduction in mean total composite score (pruritus, erythema, vesicle, and desquamation) after the end of treatment in the sertaconazole group (P = 0.0002) compared to the luliconazole group. Both the groups showed equal negative mycological assessment. Both the study drugs were well tolerated. Only one patient in the sertaconazole group showed allergic contact dermatitis.

Conclusion:

Sertaconazole was better than luliconazole in relieving signs and symptoms during the study and follow-up period, but cost-effectiveness wise, luliconazole was better than sertaconazole.

Synergistic antifungal evaluation of over-the-counter antifungal creams with turmeric essential oil or Aloe vera gel against pathogenic fungi

BACKGROUND

The frequent incidence of fungal infection and widespread of antibiotic resistance are emergent concerns in public health. Hence, there is a need to harness the potential of natural bioactive compounds from plant towards treatment of fungal infection. Combination effect of antibiotic creams with natural products from plants is prospective strategy to produce new antifungal agent. This study therefore, revealed antifungal effect of combined Antifungal Creams (AFCs) with Turmeric Essential Oil (TEO) or Aloe vera Gel (AVG).

METHODS

Phytochemicals and bioactive compounds in TEO and AVG were revealed using GC-MS. Bioactive compounds in plant extracts were compared to known compounds in database library of National Institute of Standards and Technology (U.S.). Antifungal activity and synergistic effect of AFCs with TEO or AVG were carried out using agar well diffusion method.

RESULTS

Phenol, flavonoids, saponins, alkaloids, steroids, terpenoids and cardiac glycosides were present in TEO and AVG. GCMS revealed thirty-six (36) and eighteen (18) bioactive compounds in TEO and AVG, respectively. AFCs displayed zones of inhibition with values ranged from 5.0 to 14.3 mm, TEO was 5.0 to 11.0 mm and AVG was 8.0 to 11.7 mm against tested fungi. Minimum Inhibitory Concentration (MIC) by AFCs, TEO and AVG ranged from 1.25 to 10.0 mg/ml. Combinatory effects of AFCs with TEO or AVG revealed synergistic and indifferent properties.

CONCLUSION

Development of novel products using bioactive ingredients from plants with commercially available AFCs will serve as potential alternative therapy to cure dermatological infections with no side effects.

Tinea corporis: an updated review

Background

Tinea corporis is a common fungal infection that mimics many other annular lesions. Physicians must familiarize themselves with this condition and its treatment.

Objective

This article aimed to provide a narrative updated review on the evaluation, diagnosis, and treatment of tinea corporis.

Methods

A PubMed search was performed with Clinical Queries using the key term ‘tinea corporis.’ The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies, and reviews. The search was restricted to the English language. The information retrieved from the mentioned search was used in the compilation of the present article.

Results

Tinea corporis typically presents as a well-demarcated, sharply circumscribed, oval or circular, mildly erythematous, scaly patch or plaque with a raised leading edge. Mild pruritus is common. The diagnosis is often clinical but can be difficult with prior use of medications, such as calcineurin inhibitors or corticosteroids. Dermoscopy is a useful and non-invasive diagnostic tool. If necessary, the diagnosis can be confirmed by microscopic examination of potassium hydroxide wet-mount preparations of skin scrapings from the active border of the lesion. Fungal culture is the gold standard to diagnose dermatophytosis especially if the diagnosis is in doubt and results of other tests are inconclusive or the infection is widespread, severe, or resistant to treatment. The standard treatment of tinea corporis is with topical antifungals. Systemic antifungal treatment is indicated if the lesion is multiple, extensive, deep, recurrent, chronic, or unresponsive to topical antifungal treatment, or if the patient is immunodeficient.

Conclusion

The diagnosis of tinea corporis is usually clinical and should pose no problem to the physician provided the lesion is typical. However, many clinical variants of tinea corporis exist, rendering the diagnosis difficult especially with prior use of medications, such as calcineurin inhibitors or corticosteroids. As such, physicians must be familiar with this condition so that an accurate diagnosis can be made and appropriate treatment initiated.

Low in vitro activity of sertaconazole against clinical isolates of dermatophyte

Background and Purpose:

Dermatophytes are a group of fungi specialized in invading humans and other vertebrate keratinized tissues. These fungi cause a variety of skin, nail, and hair disorders, called dermatophytosis (tinea). In some cases, drug resistance to antifungals necessitates special treatment. Among the antifungal agents, sertaconazole (i.e., a third-generation imidazole) has a broad-spectrum against dermatophyte species. Regarding this, the present study was conducted to investigate the antifungal susceptibility of dermatophytes obtained from patients with dermatophytosis in Mashhad located in northeastern Iran.

Materials and Methods:

A total of 75 clinical dermatophyte isolates, including Trichophyton mentagrophytes (n=21), T. interdigital (n=18), T. tonsurans (n=16), Epidermophyton floccosum (n=11), Microsporum canis (n=5), Nannizzia fulvum (n=2), T. benhamiae (n=1), and T. verrucosum (n=1), were evaluated against five antifungal agents of sertaconazole, itraconazole, clotrimazole, terbinafine, and griseofulvin based on the CLSI M38-A2 guideline.

Results:

According to the results, the minimum inhibitory concentration (MIC) ranges ofsertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were estimated at 0.125-16, 0.002-1, 0.5-4, 0.031-4, and 0.016-4 µg/ml, respectively, for dermatophyte species. In addition, the geometric mean (GM) values of the MIC of sertaconazole, terbinafine, griseofulvin, itraconazole, and clotrimazole were obtained as 3.39, 1, 1.44, 1.52, and 1.93, respectively.

Conclusion:

Among the tested antifungals, terbinafine and griseofulvin were the most effective agents against dermatophyte isolates. However, sertaconazole, a third-generation imidazole, did not show any significant effect. Furthermore, M. canis and E. floccosum showed the best response to the antifungal agents.

New Antifungal Agents and New Formulations Against Dermatophytes

A variety of oral and topical antifungal agents are available for the treatment of superficial fungal infections caused by dermatophytes. This review builds on the antifungal therapy update published in this journal for the first special issue on Dermatophytosis (Gupta and Cooper 2008;166:353-67). Since 2008, there have not been additions to the oral antifungal armamentarium, with terbinafine, itraconazole, and fluconazole still in widespread use, albeit for generally more severe or recalcitrant infections. Griseofulvin is used in the treatment of tinea capitis. Oral ketoconazole has fallen out of favor in many jurisdictions due to risks of hepatotoxicity. Topical antifungals, applied once or twice daily, are the primary treatment for tinea pedis, tinea corporis/tinea cruris, and mild cases of tinea unguium. Newer topical antifungal agents introduced include the azoles, efinaconazole, luliconazole, and sertaconazole, and the oxaborole, tavaborole. Research is focused on developing formulations of existing topical antifungals that utilize novel delivery systems in order to enhance treatment efficacy and compliance.