Efficacy of Topical Terbinafine and Topical Clotrimazolein the treatment of Dermatophytosis and Skin Candidiasis; an Observational Study

Fungal skin infection also called ringworm is a red, circular itchy rash. It is known as Tinea or Dermatophytosis [1]. It is referred by other names according to the part of the body affected. For example, Tinea on head is called Tinea Capitus, it is called TineaCruris if it involves the groin, it is called Tinea Pedis if it involves the feet, fungal infection of nails is Tenia Unguim or Onychomycosis and fungal infection of the body is Tinea Corporis [2-4]. Fungi reproduce by spreading microscopic spores. These spores are often present in air and soil. They can be inhaled or they come in contact with surface of the skin. Consequently fungal infection begin in lungs or skin [4]. Fungus candida is naturally occurring microorganism in the vaginal area. Lactobacillus keeps its growth in check. If there is an imbalance in defence system it grows and causes Candidiasis [5]. These infections are treated with topical antifungals [6]. In this study topical Terbinafine and topical Clotrimazole is compared with each other in their efficacy to treat Dermatophytosis [6-8].


Introduction
Fungal skin infection also called ringworm is a red, circular itchy rash. It is known as Tinea or Dermatophytosis [1]. It is referred by other names according to the part of the body affected. For example, Tinea on head is called Tinea Capitus, it is called TineaCruris if it involves the groin, it is called Tinea Pedis if it involves the feet, fungal infection of nails is Tenia Unguim or Onychomycosis and fungal infection of the body is Tinea Corporis [2][3][4]. Fungi reproduce by spreading microscopic spores. These spores are often present in air and soil. They can be inhaled or they come in contact with surface of the skin.
Consequently fungal infection begin in lungs or skin [4]. Fungus candida is naturally occurring microorganism in the vaginal area. Lactobacillus keeps its growth in check. If there is an imbalance in defence system it grows and causes Candidiasis [5]. These infections are treated with topical antifungals [6]. In this study topical Terbinafine and topical Clotrimazole is compared with each other in their efficacy to treat Dermatophytosis [6][7][8].
with fungal membrane function and cell wall synthesis. In case of candida albicans, growth inhibition with terbinafine appears to result from ergosterol deficiency. Clotrimazole is an Imidazole derivative with a broad spectrum of antimycotic activity [10]. It alters the permeability of the fungal cell wall. It binds the phospholipids of cell membrane and inhibits the biosynthesis of ergosterol and other sterols required for cell membrane production. So it has 'Fungistatic' effect [10]. Topical preparations are used for superficial fungal skin infections and oral preparations are used for deep and systemic fungal infections [6,10].

Materials and Methods
The study was carried out in 105 patients of all age groups. Patients of all age groups with Dermatophytosis and Skin Candidiasis were selected for this study. Patients of Onychomycosis and Tenia Capitis were excluded from this study because Onychomycosis and Tenis capitis is treated by oral antifungals. Diagnosis was done on clinical grounds. Informed consent was taken from all the patients. A detailed history including age, sex, and occupation, duration of disease and family history of the patients was obtained. A dermatological examination was done, taking care to note the morphology and distribution of the fungal infection. All the cases were diagnosed clinically. All the patients were followed for 6-7 weeks and were observed for clinical improvement of sign and symptoms. Statistical analysis of the data which includes the numbers and percentages was done for all the categories via SPSS ver 22.

Conclusion
According to this study Topical Terbinafine and Topical Clotrimazole are of almost equal in their efficacy for the treatment of Tinea Corporis, Tinea Cruris and Vaginal Candidiasis, but Topical Terbinafine is slightly more effective than Clotrimazole. In Tinea Pedis Topical Terbinafine is more effective than Topical Clotrimazole in terms of shorter duration of treatment requiring only 2-3 weeks of treatment while Clotrimazole takes 4-6 weeks for treatment.