Topical antifungal treatments for tinea cruris and tinea corporis.


BACKGROUND:Tinea infections are fungal infections of the skin caused by dermatophytes. It is estimated that 10% to 20% of the world population is affected by fungal skin infections. Sites of infection vary according to geographical location, the organism involved, and environmental and cultural differences. Both tinea corporis, also referred to as 'ringworm' and tinea cruris or 'jock itch' are conditions frequently seen by primary care doctors and dermatologists. The diagnosis can be made on clinical appearance and can be confirmed by microscopy or culture. A wide range of topical antifungal drugs are used to treat these superficial dermatomycoses, but it is unclear which are the most effective. OBJECTIVES:To assess the effects of topical antifungal treatments in tinea cruris and tinea corporis. SEARCH METHODS:We searched the following databases up to 13th August 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 7), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We also searched five trials registers, and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials. We handsearched the journal Mycoses from 1957 to 1990. SELECTION CRITERIA:Randomised controlled trials in people with proven dermatophyte infection of the body (tinea corporis) or groin (tinea cruris). DATA COLLECTION AND ANALYSIS:Two review authors independently carried out study selection, data extraction, assessment of risk of bias, and analyses. MAIN RESULTS:Of the 364 records identified, 129 studies with 18,086 participants met the inclusion criteria. Half of the studies were judged at high risk of bias with the remainder judged at unclear risk. A wide range of different comparisons were evaluated across the 129 studies, 92 in total, with azoles accounting for the majority of the interventions. Treatment duration varied from one week to two months, but in most studies this was two to four weeks. The length of follow-up varied from one week to six months. Sixty-three studies contained no usable or retrievable data mainly due to the lack of separate data for different tinea infections. Mycological and clinical cure were assessed in the majority of studies, along with adverse effects. Less than half of the studies assessed disease relapse, and hardly any of them assessed duration until clinical cure, or participant-judged cure. The quality of the body of evidence was rated as low to very low for the different outcomes.Data for several outcomes for two individual treatments were pooled. Across five studies, significantly higher clinical cure rates were seen in participants treated with terbinafine compared to placebo (risk ratio (RR) 4.51, 95% confidence interval (CI) 3.10 to 6.56, number needed to treat (NNT) 3, 95% CI 2 to 4). The quality of evidence for this outcome was rated as low. Data for mycological cure for terbinafine 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, NNT 3, 95% CI 2 to 4) with the quality of evidence rated as low. In one study, naftifine 1% was more effective than placebo in achieving clinical cure (RR 2.42, 95% CI 1.41 to 4.16, NNT 3, 95% CI 2 to 5) with the quality of evidence rated as low.Across two studies, mycological cure rates favoured clotrimazole 1% compared to placebo (RR 2.87, 95% CI 2.28 to 3.62, NNT 2, 95% CI 2 to 3).Data for several outcomes were pooled for three comparisons between different classes of treatment. There was no difference in mycological cure between azoles and benzylamines (RR 1.01, 95% CI 0.94 to 1.07). The quality of the evidence was rated as low for this comparison. Substantial heterogeneity precluded the pooling of data for mycological and clinical cure when comparing azoles and allylamines. Azoles were slightly less effective in achieving clinical cure compared to azole and steroid combination creams immediately at the end of treatment (RR 0.67, 95% CI 0.53 to 0.84, NNT 6, 95% CI 5 to 13), but there was no difference in mycological cure rate (RR 0.99, 95% CI 0.93 to 1.05). The quality of evidence for these two outcomes was rated as low for mycological cure and very low for clinical cure.All of the treatments that were examined appeared to be effective, but most comparisons were evaluated in single studies. There was no evidence for a difference in cure rates between tinea cruris and tinea corporis. Adverse effects were minimal - mainly irritation and burning; results were generally imprecise between active interventions and placebo, and between different classes of treatment. AUTHORS' CONCLUSIONS:The pooled data suggest that the individual treatments terbinafine and naftifine are effective. Adverse effects were generally mild and reported infrequently. A substantial number of the studies were more than 20 years old and of unclear or high risk of bias; there is however, some evidence that other topical antifungal treatments also provide similar clinical and mycological cure rates, particularly azoles although most were evaluated in single studies.There is insufficient evidence to determine if Whitfield's ointment, a widely used agent is effective.Although combinations of topical steroids and antifungals are not currently recommended in any clinical guidelines, relevant studies included in this review reported higher clinical cure rates with similar mycological cure rates at the end of treatment, but the quality of evidence for these outcomes was rated very low due to imprecision, indirectness and risk of bias. There was insufficient evidence to confidently assess relapse rates in the individual or combination treatments.Although there was little difference between different classes of treatment in achieving cure, some interventions may be more appealing as they require fewer applications and a shorter duration of treatment. Further, high quality, adequately powered trials focusing on patient-centred outcomes, such as patient satisfaction with treatment should be considered.


El-Gohary M,van Zuuren EJ,Fedorowicz Z,Burgess H,Doney L,Stuart B,Moore M,Little P




Has Abstract


2014-08-04 00:00:00








  • Devices and pressure sources for administration of nasal continuous positive airway pressure (NCPAP) in preterm neonates.

    abstract:BACKGROUND:Nasal continuous positive airway pressure (NCPAP) is used to support preterm infants recently extubated, those experiencing significant apnoea of prematurity and those with respiratory distress soon after birth as an alternative to intubation and ventilation. This review will focus exclusively on identifying...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: De Paoli AG,Davis PG,Faber B,Morley CJ

    更新日期:2002-01-01 00:00:00

  • Normal saline versus lower-chloride solutions for kidney transplantation.

    abstract:BACKGROUND:The ideal intravenous fluid for kidney transplantation has not been defined, despite the common use of normal saline during the peri-operative period. The high chloride content of normal saline is associated with an increased risk of hyperchloraemic metabolic acidosis, which may in turn increase the risk of ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Wan S,Roberts MA,Mount P

    更新日期:2016-08-09 00:00:00

  • Scalpel versus no-scalpel incision for vasectomy.

    abstract:BACKGROUND:Currently, the two most common surgical techniques for approaching the vas during vasectomy are the incisional method and the no-scalpel technique. Whereas the conventional incisional technique involves the use of a scalpel to make one or two incisions, the no-scalpel technique uses a sharp-pointed, forceps-...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Cook LA,Pun A,van Vliet H,Gallo MF,Lopez LM

    更新日期:2007-04-18 00:00:00

  • Platinum-containing regimens for triple-negative metastatic breast cancer.

    abstract:BACKGROUND:In a previous Cochrane Review, we found that for women with metastatic breast cancer unselected for triple-negative disease, there is little or no survival benefit and excess toxicity from platinum-based regimens. In subgroup analyses, however, we found preliminary low-quality evidence of a survival benefit ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Egger SJ,Chan MMK,Luo Q,Wilcken N

    更新日期:2020-10-21 00:00:00

  • Self-management education programmes for osteoarthritis.

    abstract:BACKGROUND:Self-management education programmes are complex interventions specifically targeted at patient education and behaviour modification. They are designed to encourage people with chronic disease to take an active self-management role to supplement medical care and improve outcomes. OBJECTIVES:To assess the ef...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Kroon FP,van der Burg LR,Buchbinder R,Osborne RH,Johnston RV,Pitt V

    更新日期:2014-01-15 00:00:00

  • Topical corticosteroids as adjunctive therapy for bacterial keratitis.

    abstract:BACKGROUND:Bacterial keratitis is a serious ocular infectious disease that can lead to severe visual disability. Risk factors for bacterial corneal infection include contact lens wear, ocular surface disease, corneal trauma, and previous ocular or eyelid surgery. Topical antibiotics constitute the mainstay of treatment...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Herretes S,Wang X,Reyes JM

    更新日期:2014-10-16 00:00:00

  • Haemophilus influenzae oral whole cell vaccination for preventing acute exacerbations of chronic bronchitis.

    abstract:BACKGROUND:Acute bronchitis leading to ongoing exacerbations is a serious condition predisposed to by viruses, bacteria or environmental factors. It can be fatal. Antibiotic therapy is not particularly useful. An oral Haemophilus influenzae vaccine has been developed. OBJECTIVES:To assess the effects of an oral, monob...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Foxwell AR,Cripps AW,Dear KB

    更新日期:2006-10-18 00:00:00

  • Laetrile treatment for cancer.

    abstract:BACKGROUND:Laetrile is an unconventional therapy which has been used illegally for decades by cancer patients who together with some alternative therapists claim its effectiveness as an anti-cancer treatment. It has been often referred to as amygdalin, although the two are not the same. OBJECTIVES:The aim of this revi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Milazzo S,Ernst E,Lejeune S,Schmidt K

    更新日期:2006-04-19 00:00:00

  • Interventions for the treatment of Paget's disease of the vulva.

    abstract:BACKGROUND:Extra-mammary Paget's disease is a rare form of superficial skin cancer. The most common site of involvement is the vulva. It is seen mainly in postmenopausal white women. Paget's disease of the vulva often spreads in an occult fashion, with margins extending beyond the apparent edges of the lesion. There is...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Edey KA,Allan E,Murdoch JB,Cooper S,Bryant A

    更新日期:2013-10-26 00:00:00

  • Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Individuals with chronic bronchitis or chronic obstructive pulmonary disease (COPD) may suffer recurrent exacerbations with an increase in volume and/or purulence of sputum. Because of the personal and healthcare costs associated with exacerbations, any therapy that reduces the number of exacerbations is use...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Poole P,Black PN

    更新日期:2010-02-17 00:00:00

  • Reminder packaging for improving adherence to self-administered long-term medications.

    abstract:BACKGROUND:Current methods of improving medication adherence for health problems are mostly complex, labour-intensive, and not reliably effective. Medication 'reminder packaging' which incorporates a date or time for a medication to be taken in the packaging, can act as a reminder system to improve adherence. OBJECTIV...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Heneghan CJ,Glasziou P,Perera R

    更新日期:2006-01-25 00:00:00

  • Subcutaneous unfractionated heparin for the initial treatment of venous thromboembolism.

    abstract:BACKGROUND:Venous thromboembolism (VTE) is a prevalent and serious condition. Its medical treatment requires anticoagulation, usually with either unfractionated or low molecular weight heparin (LMWH). Administration of unfractionated heparin (UFH) is usually intravenous (IV) but can be subcutaneous as well. This is an ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Robertson L,Strachan J

    更新日期:2017-02-14 00:00:00

  • Pharmacological interventions for clozapine-induced hypersalivation.

    abstract:BACKGROUND:Clozapine is widely used for people with schizophrenia. Although agranulocytosis, weight gain, and cardiac problems are serious problems associated with its use, hypersalivation, sometimes of a gross and socially unacceptable quantity, is also common (30-80%). OBJECTIVES:To determine the clinical effects of...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Syed R,Au K,Cahill C,Duggan L,He Y,Udu V,Xia J

    更新日期:2008-07-16 00:00:00

  • Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin.

    abstract:BACKGROUND:Patients who are entered in clinical trials after a transient ischaemic attack (TIA) or non disabling ischaemic stroke have an annual risk of important vascular events (death from all vascular causes, non-fatal stroke, or non-fatal myocardial infarction) of between 4 and 11 percent. Aspirin, in a daily dose ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Algra A,de Schryver EL,van Gijn J,Kappelle LJ,Koudstaal PJ

    更新日期:2001-01-01 00:00:00

  • Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children.

    abstract:BACKGROUND:Mental health problems in children are common. Research suggests that parenting has an important role to play in helping children to become well adjusted adults, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social func...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Barlow J,Parsons J

    更新日期:2002-01-01 00:00:00

  • Prevention versus treatment for malaria in pregnant women.

    abstract:OBJECTIVES:Malaria contributes to antenatal anaemia and slowing of fetal growth, especially in first-time mothers. It is thought that these effects harm the mother and baby, and interventions to prevent or mitigate the effects of malaria are often recommended. The objective of this review was to assess the effects of a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Garner P,Gülmezoglu AM

    更新日期:2000-01-01 00:00:00

  • Environmental sanitary interventions for preventing active trachoma.

    abstract:BACKGROUND:Trachoma is a major cause of avoidable blindness. It is responsible for about six million blind people worldwide, mostly in the poor communities of developing countries. One of the major strategies advocated for the control of the disease is the application of various environmental sanitary measures to such ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Rabiu M,Alhassan M,Ejere H

    更新日期:2007-10-17 00:00:00

  • Co-formulated abacavir-lamivudine-zidovudine for initial treatment of HIV infection and AIDS.

    abstract:BACKGROUND:UNAIDS estimates that 34 million people are currently living with the human immunodeficiency virus (HIV) worldwide. Currently recommended regimens for initiating HIV treatment consist of either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir-boosted protease inhibitor (PI) combined with...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Shey MS,Kongnyuy EJ,Alobwede SM,Wiysonge CS

    更新日期:2013-03-28 00:00:00

  • Oral or topical nasal steroids for hearing loss associated with otitis media with effusion in children.

    abstract:BACKGROUND:Otitis media with effusion (OME) is common and may cause hearing loss with associated developmental delay. Treatment remains controversial. OBJECTIVES:To examine evidence for or against treating children with hearing loss associated with OME with systemic or topical intranasal steroids. SEARCH STRATEGY:We ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Thomas CL,Simpson S,Butler CC,van der Voort JH

    更新日期:2006-07-19 00:00:00

  • Medical day hospital care for the elderly versus alternative forms of care.

    abstract:BACKGROUND:Geriatric day hospitals provide multi-disciplinary rehabilitation in an outpatient setting. Concern has been expressed that evidence for effectiveness is equivocal and that day hospital care is expensive. OBJECTIVES:To assess the effects of medical day hospitals for elderly people. SEARCH STRATEGY:We searc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Forster A,Young J,Langhorne P

    更新日期:2000-01-01 00:00:00

  • Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant.

    abstract:BACKGROUND:Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Ray A,Ray S

    更新日期:2014-10-01 00:00:00

  • Combined corticosteroid and long-acting beta(2)-agonist in one inhaler versus inhaled corticosteroids alone for chronic obstructive pulmonary disease.

    abstract:BACKGROUND:Both long-acting beta(2)-agonists and inhaled corticosteroids have been recommended in guidelines for the treatment of chronic obstructive pulmonary disease (COPD). Their co-administration in a combined inhaler is intended to facilitate adherence to medication regimens and to improve efficacy. Three preparat...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Nannini LJ,Poole P,Milan SJ,Kesterton A

    更新日期:2013-08-30 00:00:00

  • Celecoxib for rheumatoid arthritis.

    abstract:BACKGROUND:Rheumatoid arthritis (RA) is a systemic auto-immune disorder, involving persistent joint inflammation. NSAIDs are used to control the symptoms of RA, but are associated with significant gastro-intestinal toxicity, including a risk of potentially life threatening gastroduodenal perforations, ulcers and bleeds...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Garner S,Fidan D,Frankish R,Judd M,Shea B,Towheed T,Wells G,Tugwell P

    更新日期:2002-01-01 00:00:00

  • Community first responders for out-of-hospital cardiac arrest in adults and children.

    abstract:BACKGROUND:Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章


    authors: Barry T,Doheny MC,Masterson S,Conroy N,Klimas J,Segurado R,Codd M,Bury G

    更新日期:2019-07-19 00:00:00

  • Pharmacological treatment for Buerger's disease.

    abstract:BACKGROUND:Buerger's disease (thromboangiitis obliterans) is a non-atherosclerotic, segmental inflammatory pathology that most commonly affects the small and medium sized arteries, veins, and nerves in the upper and lower extremities. The aetiology is unknown, but involves hereditary susceptibility, tobacco exposure, i...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Cacione DG,Macedo CR,do Carmo Novaes F,Baptista-Silva JC

    更新日期:2020-05-04 00:00:00

  • Extra fluids for breastfeeding mothers for increasing milk production.

    abstract:BACKGROUND:Breastfeeding is known to be the biological norm. Despite this, many women wean their babies because of perceived insufficient breast milk production. Mothers are sometimes advised to increase their fluid intake in the hope that this could improve breast milk production. The effect of extra fluid on human br...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Ndikom CM,Fawole B,Ilesanmi RE

    更新日期:2014-06-11 00:00:00

  • Effects of glucocorticoids on radiological progression in rheumatoid arthritis.

    abstract:BACKGROUND:Glucocorticoid use in rheumatoid arthritis (RA) is widespread. Two Cochrane Reviews have been published examining the short term clinical benefit of low dose glucocorticoids compared to non-steroidal anti-inflammatory drugs and demonstrate good short term and medium term clinical benefits. The possibility th...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Kirwan JR,Bijlsma JW,Boers M,Shea BJ

    更新日期:2007-01-24 00:00:00

  • Granulocyte transfusions for treating infections in patients with neutropenia or neutrophil dysfunction.

    abstract:BACKGROUND:Transfusions of granulocytes have a long history of usage in clinical practice to support and treat severe infection in high risk groups of patients with neutropenia or neutrophil dysfunction. However, there is considerable current variability in therapeutic granulocyte transfusion practice, and uncertainty ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Stanworth SJ,Massey E,Hyde C,Brunskill S,Lucas G,Navarrete C,Marks DI

    更新日期:2005-07-20 00:00:00

  • Oral immunoglobulin for the treatment of rotavirus diarrhea in low birth weight infants.

    abstract:BACKGROUND:Rotavirus infection is the most common neonatal nosocomial viral infection. It is a major health problem worldwide. Epidemics with the newer P(6)G9 strains have been reported in neonatal units globally. These strains can cause severe symptoms in most infected infants. Infection control measures become necess...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Pammi M,Haque KN

    更新日期:2011-10-05 00:00:00

  • Nutritional support for critically ill children.

    abstract:BACKGROUND:Nutritional support in the critically ill child has not been well investigated and is a controversial topic within paediatric intensive care. There are no clear guidelines as to the best form or timing of nutrition in critically ill infants and children. This is an update of a review that was originally publ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Joffe A,Anton N,Lequier L,Vandermeer B,Tjosvold L,Larsen B,Hartling L

    更新日期:2016-05-27 00:00:00