TOPICAL ECONAZOLE VERSUS TERBINAFINE IN THE TREATMENT OF TOE WEB SPACE INFECTIONS - A COMPARISON

In toe web space infection, bacteria, dermatophyte fungi, and Candida contribute to inflammation and infection. Because direct microscopy an d bacterial and fungal cultures are not always cost-effective in routi ne practice, patients are often treated empirically. In a 4-week, eval uator-blind, randomized pilot study, therapeutic efficacy was compared in 21 patients (18 men; 3 women) with inflammatory interdigital web s pace infections who applied either once-daily econazole nitrate 1% cre am (n = 10) or twice-daily terbinafine 1% cream (n = 11) to lesions. E valuations of objective findings and subjective symptoms, and fungal a nd bacterial cultures, were performed at baseline and at weeks 2, 4, 8 , and 12. All patients completed treatment and all but 1 in each group completed posttreatment follow-up. Initial cultures were positive for dermatophytes in 57% (12/21), for Candida in 24% (5/21), and for bact eria in 81% (17/21) of patients. At the 8-week posttreatment follow-up visit (week 12), objective findings were improved 86% from baseline i n the econazole group and 58% in the terbinafine group; subjective sym ptoms were improved 91% and 95%, respectively. Although both products alleviated symptoms, with a tendency for patients treated with terbina fine to improve faster, as a result of these preliminary findings, it is concluded that econazole nitrate 1% cream may be more effective tha n terbinafine 1% cream in the relief of inflammatory interdigital toe web space infections.