Comparison of topical and oral treatments for tinea gladiatorum

Objective: Little has been published regarding treatment guidelines for tin ea gladiatorum in the competitive wresting population, where outbreaks are commonplace. This study compares the efficacy of a first-line topical treat ment regimen and an oral treatment regimen. Design: A randomized, prospective, open-label pilot study was conducted dur ing the 1997 to 1998 interscholastic wrestling season. Setting: Training rooms at two suburban high schools. Participants: Male high school wrestlers with culture-proven tinea corporis were included in the study. There were 22 wrestlers enrolled: 17 finished the study. Interventions: Wrestlers were randomized to receive either clotrimazole 1% cream applied twice daily or fluconazole 200 mg once weekly for a total tre atment duration of 3 weeks. Main Outcome Measures: Symptom scores, lesion measurements, and fungal cult ures were followed to assess treatment efficacy. Results: Eleven wrestlers received clotrimazole and six wrestlers finished the full course of fluconazole. The extrapolated time to 50% improvement in symptom scores was 11.9 days in the clotrimazole group and 10.1 days in th e fluconazole group. The extrapolated time to 50% lesion reduction was 18.7 days in the clotrimazole group and 17.2 days in the fluconazole group. The extrapolated time to 50% culture eradication was 22.7 days in the clotrima zole group and 11.1 days in the flu conazole group. Conclusion: Both clotrimazole and fluconazole produce similar improvement i n clinical parameters. Fluconazole showed arithmetically, but not statistic ally, superior culture eradication. Fluconazole in a weekly dosing schedule should be considered in the first-line treatment of tinea gladiatorum.