Efficacy and Safety of Oral Itraconazole vs Oral Itraconazole Plus Oral Isotretinoin in Treatment of Chronic Recurrent Dermatophytosis
DOI:
https://doi.org/10.66984/jsmdc.v12.i01.oa.05Keywords:
Dermatophytes, Itraconazole, Drug Resistance, Isotretinoin, Antifungal agentsAbstract
Objective: To compare the efficacy and safety of oral itraconazole alone versus oral itraconazole in combination with oral isotretinoin in the treatment of chronic recurrent dermatophytosis.
Methodology: This quasi-experimental study was conducted in the Department of Dermatology, Services Hospital, Lahore, over a duration of one year from January to December, 2025, after institutional ethical approval. Written informed consent was obtained, and a total of 125 patients with recurrent tinea cruris and/or tinea corporis were enrolled using a non-probability consecutive sampling technique. Patients were allocated into two groups: group A (n=61) received oral itraconazole alone, while group B (n=64) received oral itraconazole in combination with oral isotretinoin for one month. Patients were followed weekly during the treatment period to assess clinical cure and adverse effects. Mycological cure was assessed at the end of one month of treatment, and patients were then followed monthly for three months posttreatment to evaluate relapse. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 26.
Results: The mean age of our study participants was 33.95±7.59 years. This study found no statistically significant difference in clinical and mycological cure at treatment completion between the groups (p=0.06). However, relapse was significantly more frequent in group A (55.7%) compared to the group B (34.4%) (p=0.013). Group B experienced a significantly higher frequency of adverse effects, particularly cheilitis and lip dryness (p <0.001).
Conclusion: There was no significant difference in initial clinical or mycological cure rates between the groups. However, group B receiving combination therapy significantly reduced relapse rates but was associated with a higher frequency of adverse effects in the treatment of chronic recurrent dermatophytosis.
References
1. Kruithoff C, Gamal A, McCormick TS, Ghannoum MA. Dermatophyte infections worldwide: increase in incidence and associated antifungal resistance. Life (Basel). 2023; 14(1):1. doi:10.3390/life14010001.
2. Kashif S, Uddin F, Nasir F, Zafar S, Shahjabeen, Kumar S. Prevalence of dermatophytes in superficial skin infections in a tertiary care hospital. J Pak Assoc Dermatol. 2021; 31(3):484-8. doi:10.66344/jpad.31.3.2021.1541.
3. Moreno-Sabater A, Normand AC, Bidaud AL, Cremer G, Foulet F, Brun S, et al. Terbinafine resistance in dermatophytes: a French multicenter prospective study. J Fungi (Basel). 2022; 8(3):220. doi:10.3390/jof8030220.
4. Gupta AK, Wang T, Mann A, Polla Ravi S, Talukder M, Lincoln SA, et al. Antifungal resistance in dermatophytes - review of the epidemiology, diagnostic challenges and treatment strategies for managing Trichophyton indotineae infections. Expert Rev Anti Infect Ther. 2024; 22(9):739-51. doi:10.1080/14787210.2024.2390629.
5. Sui Y, Nizamani MM, Tarafder E, Zhang HL, Zhang Q, Acharya K, et al. Interconnected worlds: a comprehensive review of fungal defenses, antimicrobial resistance, and their evolutionary dynamics. IMA Fungus. 2026; 17:e171995. doi:10.3897/imafungus.17.171995.
6. Pathadka S, Yan VKC, Neoh CF, Al-Badriyeh D, Kong DCM, Slavin MA, et al. Global consumption trend of antifungal agents in humans from 2008 to 2018: data from 65 middle- and high-income countries. Drugs. 2022; 82(11):1193-205. doi:10.1007/s40265-022-01751-x.
7. Cosio T, Gaziano R, Zuccari G, Costanza G, Grelli S, Di Francesco P, et al. Retinoids in fungal infections: from bench to bedside. Pharmaceuticals (Basel). 2021; 14(10):962. doi:10.3390/ph14100962.
8. Naseemullah, Khan AR, Aslam K, Obaid SM. Efficacy of itraconazole vs itraconazole plus isotretinoin in treatment of chronic tinea. PJMHS. 2021; 15(10):3316-19. doi:10. 53350/pjmhs2115103316.
9. Kar C, Sarkar A, Sarkar P, Das A, Mishra R, Das NK. Recurrence of dermatophytosis and therapeutic efficacy of systemic antifungals in recurrent dermatophytosis of adults - a randomized, assessor-blind controlled trial in a tertiary institution. JPAD. 2023; 33(4):1485-94. Available from: https://www.jpad.com.pk/index.php/jpad/article/view/2305/2121.
10. Nahid A. Efficacy and safety of terbinafine and itraconazole. ClinicalTrials.gov. Bethesda (MD): National Library of Medicine (US). 2023. Available from: https://clinicaltrials.gov/study/NCT05881980.
11. Alhamdi DK, Alhamdi KI. Efficacy and safety of adding low-dose isotretinoin to itraconazole in the treatment of chronic recurrent dermatophytosis among sample of Iraqi patients: an open-labelled therapeutic clinical comparative study. Indian J Dermatol. 2022; 67(5):624. doi:10.4103/ ijd.ijd_332_22.
12. Shenoy M, Poojari S, Rengasamy M, Vedmurthy M, Barua S, Dhoot D, et al. Management of dermatophytosis: real-world indian perspective. Indian Dermatol Online J. 2023; 14(3):347-56. doi:10.4103/idoj.idoj_643_22.
13. Sarwar U, Arshad A, Ashraf A, Saeed W, Azam NB. Efficacy of itraconazole pulse therapy with adjuvant isotretinoin in the treatment of recurrent and recalcitrant dermatophytosis. PPMJ. 2025; 36(3):115-20. doi:10. 51642/ppmj.v36i03.781.
14. Khattab F, Elkholy BM, Taha M, Abd-Elbaset A, Fawzy M. Voriconazole is superior to combined itraconazole/isotretinoin therapy and itraconazole monotherapy in recalcitrant dermatophytosis. Mycoses. 2022; 65(12):1194-201. doi:10.1111/myc.13517.
15. Priyadarshi D, Agarwal D, Talwar A. Safety and efficacy of oral itraconazole versus combination with oral isotretinoin in superficial dermatophytosis: a randomised clinical trial. J Clin Diagn Res. 2023; 17(5):WC01-5 doi:10.7860/jcdr/2023/63422.17839.
16. Verma KK, Senthilnathan G, Bhatia S, Xess I, Gupta V, Dwivedi SN, et al. Oral isotretinoin combined with oral terbinafine versus oral terbinafine alone to treat recurrent dermatophytosis: an open-label randomised clinical trial. Indian Dermatol Online J. 2021; 12(6):820-5. doi:10.4103/ idoj.IDOJ_167_21.
17. Hassaan ZRAA, Mohamed HAK, Eldahshan RM, Elsaie ML. Comparison between the efficacy of terbinafine and itraconazole orally vs. the combination of the two drugs in treating recalcitrant dermatophytosis. Sci Rep. 2023; 13(1):19037. doi:10.1038/s41598-023-46361-z.
18. Khurana A, Sharath S, Sardana K, Chowdhary A, Panesar S. Therapeutic updates on the management of tinea corporis or cruris in the era of trichophyton indotineae: separating evidence from hype-a narrative review. Indian J Dermatol. 2023; 68(5):525-40. doi:10.4103/ijd.ijd_832_23.
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Copyright (c) 2026 Journal of Sharif Medical & Dental College is licensed and distributed under the terms of Creative Commons Attribution-NonCommercial 4.0 International License.
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