Comparing the Efficacy of Oral Fluconazole versus Oral Itraconazole in Treating Resistant Tinea Corporis: Oral Fluconazole versus Oral Itraconazole in Treating Resistant Tinea Corporis

Urooj Fatima; Uzma Ali; Shumaila Khan; Danial Hassan Adil; Rimsha Rehman; Ayesha Jamal

doi:10.54393/pjhs.v7i4.3777

Authors

Urooj Fatima Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan
Uzma Ali Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan
Shumaila Khan Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan
Danial Hassan Adil Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan
Rimsha Rehman Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan
Ayesha Jamal Department of Dermatology, Capital Hospital Capital Development Authority, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v7i4.3777

Keywords:

Tinea Corporis, Antifungal Resistance, Itraconazole, Fluconazole, Dermatophytosis, Randomized Controlled Trial, Trichophyton Indotineae

Abstract

Dermatophytosis, particularly tinea corporis, has become challenging due to rising antifungal resistance, notably Trichophyton indotineae. Comparative efficacy data for oral fluconazole versus itraconazole in resistant cases in local populations remain limited. Objectives: To compare the efficacy and safety of oral fluconazole versus oral itraconazole for resistant tinea corporis. Methods: This single-blind randomized controlled trial (trial reference CPSP/REU/EDR-2023-253-19306) was conducted at Capital Hospital CDA, Islamabad, from June to October 2025. 126 adults with clinically and KOH microscopy-confirmed resistant tinea corporis were randomized 1:1 to receive oral itraconazole 200 mg daily or fluconazole 150 mg every other day for 4 weeks. The primary outcome was complete clinical cure (erythema=0, scaling=0, pruritus=0, no visible lesions) at week 4. Secondary outcomes included percentage improvement in clinical signs and adverse events. Results: Complete clinical cure was achieved in 79.4% (50/63) with itraconazole versus 66.7% (42/63) with fluconazole (p=0.109; risk difference 12.7%, 95% CI −2.8 to 28.2). The primary endpoint did not reach statistical significance. However, mean percentage improvements were significantly higher with itraconazole for erythema (45.3% vs 36.4%; p=0.027), scaling (39.5% vs 30.2%; p=0.041), pruritus (52.6% vs 43.3%; p=0.038), and elevated borders (38.3% vs 31.6%; p=0.015). Itraconazole remained an independent predictor of cure (adjusted OR 2.12, 95% CI 1.04–4.31; p=0.037). Mild adverse effects occurred in 9.5% vs 14.3% (p=0.581). Conclusions: Although the difference in complete clinical cure rates (primary endpoint) was not statistically significant, itraconazole showed greater clinical improvement across secondary endpoints and was independently associated with higher odds of cure compared to fluconazole.

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