Comparative Clinical Outcomes of Three Itraconazole Regimens in Tinea Corporis: A Real-World Observational Study from Bangladesh - Abstract
Background: Tinea corporis is a common dermatophytic infection in Bangladesh. Increasing chronicity, treatment failure, recurrence, and reduced
responsiveness to conventional antifungal regimens have created important therapeutic challenges.
Objective: To compare clinical cure and relapse rates associated with three itraconazole regimens used for tinea corporis in routine dermatological
practice.
Methods: This prospective, real-world observational study was conducted in private dermatology practices in Dhaka and Mymensingh, Bangladesh.
Patients aged 15–50 years with clinically diagnosed tinea corporis were enrolled consecutively when they met the predefined eligibility criteria. Seventy-two
patients were initially enrolled; 12 were excluded because of adverse effects, clinically relevant drug interactions, non-adherence, or loss to follow-up. The
final per-protocol analysis included 60 patients, with 20 in each non-randomized treatment group. Group A received itraconazole capsules 200 mg twice daily
for 2 weeks followed by 100 mg twice daily for 6 weeks; Group B received itraconazole capsules 100 mg twice daily for 8 weeks; and Group C received
itraconazole tablets 200 mg once daily for 8 weeks. All groups also received topical luliconazole once daily, a 6% salicylic acid preparation at night, and daily
ciclopirox shampoo wash. Clinical cure was assessed at treatment completion, and cured patients were followed for 6 months to assess relapse.
Results: Clinical cure was achieved in 19/20 patients in Group A (95%; 95% confidence interval [CI], 76.4%–99.1%), 16/20 in Group B (80%; 95% CI,
58.4%–91.9%), and 9/20 in Group C (45%; 95% CI, 25.8%–65.8%) (?²=13.47; p=0.001). Relapse occurred in 2/19 cured patients in Group A (10.5%;
95% CI, 2.9%–31.4%), 5/16 in Group B (31.3%; 95% CI, 14.2%–55.6%), and 7/9 in Group C (77.8%; 95% CI, 45.3%–93.7%) (?²=12.74; p=0.002).
Among the 72 enrolled patients, exclusions included leg oedema in 6, clinically relevant drug interactions in 3, headache in 2, and suspected cardiac toxicity
in 1.
Conclusion: The Group A regimen was associated with the most favourable clinical outcome, whereas the once-daily tablet regimen showed comparatively
lower effectiveness in this cohort. However, the non-randomized design, small sample, per-protocol analysis, potential confounding, adjunctive therapy, and
absence of mycological confirmation preclude definitive conclusions regarding comparative superiority. Larger prospective randomized studies incorporating
standardized clinical assessment and mycological evaluation are required