Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear blinding of outcome assessment, and unclear compliance) and by suspected publication bias (only small and mostly commercially funded studies).
A Cochrane review [Abstract] 1 included 51 studies with a total of 9052 subjects. Ketoconazole, ciclopirox, lithium, bifonazole, and clotrimazole trial were compared with placebo, vehicle, another antifungal, or steroids. Topical ketoconazole 2% treatment showed a 31% lower risk of failed clearance of rashes compared with placebo (Table T1). Ketoconazole treatment resulted in a remission rate similar to that of steroids, but occurrence of side effects was lower in the ketoconazole group (RR 0.56, 95% CI 0.32 to 0.96; 8 studies). Ketoconozale yielded a similar remission failure rate as ciclopirox. Most comparisons between ketoconazole and other antifungals were based on single studies that showed comparability of treatment effects.Ciclopirox 1% led to a lower failed remission rate than placebo at four weeks of follow-up. Clotrimazole and miconazole efficacies were comparable with those of steroids on short-term assessment in single studies.
| Outcome (follow-up: mean 4 weeks) | Relative effect (95% CI) | Assumed risk - | Corresponding risk - Intervention = antifungal (95% CI) | Participants (studies) |
|---|---|---|---|---|
| Ketoconazole: Failure to achieve complete resolution | RR 0.69 (0.59 to 0.81) | Placebo: 686/1000 | 473/1000(405 to 556) | 2520(8 ) |
| Ciclopirox: Failure to achieve complete resolution | RR 0.79 (0.67 to 0.94) | Placebo: 736/1000 | 581/1000(493 to 692) | 1525(8) |
| Ketoconazole: Failure to achieve complete resolution | RR 1.17 (0.95 to 1.44) | Steroids: 335/1000 | 392/1000(318 to 482) | 302(6) |
Date of latest search: 16 December 2014
Primary/Secondary Keywords