Skin is a protective barrier also has cosmetic value. Dermatophyte infection is commonest superficial fungal infection in the world which affect skin, hair nail. It is more prevalent in tropical countries like India. Dermatophyte infection can cause significant morbidity. Working days may be lost and social life may be affected. Several environmental, social and immunological factors contributes to the disease. Disease like diabetes malignancy HIV/AIDS  which decreases immunity and immunosuppressive drugs, steroid use prolongs disease. For the treatment of superficial fungal diseases topical antifungal agents are used. Imidiazole group antifungal miconazole is a common drugs used in this purpose. Newer imidiazole antifungals like sertaconazole and eberconazole claims to have better efficacy than miconazole as they have additional anti-inflammatory property. The imidiazole group of antifungal drugs attains significant amount of concentration in superficial layers of skin. Drug level in deeper layer and systemic absorption is negligible. They penetrate horny layer of skin and remains there for long time, so their use in superficial fungal infection is preffered.

The objective of the study was to carry out a head-to-head comparison of the newer imidazoles, topical sertaconazole and topical eberconazole, with the established topical antifungal miconazole in the management of cutaneous dermatophyte infection with respect to both effectiveness and safety.

Over a recruitment period of 12 months 206 patients who gave consent were randomized to three study arms. First follow up visit was at 2 weeks and end of study visit was at 4 weeks. Overall, 69 patients on miconazole, 62 on sertaconazole and 68 on eberconazole completed the study.

Baseline characteristics of all three groups were comparable. We looked for decrease in erythema, pruritus, scaling and total symptom score. These parameters decreased significantly from base line to 2nd week follow-up and to study end in each of the three study groups, with no significant intergroup differences at any time point. Complete clinical cure (that is resolution of lesion with all associated symptoms) in miconazole, sertaconazole, eberconazole group was 46.38%, 46.77% and 58.82% respectively. This difference was not significant statistically. However, clinical cure rate at 2 weeks was 3.23% and 16.18% in sertaconazole and eberconazole group respectively (p = 0.018) without any such case in the miconazole. Compliance, assessed with the help of a medication adherence record sheet, was good to excellent in most study subjects. No clinically significant adverse drug reactions were noted in any study arm.

Therefore, in conclusion, despite an early trend favoring eberconazole, clinical cure at 4 weeks was comparable with the older drug miconazole. Clinical cure was not achieved in approximately 50% of the subjects at 4 weeks. Tolerability of all three preparations was excellent.