There is moderate evidence that topical terbinafine, and weak evidence that topical imidazoles, are effective for the treatment of fungal infections of the groin and body.

Topical antifungal treatment compared with placebo

• Topical clotrimazole compared with placebo:
• In one randomized controlled trial (RCT) people with mycologically-confirmed athlete's foot, ringworm of the body, fungal groin infection, pityriasis versicolor, or cutaneous candidiasis were randomized to receive one of four treatments: clotrimazole cream, its placebo vehicle alone, clotrimazole solution, or its placebo vehicle alone, for 4–6 weeks.
• Significantly more people with fungal infection of the body or groin treated with clotrimazole cream or with clotrimazole solution had negative microscopy at 6 weeks, compared with people treated with the placebo vehicles (p < 0.001 for clotrimazole cream compared with placebo, p < 0.001 for clotrimazole solution compared with placebo) [Spiekermann and Young, 1976].
• Topical terbinafine compared with placebo:
• In one RCT (n = 66), treatment for 1 week with terbinafine 1% solution was compared with placebo solution in people with mycologically-confirmed skin ringworm or fungal groin infection [Lebwohl et al, 2001]. The primary outcome measure was mycological cure.
• After 4 weeks, 65% of the terbinafine group were cured, compared with 8% of the placebo group (p < 0.001).
• An RCT (n = 117) compared treatment with terbinafine 1% cream for 1 week with placebo cream [Budimulja et al, 2001]. Efficacy was assessed by comparing the mycological cure rates in the two groups.
• At week 8, 84% of people in the terbinafine group were cured, compared with 23% of people using placebo (p < 0.001).
• An RCT (n = 83) randomized people with mycologically-confirmed skin ringworm or fungal groin infection to treatment with topical terbinafine 1% gel or placebo gel, once a day for 1 week [van Heerden and Vismer, 1997].
• At 8 weeks, 83% of the terbinafine group were cured, compared with 27% of the placebo group (p < 0.001).

Comparative trials of topical antifungal treatments

• Topical terbinafine compared with topical ketoconazole:
• One RCT (n = 65) found that terbinafine was more effective than ketoconazole [Bonifaz and Saul, 2000]. Topical terbinafine 1% gel, applied once a day for 1 week was compared with ketoconazole 2% cream applied once a day for 2 weeks.
• At week 2, 94% of the terbinafine group were cured, compared with 69% of the ketoconazole group (p < 0.027).
• Topical miconazole compared with topical sulconazole:
• One RCT (n = 94) found similar cure rates for miconazole and sulconazole [Tanenbaum et al, 1982]. People with athlete's foot, skin ringworm, or fungal groin infection were randomized to receive sulconazole nitrate 1% cream or miconazole 2% cream, twice a day for 3 weeks.
• At week 3, the cure rate for sulconazole nitrate (29/32) was similar to the cure rate for miconazole (31/31) for people with skin ringworm or fungal groin infection. No p-values were quoted.