Topical econazole versus terbinafine in the treatment of toe web space infections: A comparison

In toe web space infection, bacteria, dermatophyte fungi, and Candida contribute to inflammation and infection. Because direct microscopy and bacterial and fungal cultures are not always cost-effective in routine practice, patients are often treated empirically. In a 4-week, evaluator-blind, randomized pilot study, therapeutic efficacy was compared in 21 patients (18 men; 3 women) with inflammatory interdigital web space infections who applied either once-daily econazole nitrate 1% cream (n = 10) or twice-daily terbinafine 1% cream (n = 11) to lesions. Evaluations of objective findings and subjective symptoms, and fungal and bacterial cultures, were performed at baseline and at weeks 2, 4, 8, and 12. All patients completed treatment and all but 1 in each group completed posttreatment follow-up. Initial cultures were positive for dermatophytes in 57% (12/21), for Candida in 24% (5/21), and for bacteria in 81% (17/21) of patients. At the 8-week posttreatment follow-up visit (week 12), objective findings were improved 86% from baseline in the econazole group and 58% in the terbinafine group; subjective symptoms were improved 91% and 95%, respectively. Although both products alleviated symptoms, with a tendency for patients treated with terbinafine to improve faster, as a result of these preliminary findings, it is concluded that econazole nitrate 1% cream may be more effective than terbinafine 1% cream in the relief of inflammatory interdigital toe web space infections.