Reviews Sulconazole - an alternative treatment in superficial fungal skin infections

Sulconazole is a substituted imidazole antimicrobial agent structurally related to other drugs in this group.

It has similar antifungal activity to other imidazoles Sulconazole possesses a broad spectrum of

antifungal activity, inhibiting the growth of dermatophytes, yeasts and various filamentous and dimorphic fungi at concentrations below 5 mg/L in vitro. To test the in vitro activity of antifungal agents, a system of measurement of a relative inhibition factor (RIF) has been devised, as MIC values may vary depending upon experimental conditions . The RIF is devised from the area under a fixed sector of an antifungal dose-response curve, expressed as a percentage of the AUC of a theoretical non-inhibitory drug. It approaches 0% for a drug to which a fungus is highly sensitive and 100% for a drug which is non-inhibitory. In one . study the RIFs of sulconazole against Candida species (69%), dermatophytes (12%) and Aspergillus species (71 %) were broadly similar to

"those of clotrimazole, econazole, ketoconazole, miconazole and tioconazole.

The fungicidal potency of sulconazole in vitro depends on its concentration and on the growth phase of the inoculum cells. Sulconazole has also demonstrated antibacterial activity in vitro, with MIC values below 12.5 mg/L against several Staphylococcus species, Streptococcus faecalis and certain Gram-positive anaerobes.

It appears that sulconazole exerts antifungal activity through effects which destroy the capacity of the fungal cell membrane to maintain the intracellular environment.

Resolution may be more rapid with sulconazole In controlled, comparative clinical trials of

patients with superficial fungal infections of the skin, sulconazole has demonstrated clear superiority over placebo and generally had similar clinical efficacy to clotrimazole, econazole and miconazole. Treatment was normally administered twice daily for between 2 and 5 weeks in these studies. Two studies showed that, compared with clotrimazole, sulconazole possessed significantly greater overall clinical efficacy in patients with tinea cruris or tinea pedis, and it appears that sulconazole may relieve some of the symptoms of tinea pedis (erythema, scaling, pruritus and maceration/erosion) more quickly than clotrimazole. The 2 drugs were otherwise found to be of similar efficacy, with mycological cure achieved in over 70% of patients. No Significant differences were reported in the results of 2 comparisons with

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econazole, both drugs achieving very high cure rates in patients with tinea pedis or tinea cruris. Likewise, sulconazole and miconazole usually had similar overall clinical efficacy, although in 2 studies of patients with tinea pedis sulconazole tended towards superiority, but the differences were not statistically significant. Sulconazole again tended to cause a more rapid relief of some clinical symptoms.

Reported relapse rates 4 to 12 weeks following the end of treatment were low for sulconazole and the other imidazole antifungal drugs tested. Differences that were observed usually favoured sulconazole.

Sulconazole 1 % cream should be rubbed gently into the affected and surrounding skin area twice daily. To minimise the risk of reinfection treatment should continue for 3 weeks in Candida infections, tinea cruris, tinea corporis and pityriasis versicolor, and for 4 weeks in patients with tinea pedis.

About 12% of a topical dose is absorbed About 12% of a topically administered (forearm) .

dose of sulconazole 1 % cream was estimated to be percutaneously absorbed in humans. This value varied markedly in different animal species.

Sulconazole has generally been very well tolerated in clinical trials. In the largest study, involving 323 patients, the overall incidence of adverse effects was 3.4%, with redness, irritation, contact dermatitis and pruritus being the most frequently reported . Few patients have withdrawn from sulconazole treatment due to side effects.

Thus, sulconazole would appear to be an effective and well tolerated alternative to other topical imidazole drugs in the treatment of superficial dermatomycoses. Benfield P, Clissold SP. Drugs 35: 143·153, Feb 1988 [30 references) ....

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