TREATMENT OE DERMATOPHYTOSES II: NEWER TOPICAL ANTIEUNGAL DRUGS

Tbe first imidazole developed for topical antifungal use was cblorimidazole in 1959.*' In tbe late 1980s the tbird-generation imidazoles oxiconazole (Fig. 1) and sulconazole (Fig. 2) became available in tbe United States. Tbese agents along witb otber agents of tbis class of drugs are currently tbe mainstay of topical antifungal tberapy. Tbe fungistatic imidazoles act by inbibiting syntbesis of ergosterol, an essential component of fungal cell membranes. Tbeir activity is cytocbrome p-450 dependent, and most act by inbibiting 14 a-demetbylation of lanosterol (Fig. 3).''"' Clotrimazole and miconazole (Fig. 4) bave been available for more tban two decades. Tbey bave become available over-tbe-counter after development of tbe newer imidazoles. In addition to clotrimazole and miconazole, tbe agents oxiconazole (Fig. 1), sulconazole (Fig. 2), econazole (Fig. 4), and ketoconazole (Fig. 5), are currently approved for use in tbe United States. In Furope additional azoles are eitber available or in development, including bifonazole, fenticonazole, tioconazole, terconazole, and isoconazole.^'^-^'* Is tbere a significant difference among tbese topical imidazole antifungals.' Tbis question is difficult to answer because tbere are too few clinical trials comparing members of tbis class of drugs, and tbe results of publisbed