A systematic review «Taudorf EH, Jemec GBE, Hay RJ ym. Cutaneous candid...»1 included 44 original trials. Study populations were infants and small children in 20 %, children and adults in 23 %, adolescents and adults in 43 %, elderly in 2 % and unspeciﬁed in 11 %. The studies investigated cheilitis in 2 %; perineal dermatitis in 2 %; intertrigo, interdigital, perleche and/or paronychia in 16 %; diaper dermatitis in 18 %; all body areas in 55 % and unspeciﬁed areas in 7 %.
Overall, 41 articles (n = 2711) investigated topical therapy for candidiasis, 35 trials being randomized controlled trials (RCTs) and seven prospective blinded or open-label trials, one article reporting two trials. Candida was specified by microscopy and/or culture and the majority recorded C. albicans.
Clotrimazole: Topical clotrimazole 1 % twice daily for 2–12 weeks was tested in 12 studies including all body sites in adults and children above the age of ﬁve, infants with diaper dermatitis and uncharacterized study populations, respectively. Complete cure (clinically as well as mycologically) occured in the intervention group from 73 % to 100 %, which was signiﬁcantly higher than in the placebo group (complete cure rates of 0 %–52 % (P < 0.01)). Clotrimazole was comparable to miconazole 2 % twice daily (complete cure in both groups), nystatin 100 000 U/g twice daily: complete cure/clinical cure in 55 % vs. 58 %/microscopy and culture cure in 92 % vs. 92 % (no P-values).
Nystatin: Topical nystatin 100 000 U/g applied 2–4 times daily for 6–8 days was investigated in 10 studies including cutaneous candidiasis at all body regions in infants to elderly patients. Nystatin demonstrated clinical cure rates compared to placebo of 76 % vs. 28 % (P < 0.01), mycological cure rates of 68 % vs. 16 % (P < 0.01) and complete cure rates of 100 % vs. 13 %
Miconazole: In total, eight studies considered topical miconazole. Four studies investigated 1–4 weeks of topical miconazole 2 % twice daily for all body areas in adults. Three studies treated diaper dermatitis in infants for 1–2 weeks, while one study investigated prophylactic once-daily 0.75 % miconazole soap vs. placebo for 4 weeks in elderly with Candida intertrigo. Miconazole was superior to placebo, and efﬁcacy was similar to clotrimazole 1 %, haloprogin 1 % and sulconazole 1 % (no P-values). Overall, mycological cure ranged from 81 % to 100 %; with 96 %–100 % mycological cure for infants with diaper dermatitis and 81 %–100 % for adults with Candida at various body sites. Complete clinical as well as mycological cure was reported 87 % in one study. Prophylactic miconazole soap compared to placebo soap for 4 weeks generated signiﬁcantly fewer pseudohyphae detected by microscopy (17.9 % vs. 44.4 %, P < 0.05).
Single-drug therapy was as effective as combinations of antifungal, antibacterial, and topical corticosteroids.