Comparative Efficacy of Low-Dose Short-Course Oral Fluconazole versus Topical 1% Clotrimazole in the Treatment of Pityriasis Versicolor: A Randomized Controlled Trial
DOI:
https://doi.org/10.52206/jsmc.2026.16.2.1420Abstract
Background: Pityriasis versicolor (PV) is a common superficial fungal infection caused by Malassezia species, with higher prevalence in tropical and humid regions. Despite the availability of both systemic and topical antifungal therapies, comparative evidence on their efficacy in local populations remains limited.
Objective: To compare the efficacy and safety of a low-dose short-course oral fluconazole regimen with topical 1% clotrimazole in patients with pityriasis versicolor.
Methodology: This randomized controlled trial was conducted at the Department of Dermatology, Hayatabad Medical Complex, Peshawar, Pakistan, from November 2022 to May 2023. A total of 226 patients aged 15–60 years with clinically and mycologically confirmed PV were randomized into two equal groups. Group A received oral fluconazole 150 mg weekly for two weeks, while Group B received topical 1% clotrimazole twice daily for 14 days. The primary outcome was overall efficacy at week 4, defined as the combination of clinical and mycological cure. Data were analyzed using intention-to-treat principles, with logistic regression applied to adjust for potential confounders.
Results: Topical clotrimazole demonstrated significantly higher efficacy compared to oral fluconazole (85.8% vs 62.8%, p < 0.001). Multivariable analysis confirmed that clotrimazole was independently associated with higher odds of treatment success (adjusted OR = 3.42; 95% CI: 1.85–6.33). Subgroup analyses consistently favored clotrimazole across age, gender, and duration of illness. No adverse drug reactions were reported in either group.
Conclusion: Topical 1% clotrimazole is more effective than low-dose oral fluconazole in achieving short-term clinical and mycological cure in pityriasis versicolor. These findings support the preferential use of topical therapy as first-line treatment, although longer follow-up studies are needed to assess recurrence and long-term safety.
Keywords: Antifungal efficacy, Oral Fluconazole, Pityriasis Versicolor, Topical Clotrimazole.
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