Forty RCTs (n=5,010) were included in the review.
Azole versus placebo: all studies showed more improvement in the azole group than in the placebo group (15 trials). The mycological cure rates ranged from 60 to 91% (placebo group: 10 to 67%) and the clinical cure rates from 64 to 95% (placebo group: 10 to 63%).
Allylamine versus placebo: all studies showed more improvement in the allylamine group than in the placebo group (12 trials). The mycological cure rates ranged from 62 to 100% (placebo group: 10 to 45%) and the clinical cure rates from 66 to 86% (placebo group: 4 to 44%).
Allylamine versus azole: in 2 out of 5 studies comparing the effects of naftifine with bifonazole or clotrimazole, this allylamine showed a significantly better effect.; 4 of the 8 studies comparing terbinafine with clotrimazole, miconazole, bifonazole or oxiconazole showed an advantage for this allylamine.
The side-effects of azoles were documented for 82 out of 1,556 patients; such side-effects caused 0.8% of the patients to withdraw from the treatment. For allylamines, 116 out of 1,569 patients reported side-effects and 0.8% withdrew. For placebo, 40 out of 854 patients had side-effects and 0.6% withdrew.
High cure rates with terbinafine were detected after 1 week of therapy, whereas the azoles had to be applied for 4 weeks before the effectiveness showed.