Econazole nitrate 1% topical cream is used for the treatment of certain dermatophytoses, including tinea corporis (body ringworm), tinea cruris (jock itch), and tinea pedis (athlete's foot) caused by Epidermophyton floccosum, Microsporum audouinii, M. canis, M. gypseum, Trichophyton mentagrophytes, T. rubrum, or T. tonsurans.
Clinical studies to date indicate that econazole nitrate 1% cream is effective for the topical treatment of dermatophytoses and appears to be equivalent in efficacy and safety to topical clotrimazole 1% cream, miconazole nitrate 1% cream, or tioconazole 1 or 2% cream (not commercially available in the US).
Like other imidazole derivatives (e.g., clotrimazole, ketoconazole, miconazole, oxiconazole, sulconazole) and ciclopirox olamine, econazole nitrate has an advantage over some other topical antifungal agents (e.g., nystatin, tolnaftate) in the treatment of mixed infections or for empiric treatment pending identification of the causative organism, since the drug is active against both dermatophytes and Candida.
Tinea Corporis and Tinea Cruris
Tinea corporis and tinea cruris generally can be effectively treated using a topical antifungal; however, an oral antifungal may be necessary if the disease is extensive, dermatophyte folliculitis is present, the infection is chronic or does not respond to topical therapy, or the patient is immunocompromised because of coexisting disease or concomitant therapy.
Many clinicians consider topical imidazole-derivative azole antifungals (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole) or topical allylamine antifungals (e.g., naftifine, terbinafine) the drugs of first choice for the topical treatment of tinea corporis or tinea cruris, although other antifungals (e.g., ciclopirox olamine, butenafine hydrochloride, tolnafate, undecylenic acid) also can be effective in the treatment of these infections.
While topical antifungals usually are effective for the treatment of uncomplicated tinea pedis, an oral antifungal usually is necessary for the treatment of hyperkeratotic areas on the palms and soles, for chronic moccasin-type (dry-type) tinea pedis, and for the treatment of tinea unguium (fingernail or toenail dermatophyte infections, onychomycosis).
Pityriasis (Tinea) Versicolor
Econazole nitrate 1% topical cream is used for the treatment of pityriasis (tinea) versicolor, a superficial infection caused by Malassezia furfur (Pityrosporum orbiculare or P. ovale).
Pityriasis versicolor generally can be treated topically with an imidazole-derivative azole antifungal (e.g., clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, sulconazole), an allylamine antifungal (e.g., terbinafine), ciclopirox olamine, or certain other topical therapies (e.g., selenium sulfide 2.5%). However, an oral antifungal (e.g., itraconazole, ketoconazole) may be indicated, with or without a topical antifungal, in patients who have extensive or severe infections or who fail to respond to or have frequent relapses with topical therapy.
Econazole 1% topical cream is used for the treatment of cutaneous candidiasis caused by Candida albicans.
Econazole nitrate has been used effectively as a 1% vaginal cream or 150-mg vaginal suppositories for the treatment of vulvovaginal candidiasis. In a few comparative studies, these vaginal preparations produced cure rates similar to those produced by clotrimazole or nystatin vaginal tablets. Econazole nitrate has also been used with some success as a 1% otic solution for the treatment of otomycoses. The vaginal cream and suppositories and otic solution currently are not commercially available in the US.