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Editor's Note
March 2013

Lack of Significant Difference Among Antifungal Agents in Dermatophytosis

JAMA Dermatol. 2013;149(3):349. doi:10.1001/jamadermatol.2013.1734

The statistical methods used in this study are very complex. Therefore, JAMA Dermatology sent the manuscript out for statistical review. The conclusions of the meta-analysis, however, were quite simple. Pooled data failed to demonstrate significant differences among the antifungals for the outcome of mycologic cure at the end of treatment. This result is consistent with those of other published systematic reviews. Butenafine, naftifine, and terbinafine were significantly more efficacious for the outcome of sustained cure than were antifungals with which they were compared.

The strengths of the study include a thorough literature search and exclusion of low-quality trials assessed using the Jadad score. The Jadad score assesses 3 key features of a clinical trial: randomization, masking, and intent-to-treat analysis.1 A limitation of the study is that fungal infections of the feet, groin, and body were combined. See also the work of Crawford and Hollis2 on topical antifungal treatment.

References
1.
Jadad AR, Moore RA, Carroll D,  et al.  Assessing the quality of reports of randomized clinical trials: is blinding necessary?  Control Clin Trials. 1996;17(1):1-12PubMedArticle
2.
Crawford F, Hollis S. Topical treatments for fungal infections of the skin and nails of the foot.  Cochrane Database Syst Rev. 2007;(3):CD001434PubMed
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