EFFECTIVENESS OF LULICONAZOLE VS CICLOPIROX ACROSS DIFFERENT DERMATOPHYTE SPECIES AND MOLECULAR SUBTYPES: A SECONDARY DATA STUDY

Abstract

Background: Dermatophytosis affects approximately 20–25% of the global population, with rising antifungal resistance heightening the urgency for evidence-based agent selection.[1,2] Luliconazole, a novel imidazole, and ciclopirox olamine, a hydroxypyridone, employ pharmacologically distinct mechanisms; however, their comparative effectiveness across dermatophyte species and molecular subtypes remains incompletely characterised. This study synthesised open-access data to compare in vitro potency, mycological cure rates, clinical cure rates, and adverse event (AE) profiles of both agents across major dermatophyte species and internally transcribed spacer (ITS) molecular subtypes. Methods: A secondary data analysis was conducted using seven peer-reviewed open-access datasets (2004–2024). Data from 820 isolates or patients (luliconazole n = 412; ciclopirox n = 408) were harmonised under CLSI M38 A2 and EUCAST E.DEF 11.0 standards. Primary outcomes included geometric mean (GM) minimum inhibitory concentration (MIC), MIC90, mycological cure rate, and clinical cure rate stratified by species and ITS subtype. No institutional ethics committee (IEC) approval was required as all data were publicly available without patient identifiers. The STROBE checklist was followed throughout. Results: Luliconazole demonstrated markedly superior in vitro potency (overall GM MIC 0.00028 vs. 0.3107 µg/mL; ~1,110-fold difference).[13,14] Despite this, six-week mycological cure rates were equivalent (86.04% vs. 86.36%; p = 0.941). Ciclopirox showed significantly faster early clinical response at weeks two and four (p = 0.031; p = 0.048), attributable to its synergistic anti-inflammatory activity with itraconazole. No intergroup differences were detected in complete cure, AE rates, or recurrence. Luliconazole retained in vitro potency against Trichophyton indotineae (ITS Type VIII; GM MIC 0.00038 µg/mL vs. ciclopirox 0.4200 µg/mL). Conclusion: Both agents achieve equivalent long-term clinical and mycological outcomes across dermatophyte species and molecular subtypes. Luliconazole offers a pronounced in vitro advantage particularly against emerging resistant pathogens. Ciclopirox may be preferred for early symptomatic relief or in combination regimens. Molecular subtyping should guide antifungal selection in recalcitrant dermatophytosis.