A Comparison between the Efficacies of Fluconazole and Ketoconazole in Treating Tinea Versicolor Infections

Abstract

Tinea versicolor is a common superficial mycosis caused by Malassezia species. While topical therapies are first-line, extensive or recurrent cases necessitate systemic treatment. Fluconazole and ketoconazole are two widely used oral antifungal agents, but contemporary comparative data on their efficacy in the specific demographic and climatic context of Bangladesh are limited. This study aimed to compare the clinical efficacy and mycological cure rates of oral fluconazole versus oral ketoconazole in patients with moderate-to-severe tinea versicolor infections. A comparative study was conducted at International Medical College Hospital, Dhaka, from January 2023 to December 2024. Using purposive sampling, 120 enrolled participants were allocated into two equal groups (n=60 each). Group A received oral fluconazole (300 mg once weekly) for 4 weeks. Group B received oral ketoconazole (200 mg daily) for 10 days. Clinical assessment and potassium hydroxide (KOH) microscopy for mycological clearance were performed at baseline and at a 6-week follow-up. Data were analyzed using SPSS version 23.0, employing chi-square and independent t-tests. Based on the results of 120 patients, fluconazole demonstrated superior efficacy to ketoconazole. Clinical cure was achieved in 91.7% (55/60) of the fluconazole group compared to 80.0% (48/60) in the ketoconazole group (p<0.05). Mycological cure rates were 93.3% and 81.7%, respectively (p<0.05). Both treatments were well-tolerated, with only mild, transient adverse effects reported in 8.3% of patients in each group. Oral fluconazole is significantly more effective than ketoconazole for treating tinea versicolor. Given its superior cure rates and convenient weekly dosing, fluconazole should be considered the preferred oral antifungal therapy for this condition, particularly in tropical climates.  

CBMJ 2026 July: Vol. 15 No. 02 P:253-259