Pramoxine containing topical formulation of eberconazole in the management of dermatophytosis in India: a consensus statement


  • Uday Khopkar Department of Dermatology and Venereology at KEM Hospital and GS Medical College Mumbai, Maharashtra, India
  • Shyamanta Barua Department of Dermatology, Assam Medical College and Hospital, Dibrugarh, Assam, India
  • Sanjay Kumar Rathi Dr Sanjay K Rathi Clinic, Siliguri, West Bengal, India
  • A. N. Tiwari Skin Institute, Lucknow, Uttar Pradesh, India
  • Balakrishna Nikam Krishna Institute of Medical Science, Karad, Maharashtra, India
  • Chitra Nayek Department of Dermatology, BYL Nair Charitable Hospital and TN Medical College, Mumbai, India
  • Hemen Shah Healin Touch Clinic, Mumbai, Maharashtra, India
  • H. M. Srinivas Skin Cosmetic Clinic, Bangalore, Karnataka, India
  • Praneetha Kest R K Medical Centre, Anakapalli, Andhra Pradesh, India
  • P. V. S. Prasad Skin Care Clinic, Chidambaram, Tamil Nadu, India
  • Rajesh Katariya Well Skin Clinic, Indore, Madhya Pradesh, India
  • Rathish Pillai Azeezia Medical College Hospital, Kerala, India
  • Satyaprakash Mahajan Dr Satyaprakash Mahajan Skin Care Clinic, Nashik, Maharashtra, India
  • Saurabh K. Mishra The Leprosy Mission Trust India, Delhi, India
  • Yaseen Umar Government Medical College, Anantnag, Jammu and Kashmir, India
  • Monil Yogesh Neena Gala Dr Reddy’s Laboratories, Hyderabad, Telangana, India
  • Snehal Sameer Muchhala Dr Reddy’s Laboratories, Hyderabad, Telangana, India



Dermatophytosis, Corticosteroids, Eberconazole, Pramoxine, Tronothane hydrochloride, Azoles


Dermatophytosis, a superficial fungal infection has attained significant extents among Indian population. Its clinical presentation is diverse, often in terms of morphology, severity type and involvement of all age groups. Management of dermatophytosis has become an important public health issue in India. Cases of steroid modified dermatophytosis are being encountered frequently, mostly caused due to the inadvertent use of steroid in combination with topical antifungal agents. This combination is available over the counter and is often used for the management of inflammation and pruritis associated with the disease. Current treatment recommendations must be reviewed as per the current clinical scenario of the disease. Thus, a topical formulation of an anti-itch agent like pramoxine and antifungal agent with an anti-inflammatory property like eberconazole holds a promising treatment approach for dermatophytosis. This article focuses on the challenges encountered in the management of dermatophytosis and strategies for optimizing treatment for better patient outcomes. An expert’s panel discussion was conducted involving fifteen dermatologists all over India, during which modified Delphi method was executed for a set of nine statements. Agreement of more than 75% was set to reach the consensus. This consensus document was developed to review the available evidence and make recommendation based on the expert group’s opinion for the use of pramoxine containing topical formulation of eberconazole, as it provides the benefit of having an anti-inflammatory and anti-pruritic activity in a single formulation, where pramoxine can be utilised as an excipient to combat pruritis associated with dermatophytosis.


Author Biography

Monil Yogesh Neena Gala, Dr Reddy’s Laboratories, Hyderabad, Telangana, India

Medical Advisor


Lyngdoh CJ, Lyngdoh WV, Choudhury B, Bora I, Khyriem AB. Clinico-mycological profile of dermatophytosis in Meghalaya. 2013;3(4):2012-4.

Ely JW, Rosenfeld S, Stone MS. Diagnosis and management of tinea infections. Am Fam Physician. 2014;90(10):702-10.

Thai K. Fitzpatrick’s dermatology in general medicine. Wiley Online Library. 2008.

Shenoy MM, Jayaraman J. Epidemic of difficult-to-treat tinea in India: Current scenario, culprits, and curbing strategies. Arch Med Heal Sci. 2019;7(1):112.

Al-Khikani F. Dermatophytosis a worldwide contiguous fungal infection: Growing challenge and few solutions. Biomed Biotechnol Res J. 2020;4(2):117-22.

Havlickova B, Czaika VA, Friedrich M. Epidemiological trends in skin mycoses worldwide. Mycoses. 2008;52(1):95.

Alemayehu A, Minwuyelet G, Andualem G. Prevalence and Etiologic Agents of Dermatophytosis among Primary School Children in Harari Regional State, Ethiopia. J Mycol. 2016;2016:1-5.

Heidrich D, Garcia MR, Stopiglia CDO, Magagnin CM, Daboit TC, Vetoratto G et al. Dermatophytosis: A 16-year retrospective study in a metropolitan area in southern Brazil. J Infect Dev Ctries. 2015;9(8):865-71.

Naglot A, Shrimali DD, Nath BK, Gogoi HK, Veer V, Chander J et al. Original Research Article Recent Trends of Dermatophytosis in Northeast India (Assam) and Interpretation with Published Studies. Int J Curr Microbiol App Sci. 2015;4(11):111-20.

Pires CAA, da Cruz NFS, Lobato AM, de Sousa PO, Carneiro FRO, Mendes AMD. Clinical, epidemiological, and therapeutic profile of dermatophytosis. An Bras Dermatol. 2014;89(2):259-64.

Song J, Xian D, Yang L, Xiong X, Lai R, Zhong J. Pruritus: Progress toward Pathogenesis and Treatment. Biomed Res Int. 2018;2018.

Patro N, Panda M, Jena AK. The menace of superficial dermatophytosis on the quality of life of patients attending referral hospital in Eastern India: A cross-sectional observational study. Indian Dermatol Online J. 2019;10(3):262.

Verma S. Prevalence and clinical characteristics of itch in epidemic- like scenario of dermatophytoses in India : a cross-sectional study. 2019;7-10.

Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana K. Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). 2018;1-11.

Verma SB, Panda S, Nenoff P, Singal A, Rudramuruthy SM, Uhrlass S et al. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol. 2021;87(2):154-75.

Elmariah SB, Lerner EA. Topical therapies for pruritus. Semin Cutan Med Surg. 2011;30(2):118-26.

Zhai H, Simion FA, Abrutyn E, Koehler AM, Maibach HI. Screening topical antipruritics: A histamine-induced itch human model. Skin Pharmacol Appl Skin Physiol. 2002;15(4):213-7.

Pramocaine. Available at: https://pubchem.ncbi. Accessed on July 11 2021.

McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38:655-62.

Sahni K, Singh S, Dogra S. Newer topical treatments in skin and nail dermatophyte infections. Indian Dermatol Online J. 2018;9(3):149.

Moodahadu LS, Patnaik A, Arvind VV, Bhide RM. Preclinical pharmacological profile of Eberconazole : A review and update. 2014;5(2):159-65.

Bothiraja C, Gholap AD, Shaikh KS, Pawar AP. Investigation of ethyl cellulose microsponge gel for topical delivery of eberconazole nitrate for fungal therapy. Ther Deliv. 2014;5(7):781-94.

Thomas J, Das S, Ghate S, Chatterjee M, Teltumde S, Charugulla SN et al. Effectiveness and safety of eberconazole 1% cream in Indian patients with Tinea corporis and Tinea cruris: a prospective real-world study. Int J Res Dermatology. 2020;7(1):96.

Montero TR, López S, Rodríguez C, del Rio R, Badell A, Gratacós MR. Eberconazole 1% cream is an effective and safe alternative for dermatophytosis treatment: Multicenter, randomized, double-blind, comparative trial with miconazole 2% cream. Int J Dermatol. 2006;45(5):600-4.

Nakka AR, Bommakanti J, Karumuri SRR, Thambisetti NB. Evaluation of newer imidazoles in dermatophytosis. 2020;6(1):75-9.

Choudhary S, Aghi T, Bisati S. Efficacy and safety of terbinafine hydrochloride 1% cream vs eberconazole nitrate 1% cream in localised tinea corporis and tinea cruris. Indian Dermatol Online J. 2014;5(2):128.

Liebel F, Lyte P, Garay M, Babad J, Southall MD. Anti-inflammatory and anti-itch activity of sertaconazole nitrate. Arch Dermatol Res. 2006;298(4):191-9.

Havlickova B, Friedrich M. The advantages of topical combination therapy in the treatment of inflammatory dermatomycoses. Mycoses. 2008;51(4):16-26.

Verma S, Hay RJ. Topical steroid-induced tinea pseudoimbricata: a striking form of tinea incognito. Int J Dermatol. 2015;54(5):e192-3.

Alston SJ, Cohen BA, Braun M. Persistent and recurrent tinea corporis in children treated with combination antifungal/corticosteroid agents. Pediatrics. 2003;111(1):201-3.

Sheth HJ, Rathod SP, Chaudhary RG, Malhotra SD, Patel PR. Tinea incognito with unjustified use of potent Topical Corticosteroids: a case series. Int J Basic Clin Pharmacol. 2017;6(8):2087.

Del Boz J, Crespo V, Rivas-Ruiz F, de Troya M. Tinea incognito in children: 54 cases. Mycoses. 2011;54(3):254-8.

Bornali Dutta ESR, Bobita B. Clinico‑epidemiological study of tinea incognito with microbiological correlation. Indian J Dermatology, Venereol Leprol. 2017;83:3.

Jacobs JA, Kolbach DN, Vermeulen AH, Smeets MH, Neuman HA. Tinea incognito due to Trichophytom rubrum after local steroid therapy. Clin Infect Dis. 2001;33(12):142-4.

Elghblawi E. Extensive ‘Tinea Incognito’ Due to Topical Steroid: A Case Report. JMED Res. 2013;2013:1-3.

Indramaya DM, Karim A, Ahmad Z. A Case of Tinea Incognito: A Misuses of Steroid. Berk Ilmu Kesehat Kulit dan Kelamin. 2019;31(3):242-7.

Brunton LL, Hilal-Dandan R, Knollmann BC. Goodman and Gilman’s the pharmacological basis of therapeutics. McGraw-Hill Education New York; 2018.

NOOJIN RO. Tronothane hydrochloride (pramoxine hydrochloride) in the control of pruritus. Postgrad Med. 1954;16(5):453-5.

Young TA, Patel TS, Camacho F, Clark A, Freedman BI, Kaur M et al. A pramoxine-based anti-itch lotion is more effective than a control lotion for the treatment of uremic pruritus in adult hemodialysis patients. J Dermatolog Treat. 2009;20(2):76-81.

Rosen JD, Fostini AC. Diagnosis and Management of Neuropathic Itch Pruritus Neuropathic Diagnosis Treatment Peripheral nerves. Dermatol Clin. 2018;02:005

SCHWARTZ FR. Tronothane in common pruritic syndromes. Postgrad Med. 1954;16(1):19-21.

Weinstein A, Berman B. Topical treatment of common superficial tinea infections. Am Fam Physician. 2002;65(10):2095-102.

Del PA, Ortiz FJ, Pérez A, Pazos C, Garau M, Font E. A double-blind randomized comparative trial: Eberconazole 1% cream versus clotrimazole 1% cream twice daily in Candida and dermatophyte skin infections. Mycoses. 2001;44(5-6):173-80.

Del Palacio A, Cuétara S, Noriega AR. Topical treatment of tinea corporis and tinea cruris with eberconazole (WAS 2160) cream 1% and 2%: a phase II dose‐finding pilot study: Topische Behandlung der Tinea corporis und Tinea cruris mit Eberconazol‐(WAS 2160)‐1% und‐2%‐Creme: Eine Phase‐II‐Dos. Mycoses. 1995;38(7-8):317-24.

Harrison IP, Spada F. Breaking the Itch–Scratch Cycle: Topical Options for the Management of Chronic Cutaneous Itch in Atopic Dermatitis. Medicines. 2019;6(3):76.

Fallon JD, Sober A. Relief of pruritus in patients with atopic dermatitis after treatment with topical doxepin cream. J Am Acad Dermatol. 1994;31(4):613-6.

Lynn A. Drake, MD; Larry E. Millikan M. The Antipruritic Effect of 5% Doxepin Cream. Arch Dermatol. 1995;(131):1403-8.

Mahajan S, Tilak R, Kaushal SK, Mishra RN, Pandey SS. Clinico-mycological study of dermatophytic infections and their sensitivity to antifungal drugs in a tertiary care center. Indian J Dermatology, Venereol Leprol. 2017;83(4):436.

Noble SL, Forbes RC, Stamm PL. Diagnosis and management of common tinea infections. Am Fam Physician. 1998;58(1):163.






Review Articles