Econazole
| Evidence Level: L4 | Predicted Indications: 7 |
Table of Contents
Econazole: From Tinea Infections to Majocchi Granuloma
One-Sentence Summary
Econazole is a topical imidazole antifungal, originally used for tinea pedis, tinea corporis, cutaneous candidiasis and pityriasis versicolor. The TxGNN model predicts it may be effective for Majocchi granuloma, but there are 0 registered clinical trials and only 1 publication (a case report that is not confirmed to involve econazole), so the evidence is limited to model prediction and indirect literature.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Tinea pedis, tinea corporis, tinea infection, cutaneous candidiasis, pityriasis versicolor, dermatophytosis of groin and perianal area (from the knowledge graph; the New Zealand licence records contain no indication text) |
| Predicted New Indication | Majocchi granuloma |
| TxGNN Prediction Score | 99.97% |
| Evidence Level | L4 |
| New Zealand Market Status | ✓ Marketed |
| Number of Authorizations | 2 (1 valid, 1 cancelled) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Detailed mechanism of action data is not available in the data compiled for this report. Based on known information, econazole is an imidazole antifungal that inhibits fungal lanosterol 14-alpha-demethylase (ergosterol synthesis). Its efficacy in superficial dermatophyte infections such as tinea corporis is established, and mechanistically it may be applicable to Majocchi granuloma.
Majocchi granuloma is a deep follicular and perifollicular dermatophyte infection, typically caused by Trichophyton rubrum. The causative organisms are the same kind that econazole already targets in tinea, so the mechanistic fit is plausible.
The main caveat is drug delivery. Deep dermal and follicular involvement usually requires systemic therapy because topical agents penetrate poorly. The same limitation applies to the other high-scoring predictions (ectothrix and endothrix infections, tinea profunda, and scalp or beard dermatophytosis).
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
For Majocchi granuloma, the only publication found is a single case report. It is not confirmed to involve econazole.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 37899944 | 2023 | Case report | Case Reports in Dermatology | Majocchi granuloma as a "great mimicker" that can be mistaken for eczema or psoriasis and worsened by topical corticosteroids (tinea incognita); no econazole-specific efficacy data |
Other predicted indications (for context):
| Predicted Indication | TxGNN Score | Evidence Level | Literature Summary |
|---|---|---|---|
| Superficial mycosis | 99.97% | L4 | 17 items, mostly reviews of other azoles; largely a restatement of existing indications |
| Vulvovaginal candidiasis | 99.50% | L3 | Includes randomized comparisons of econazole against clotrimazole (1994) and butoconazole (1990), and a 996-patient multicentre study (1976) |
| Dermatophytosis of scalp or beard | 99.97% | L4 | Reviews, surveys and case reports; no controlled efficacy data |
| Ectothrix infection, endothrix infection, tinea profunda | 99.96–99.97% | L5 | No trials and no literature |
New Zealand Market Information
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| 383872 (valid) | Pevaryl | Foaming solution 1%, 10 ml sachets | Not recorded |
| 2165953 (cancelled) | Pevaryl | Cream 1% | Not recorded |
Safety Considerations
Please refer to the package insert for safety information.
Pharmacology data compiled for this report lists econazole binding to TRPM2, TRPV5 and CYP8B1 (inhibition of CYP8B1 is reported). These are target interactions, not clinically graded drug-drug interactions, and no interaction severity levels are available.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction is mechanistically plausible, but the only supporting literature is one case report, there are no registered trials, and topical econazole is unlikely to reach deep follicular lesions at adequate concentrations. Of the predicted indications, vulvovaginal candidiasis has the strongest evidence (L3, with randomized comparisons). It is probably a regional labelling difference rather than a true new indication, and its older data should be checked against current susceptibility data.
To proceed, the following is needed:
- Package insert warnings and contraindications from Medsafe, which are currently missing and block safety screening
- Detailed mechanism of action data (MOA)
- Evidence that topical econazole achieves adequate penetration in deep or follicular dermatophyte infection, or a rationale for a systemic route
- Econazole-specific clinical data for Majocchi granuloma
- A review of current local Candida susceptibility data if vulvovaginal candidiasis is pursued
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.