***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Summary : A single blind study of 1 % bifonazole cream applied once dalty and 2 % miconazole cream applied twice daily was canied out on 31 patients with tinea pedis proven by microscopy and culture . After three weeks treatment the mycological cure rate in the bifommle group was 73 % against 69 % in the miconazole group . This study indicates that bifonazole 1 % cream used once daily is as effective in treating tinea pedis as twice daily miconazole 2 % cream . Zusammenfassung : Ein einfach blinder klinischer Versuch mit 1-%-Bifonazol-Creme , die einmal taglrch adgelragen wurde , und mit 2-%-Miconazol-Creme , die meimal taglich aufgetragen wurde , wurde an 31 Patienten ansgeluhrt , die an mikroskopisch und kulturell nachgewiesener Fusmykose litten . Nach dreiwochiger Beh and hmg waren 73 Prozent in der Bifonazol-Gruppe gegenuber 69 Prozent in der Miconazol-Gruppe geheilt Dieser klinische Versuch deutet darauf hin , das 1-%-Bifonazol-Creme , einmal taglich aufgetragen , ebenso wirksam in der Beh and lung von Fusmykosen ist wie 2-%-Miconazol-Creme , zweimal taglich aufgetragen BACKGROUND Butenafine hydrochloride , a benzylamine derivative with potent antifungal activity , has been used in Japan to treat superficial fungal diseases . OBJECTIVE We evaluated the safety and efficacy of twice-daily butenafine versus its vehicle in the treatment of interdigital tinea pedis in a multicenter , r and omized , double-blind , parallel-group trial . METHODS A total of 402 patients with interdigital tinea pedis and a positive potassium hydroxide examination were enrolled . Of the 271 patients who had culture-confirmed tinea pedis and were assessed for efficacy , 132 applied butenafine and 139 applied vehicle twice daily for 1 week . Patients were assessed for mycologic cure , effective treatment , overall cure , and mycologic/ clinical cure . RESULTS The rates of all four end points were significantly higher with butenafine than with vehicle 5 weeks after treatment ended . Rates of mycologic cure and effective treatment with butenafine were significantly higher than with vehicle at cessation of treatment . Adverse events to treatment occurred in less than 1 % of patients treated with butenafine and 2 % of patients who applied vehicle . CONCLUSION Butenafine applied twice daily for 1 week is highly effective in treating interdigital tinea pedis Clotrimazole is a new antifungal agent which is effective topically in dermatophytosis , cutaneous c and idiasis , and tinea vesicolor . The authors performed a controlled double-blind clinical trial comparing topical clotrimazole with its vehicle in the treatment of 66 patients with dermatophytic infections of the skin of the feet .  Clotrimazole proved to be effective in the treatment of tinea pedis of both the interdigital and the plantar hyperkeratotic types In a double-blind r and omized comparative study , 75 patients were treated with amorolfine cream  0.125 , 0.25 or 0.5 % . At the end of treatment clinical cure rates of 80 , 76 and 84 % , respectively , and mycological cures of 72 , 64 and 76 % were obtained . At 2 months posttherapy follow-up relapse rates were 0 , 12 and 12 % , respectively . There was no significant difference between the three groups in terms of clinical and mycological response , duration of treatment or tolerance . In a double-blind parallel study , 40 patients were treated topically with either 0.5 % amorolfine cream or 1 % bifonazole cream . The percentages of combined clinical and mycological cures were 83.3 and 78.95 % , respectively . There was no significant difference in terms of tolerance and clinical and mycological cure rates . All treatments were applied once daily . Posttreatment MIC values did not indicate development of resistance to either amorolfine or bifonazole Twenty-three patients were enrolled in a r and omized , double-blind trial of terbinafine 1 % cream compared with placebo vehicle in the treatment of tinea pedis . Of the 20 patients who were evaluated for efficacy , 10 received terbinafine and 10 received placebo . Except for the  terbinafine-treated patients being an average of 11 years older than the patients receiving placebo  and the median duration of disease being 6 weeks longer in the placebo group , the two groups were demographically and clinical ly similar . Results of mycologic tests and clinical findings showed terbinafine to be significantly more effective than placebo in the treatment of tinea pedis . Significantly more terbinafine-treated patients than placebo-treated patients showed conversion to negative culture and microscopy at end of therapy and a significant reduction in scored signs and symptoms . Overall efficacy at follow-up ( combined mycologic and clinical findings ) was also significantly greater in the terbinafine group ( 78 % ) than in the placebo group ( zero ) ( p less than 0.001 ) . Unexplained elevation of liver function test results was noted in three placebo-treated patients and in one terbinafine-treated patient , but these changes were not considered clinical ly relevant or drug related 1 . Steere AC , Malawista SE , Bartcnhagen NR , et al. The clinical spectrum and treatment of Lyme disease . Yale J Bioi Med 1984;57:453 - 61 . 2 . Berger BW . Erythema chronicum migrans of Lyme disease . Arch DermatoI1984;120:1017 - 21 . 3 . Kramer N , Rickert RR , Brodkin RH , et al. Septal panniculitis as a manifestation of Lyme disease . Am J Med 1986 ; 81:149 - 52 . 4 . Eichenfield AR , Goldsmith DP , Benach JL , et al. Childhood Lyme arthritis : experience in endemic area . J Pediatr 1986;109:753 - 8 . 5 . Russell H , Sampson JS , Schmid GP , et al. Enzyme-linked immunosorbent assay and indirect immunofluorescence assay for Lyme disease . ] Infect Dis 1984;149:465 - 70 . 6 . Duffy J , Mertz LE , Wobig GH , et al. Diagnosing Lyme disease : the contribution of serologic testing . Mayo Clin Proc 1988;63 : 1116 - 21 . 7 . Gammon WR . Urticarial vasculitis . Dermatol Clin 1985 ; 3:97 - 105 . 8 . Monroe EW , Schulz CI , Maize JC , et al.  Vasculitis in chronic urticaria : an immunopathologic study . J Invest DcrmatoI1981;76:103 - 7 . 9 . Midgard R , Hofstad R. Unusual manifestations of nervous system Borrelia burgdorferi infection . Arch Neurol J987 ; 44:781 - 3 . 10 . Camponovo F , Meier C. Neuropathy of vasculitic origin in a case of Garin-Boujadoux-Bannwarth syndrome with positive Borrelia antibody response . J Ncurol 1986;233 : 69 - 72 Sixty patients were treated for tinea pedis with 2 % topical ketoconazole cream either once or twice daily . All diagnoses were confirmed mycologically . They were r and omly assigned in a double-blind study into three groups on the basis of their clinical lesions , that is , vesicular pedis , interdigital pedis , and hyperkeratotic " moccasin " pedis . Patients were treated for a period of 1 month and were evaluated weekly . A 4-week posttreatment evaluation permitted an assessment of recurrence or improvement . The follow-up visits showed 93 % of the vesicular patients , 86 % of the interdigital patients , and 83 % of the moccasin patients had responded to topical ketoconazole therapy . The high percent of clinical efficacy seen in the first two groups corroborates treatment experiences held by most practicing dermatologists . Of practical interest , however , was the high number of responders among the moccasin-type of tinea pedis . Dermatologists rarely consider topical treatment useful for this clinical entity Twenty-seven patients with chronic tinea pedis , athlete 's foot type , were enrolled in a r and omized , double-blind trial of topical treatment with terbinafine 1 % cream versus its vehicle ( placebo ) . Patients were examined weekly during 4 weeks of twice-daily treatment and at follow-up 2 weeks after the conclusion of therapy . No adverse events were reported in either treatment group . Drug efficacy was evaluated in 22 patients , of whom nine ( 41 % ) were treated with terbinafine and 13 ( 59 % ) with placebo . Analysis of combined mycologic and clinical results showed that terbinafine was significantly more effective than placebo at the end of therapy ( 78 % vs zero ) and at the 2-week follow-up ( 89 % vs zero ) ( p less than or equal to 0.001 at both intervals Sulconazole nitrate 1 % cream applied twice daily was compared with its vehicle in the treatment of 229 patients with chronic moccasin-type tinea pedis confirmed by positive results of a potassium hydroxide preparation . At admission in this r and omized , double-blind , parallel multicenter trial , 131 patients had positive dermatophyte cultures ; Trichophyton rubrum was identified in 121 ( 92 % ) . After 4 weeks of treatment , patients were examined and , if necessary , were treated for an additional 2 weeks . Sulconazole cream was significantly more effective than the vehicle in the treatment of chronic T. rubrum tinea pedis ; 57 % of patients were cured by sulconazole , compared with 13 % cured with the vehicle .  Relapse rates , assessed 2 weeks after the end of treatment , were significantly lower in patients treated with sulconazole than in those receiving vehicle ( 27 % vs 71 % ) . The 103 patients with moccasin-type tinea pedis whose cultures were not positive for T. rubrum achieved similar results BACKGROUND Patients with tinea pedis often discontinue treatment before eradication of the fungus when their symptoms improve . The result is an incomplete cure/recurrence . OBJECTIVE Terbinafine , a topical fungicidal agent , was evaluated in double-blind , placebo-controlled trials ( 159 patients ) for its ability to achieve cure and relief of symptoms in the same time frame , that is , before compliance wanes . METHODS Mycologic characteristics ( with potassium hydroxide examination and culture ) and clinical signs and symptoms were assessed at baseline , at the end of a 1-week , twice-daily treatment and at 1 , 3 , and 5 weeks after the completion of therapy . RESULTS Both terbinafine and vehicle provided early relief of symptoms . However , only terbinafine gave progressive mycologic improvement such that at 5 weeks after treatment , 88 % of the patients receiving terbinafine had converted from positive to negative mycology compared with 23 % of the patients treated with vehicle . CONCLUSION The rapid and potent fungicidal action of terbinafine results in a high cure rate in interdigital tinea pedis with 1 week of treatment and may avoid failures caused by non-compliance chenoid infiltrate of lymphocytes . Immunofluorescence examination of a perivesicular papule was characterized by numerous ovoid bodies scattered in the papillary dermis . These stained for IgM , IgG , and fibrinogen . IgG , C3 , and fibrinogen were also deposited linearly along the dermoepidermal junction . Immunofluorescence studies on normal-appearing skin showed a strong linear b and of IgG and C3 at the dermoepidermal junction without staining of colloid bodies . Serum and blister fluid were positive at a titer of 1:80 for basement membrane zone ( BMZ ) antibodies . A diagnosis ofLPP was made . She was initially treated with prednisone , 40 mg daily ( 1.5 mg/kg/day ) , with a good response , no new vesicles appeared and the papular lesions cleared . After 2 weeks circulating BMZ antibodies decreased to a titer of 1:20 . The dosage of prednisone was reduced to 20 mg daily for 14 days and then discontinued . Topical fluorinated corticoids were administered for an additional month . At that time she had resolution of all lesions . Two months later , she had a relapse of LP , without blistering , on both ankles . At the time of relapse circulating BMZ antibodies were absent I. Dicken CH , Carrington SG , Winkelmann RK . Generalized granulomaannulare . Arch DermatolI969;99:556 - 63 . 2 . Mobacken H , Gisslen H , Johannisson G. Granuloma annulare : cortisone-glucose tolerancetest in a non-diabetic group . Acta Derm Venereal ( Stockh ) 1970;50:440 - 4 . 3 . Williamson DM , Dykes JRW . Carbohydrate metabolism in gran 
    Output:
    
The two trials of nail infections did not provide any evidence of benefit for topical treatments compared with placebo .
REVIEW ER 'S CONCLUSIONS CONCLUSIONS In placebo-controlled trials allylamines , azoles and undecenoic acid were efficacious .
There are sufficient comparative trials to judge relative efficacy only between allylamines and azoles .
Allylamines cure slightly more infections than azoles but are much more expensive .