Ketoconazole vs Hypochlorous Acid in Dermatophytosis: Comparative Efficacy in Companion Animals Original paper
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Karen Pendergrass
What was studied?
This original research study investigated and compared the therapeutic efficacy of ketoconazole (KT), a well-established antifungal, and hypochlorous acid (HOCl), a novel antimicrobial, for treating dermatophytosis caused by
M. canis,Trichophyton and Epidermophyton spp. in cats and dogs. The primary aim was to determine whether HOCl, a relatively new candidate in veterinary antifungal therapy, could match or approach the efficacy of ketoconazole when applied topically over 14 days. The study employed clinical inspection, Wood’s lamp examination, and microscopic assessment of skin scrapings to monitor therapeutic outcomes. Statistical analyses, including Chi-square, Friedman tests, principal component (PC) analysis, and CART decision tree models, were used to evaluate group-wise and time-dependent differences in treatment response.
Who was studied?
The study included 76 animals diagnosed with dermatophytosis—26 cats (15 males, 11 females) and 50 dogs (14 males, 36 females)—that were otherwise healthy, confirmed via clinical, hematological, and biochemical evaluations. Animals were randomly allocated into two treatment groups within species: HOCl (HP group) or ketoconazole (KT group). Topical applications were administered twice daily for 14 days. Microscopic confirmation of dermatophytosis was achieved via skin scrapings processed with 10% KOH, and fluorescent patterns under Wood’s lamp examination were used to further verify infection sites.
Most important findings
Both treatment groups showed significant clinical improvement by the 15th day under visual inspection (P<0.001). However, disparities emerged when comparing inspection data to more objective measures. While the KT group achieved 100% visible recovery in both cats and dogs, the HP group achieved 84.62% in cats and 92% in dogs. Microscopic confirmation revealed significantly higher cure rates in the KT group (77.78%) compared to the HOCl group (40.11%) (P=0.005). Wood’s lamp data showed moderate recovery (KT: 60.53%, HP: 47.37%) with no statistical difference between treatments. These results highlight that visible improvement may overestimate true recovery and underscore the importance of microscopic confirmation.
Recovery rates by method and treatment (Total n=76):
| Examination Method | KT Group Recovery | HP Group Recovery |
|---|---|---|
| Visual Inspection | 100% (38/38) | 89.47% (34/38) |
| Wood’s Lamp | 60.53% (23/38) | 47.37% (18/38) |
| Microscopic Examination | 77.78% (28/36) | 40.11% (16/36) |
Key implications
This study reinforces ketoconazole’s superior mycological efficacy in treating dermatophytosis in companion animals, while suggesting HOCl as a potential adjunct or alternative, particularly where conventional antifungals may be contraindicated. Although HOCl showed a promising clinical response, its lower microscopic cure rates suggest that it may be insufficient as monotherapy under the tested regimen and duration. The findings advocate for incorporating objective diagnostic tools such as Wood’s lamp and microscopy into treatment monitoring, as visual inspection alone may misrepresent actual fungal clearance. Moreover, the study lays the groundwork for future research on dose optimization and prolonged treatment duration for HOCl to improve its therapeutic outcomes.