Background: Tinea infections are among the most prevalent superficial fungal infections affecting the skin, particularly in tropical and subtropical regions. Topical antifungals such as terbinafine and sertaconazole are widely used; however, comparative evidence on their clinical effectiveness in monotherapy, without systemic antifungals, remains limited.

Material and Methods: This prospective, randomized, open-label comparative study was conducted on 156 clinically diagnosed patients with tinea corporis or tinea cruris. Participants were randomly divided into two groups: Group A received topical terbinafine 1% cream, and Group B received topical sertaconazole 2% cream. Both medications were applied twice daily for four weeks. The primary outcome was clinical improvement assessed via the Total Symptom Score (TSS), which included pruritus, erythema, and scaling. Secondary outcomes included patient satisfaction on a Visual Analogue Scale (VAS) and any reported adverse events.

Results: At baseline, both groups were comparable in terms of demographic and clinical characteristics (p > 0.05). By week 4, Group B (sertaconazole) showed significantly greater reduction in TSS compared to Group A (terbinafine) (mean ± SD: 2.10 ± 0.71 vs. 2.76 ± 0.86; p < 0.001). Patient-reported symptom relief on VAS also favored sertaconazole, with 69.2% of patients reporting good relief versus 53.8% in the terbinafine group (p = 0.037). Adverse events were minimal and comparable between both groups, with no serious reactions reported.

Conclusion: Topical sertaconazole demonstrated superior efficacy in symptom reduction and patient satisfaction compared to topical terbinafine in the treatment of tinea infections, without systemic antifungals. Both agents were well-tolerated. Sertaconazole may be considered a more effective topical monotherapy option for dermatophytosis in outpatient settings.