Efficacy of three short-term regimens of itraconazole in the treatment of pityriasis versicolor

Efficacy of Azole Antifungal in Treatment of Pityriasis Versicolor

AIM:

Compare itraconazole alone, fluconazole combined with ketoconazole and ketoconazole in the treatment of patients with pityriasis versicolor.

MATERIAL AND METHODS:

A group of 240 pityriasis versicolor patients (confirmed with KOH and culture) were classified into 3 groups: Fluconazole 300 mg a week and 2% ketoconazole foam twice a week for 2 weeks (Category I), Itraconazole 200 mg daily for one week (category II); Ketoconazole 2% foam daily for 2 weeks (Category 3). Clinical (colour of macule, scale, pruritus) and mycological assessment were done after 4 weeks of therapy.

RESULTS:

After 4 weeks of treatment, clinical cure was observed in 62.4% (Category I), 36.3% (Category II) and 37.5% (Category III).

CONCLUSION:

It was reported in our study that the most effective regimen for PV patients is fluconazole 300 mg per week combined with ketoconazole 2% twice a week for 2 weeks.

Antifungal Treatment for Pityriasis Versicolor

BACKGROUND

Pityriasis versicolor (PV), also known as tinea versicolor, is caused by Malassezia species. This condition is one of the most common superficial fungal infections worldwide, particularly in tropical climates. PV is difficult to cure and the chances for relapse or recurrent infections are high due to the presence of Malassezia in the normal skin flora. This review focuses on the clinical evidence supporting the efficacy of antifungal treatment for PV.

METHOD

A systematic review of literature from the PubMed database was conducted up to 30 September 2014. The search criteria were "(pityriasis versicolor OR tinea versicolor) AND treatment", with full text available and English language required.

CONCLUSIONS

Topical antifungal medications are the first-line treatment for PV, including zinc pyrithione, ketoconazole, and terbinafine. In cases of severe or recalcitrant PV, the oral antifungal medications itraconazole and fluconazole may be more appropriate, with pramiconazole a possible future option. Oral terbinafine is not effective in treating PV and oral ketoconazole should no longer be prescribed. Maintenance, or prophylactic, therapy may be useful in preventing recurrent infection; however, at this time, there is limited research evaluating the efficacy of prophylactic antifungal treatment.

Systematic Review of Systemic Treatments for Tinea Versicolor and Evidence-Based Dosing Regimen Recommendations

Background:

Extensive or recurrent tinea versicolor (TV) can be treated with systemic antifungal therapies, but no dosing regimens have been approved for this indication.

Objective:

To provide evidence-based recommendations for dosing regimens.

Methods:

A systematic literature search was performed to identify trials reporting mycologic cure. All trials were included and assessed for quality. Correlation and statistical analyses were used to evaluate the effects of different dosing regimen parameters on efficacy.

Results:

Fifty-seven trials investigating itraconazole, ketoconazole, fluconazole, and pramiconazole were included. Cumulative dose, treatment duration, and daily/weekly concentrations were shown to significantly influence mycologic cure rates for ketoconazole and pramiconazole but not for itraconazole and fluconazole.

Conclusion:

Based on the efficacy evidence and potential safety concerns, this review supports the following dosing regimens: 200 mg/d for 5 or 7 days of itraconazole, 300 mg/wk for 2 weeks of fluconazole, and 200 mg/d for 2 days of pramiconazole.

Minimum effective dosage in the treatment of chronic atopic dermatitis with itraconazole

Fungi including Malassezia furfur and Candida albicans are involved in the development of atopic dermatitis (AD), due to increased sensitivity to these allergens or increased serum immunoglobulin E levels in AD patients. Previously, I reported successful treatment of AD with oral administration of the anti-mycotic agent, itraconazole. Recently, I developed protocols for AD treatment, based on the determined minimum effective dose. Three oral administration regimens with itraconazole were studied: single-phase treatment (regimen 1), 100 mg/day for 1 week with a 3-week rest, repeating; regimen 2, 200 mg/week for 4 weeks, repeating; and dual-phase treatment (regimen 3), 100 mg/day for 1 week (introduction phase) then 200 mg/week (maintenance phase) for 11 weeks. For regimens 1 and 2, each treatment cycle was 4 weeks, and three cycles were undertaken. Each regimen was completed in 12 weeks. All three regimens reduced AD symptoms, regimen 3 being the most effective and efficient therapy as evaluated by overall efficacy and low drop-out rate.