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Mochizuki T, Tsuboi R, Iozumi K, Ishizaki S, Ushigami T, Ogawa Y, Kaneko T, Kawai M, Kitami Y, Kusuhara M, Kono T, Sato T, Sato T, Shimoyama H, Takenaka M, Tanabe H, Tsuji G, Tsunemi Y, Hata Y, Harada K, Fukuda T, Matsuda T, Maruyama R. Guidelines for the management of dermatomycosis (2019). J Dermatol 2020; 47:1343-1373. [DOI: 10.1111/1346-8138.15618] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 01/19/2023]
Affiliation(s)
| | - Ryoji Tsuboi
- Department of Dermatology Tokyo Medical University TokyoJapan
| | - Ken Iozumi
- Department of Dermatology Tokyo Metropolitan Police Hospital TokyoJapan
| | - Sumiko Ishizaki
- Department of Dermatology Tokyo Women’s Medical University Medical Center East TokyoJapan
| | | | - Yumi Ogawa
- Department of Dermatology Juntendo University TokyoJapan
| | - Takehiko Kaneko
- Graduate School of Human Ecology Wayo Women’s University IchikawaJapan
| | - Masaaki Kawai
- Department of Dermatology Juntendo University Koshigaya Hospital KoshigayaJapan
| | - Yuki Kitami
- Department of Dermatology Showa University TokyoJapan
| | | | - Takeshi Kono
- Department of Dermatology Nippon Medical School Chibahokusoh Hospital InzaiJapan
| | | | - Tomotaka Sato
- Department of Dermatology Teikyo University Medical Center IchiharaJapan
| | - Harunari Shimoyama
- Department of Dermatology Teikyo University Mizonokuchi Hospital KawasakiJapan
| | - Motoi Takenaka
- Department of Dermatology Nagasaki University NagasakiJapan
| | | | - Gaku Tsuji
- Department of Dermatology Kyushu UniversityGraduate School of Medical Sciences FukuokaJapan
| | - Yuichiro Tsunemi
- Department of Dermatology Saitama Medical University MoroyamaJapan
| | - Yasuki Hata
- Kanagawa Hata Dermatology Clinic YokohamaJapan
| | | | - Tomoo Fukuda
- Department of Dermatology Saitama Medical Center KawagoeJapan
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Gupta AK, Lane D, Paquet M. Systematic Review of Systemic Treatments for Tinea Versicolor and Evidence-Based Dosing Regimen Recommendations. J Cutan Med Surg 2014; 18:79-90. [DOI: 10.2310/7750.2013.13062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Aditya K. Gupta
- From the Department of Medicine, University of Toronto, Toronto, ON, and Mediprobe Research Inc., London, ON
| | - Danielle Lane
- From the Department of Medicine, University of Toronto, Toronto, ON, and Mediprobe Research Inc., London, ON
| | - Maryse Paquet
- From the Department of Medicine, University of Toronto, Toronto, ON, and Mediprobe Research Inc., London, ON
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Abstract
OBJECTIVE To evaluate the quality of the published literature on the treatment of pityriasis versicolor and to compare this evaluation with the number of times the work has been cited. METHODS A search was performed using MEDLINE (1966-2002) to find publications evaluating the treatment of pityriasis versicolor. Two reviewers evaluated each clinical trial according to a list of pre-determined criteria including randomization and blinding, prior sample size calculation, treatment regimen clearly explained, and well-defined efficacy parameters. A maximum score of 20 could be attained by each publication. A citation count was performed using the ISI Web of Science Database (http://www.isinet.com/isi/products/citation/wos/). RESULTS A total of 94 studies were included in this analysis of quality. Studies with a score of 8 or more were considered to be high quality, and 61 studies were rated as high-quality studies (65%). There was no significant correlation between paper quality and citation count. CONCLUSION It is important for investigators and clinicians to be aware of the design of a high-quality protocol, since such high-quality studies are more likely to reflect accurate efficacy rates. Also, it is important for the information on the design and conduct of the trial to be conveyed to the reader so that a meaningful comparison between the studies can be made.
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Affiliation(s)
- A K Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center, University of Toronto, Ontario, Canada.
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HAVU V, BRANDT H, HEIKKILÄ H, HOLLMEN A, OKSMAN R, RANTANEN T, SAARI S, STUBB S, TURJANMAA K, PIEPPONEN T. A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe-nail onychomycosis. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.d01-1175.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chang CH, Young-Xu Y, Kurth T, Orav JE, Chan AK. The safety of oral antifungal treatments for superficial dermatophytosis and onychomycosis: a meta-analysis. Am J Med 2007; 120:791-8. [PMID: 17765049 DOI: 10.1016/j.amjmed.2007.03.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 03/10/2007] [Accepted: 03/13/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE We estimated the absolute risks of treatment termination and incidence of adverse liver outcomes among all commonly used oral antifungal treatments for superficial dermatophytosis and onychomycosis. METHODS MEDLINE, EMBASE, and Cochrane Library were searched to identify randomized and nonrandomized controlled trials, case series, and cohort studies published before December 31, 2005. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Treatment arms with the same regimen in terms of drug, type (continuous or intermittent), and dosage were combined to estimate the risk of an outcome of interest. RESULTS We identified 122 studies with approximately 20,000 enrolled patients for planned comparison. The pooled risks (95% confidence intervals) of treatment discontinuation resulting from adverse reactions for continuous therapy were 3.44% (95% confidence interval [CI], 2.28%-4.61%) for terbinafine 250 mg/day; 1.96% (95% CI, 0.35%-3.57%) for itraconazole 100 mg/day; 4.21% (95% CI, 2.33%-6.09%) for itraconazole 200 mg/day; and 1.51% (95% CI, 0%-4.01%) for fluconazole 50 mg/day. For intermittent therapy, the pooled risks were as follows: pulse terbinafine: 2.09% (95% CI, 0%-4.42%); pulse itraconazole: 2.58% (95% CI, 1.15%-4.01%); intermittent fluconazole 150 mg/week: 1.98% (95% CI, 0.05%-3.92%); and intermittent fluconazole 300 to 450 mg/week: 5.76% (95% CI, 2.42%-9.10%). The risk of liver injury requiring termination of treatment ranged from 0.11% (continuous itraconazole 100 mg/day) to 1.22% (continuous fluconazole 50 mg/day). The risk of having asymptomatic elevation of serum transaminase but not requiring treatment discontinuation was less than 2.0% for all treatment regimens evaluated. CONCLUSION Oral antifungal therapy against superficial dermatophytosis and onychomycosis, including intermittent and continuous terbinafine, itraconazole, and fluconazole, was associated with a low incidence of adverse events in an immunocompetent population.
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Affiliation(s)
- Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Gupta AK, Kogan N, Batra R. Pityriasis versicolor: a review of pharmacological treatment options. Expert Opin Pharmacother 2006; 6:165-78. [PMID: 15757415 DOI: 10.1517/14656566.6.2.165] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pityriasis versicolor is a common disorder of the skin, which is characterised by scaly hypo- or hyperpigmented lesions on the body. The lipophilic yeast, Malassezia, is considered to be the aetiological agent of this disease. A number of treatment options, both topical and systemic, have been shown to be effective. A critical evaluation of treatment options is presented.
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Affiliation(s)
- Aditya K Gupta
- University of Toronto, and the Sunnybrook and Womens' College Health Sciences Center (Sunnybrook site), Toronto, Ontario, Canada.
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Del Rosso JQ, Gupta AK. The use of intermittent itraconazole therapy for superficial mycotic infections: a review and update on the 'one week' approach. Int J Dermatol 1999; 38 Suppl 2:28-39. [PMID: 10515527 DOI: 10.1046/j.1365-4362.1999.00011.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Q Del Rosso
- Department of Dermatology, University of Nevada School of Medicine, Las Vegas, USA
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Doncker PD, Gupta AK, Marynissen G, Stoffels P, Heremans A. Itraconazole pulse therapy for onychomycosis and dermatomycoses: an overview. J Am Acad Dermatol 1997; 37:969-74. [PMID: 9418766 DOI: 10.1016/s0190-9622(97)70074-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Itraconazole is a broad-spectrum antifungal agent that has been used to treat dermatomycosis and onychomycosis using continuous therapy. More recently the drug has been used as pulse dosing. OBJECTIVE Our purpose was to review the studies in which itraconazole pulse therapy (PT) has been administered in the management of dermatomycoses. RESULTS For tinea pedis and manuum, the recommended dosage is itraconazole 200 mg twice daily for 1 week (n = 220). A clinical response and mycologic cure rate of 90% +/- 4% and 76% +/- 6%, respectively, has been obtained. For tinea corporis/cruris, itraconazole 200 mg/day for 1 week (n = 354) resulted in a clinical response and mycologic cure rate of 90% +/- 4% and 77% +/- 6%, respectively. When three pulses of itraconazole are used to treat toenail onychomycosis (n = 1389), the clinical cure rate, clinical response, and mycologic cure rate at follow-up 12 months after the start of therapy were 58% +/- 10%, 82% +/- 3%, and 77% +/- 5%, respectively. With two pulses for onychomycosis of the fingernails, the clinical cure rate, clinical response, and mycologic cure rate at follow-up, 9 months after the start of therapy, were 78% +/- 10%, 89% +/- 6%, and 87% +/- 8%, respectively. CONCLUSION Itraconazole PT is effective and safe in the treatment of tinea pedis/manuum, tinea corporis/cruris, and onychomycosis.
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Affiliation(s)
- P D Doncker
- Janssen Research Foundation, Beerse, Belgium
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Georgiou S, Monastirli A, Pasmatzi E, Zografakis C, Tsambaos D. Oral itraconazole therapy for pityriasis versicolor. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1111/j.1468-3083.1997.tb00479.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gupta AK, Doncker PD, Heremans A, Stoffels P, Piérard GE, Decroix J, Heenen M, Degreef H. Itraconazole for the treatment of tinea pedis: a dosage of 400 mg/day given for 1 week is similar in efficacy to 100 or 200 mg/day given for 2 to 4 weeks. J Am Acad Dermatol 1997; 36:789-92. [PMID: 9146548 DOI: 10.1016/s0190-9622(97)80351-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A K Gupta
- Department of Dermatology, University of Toronto, Canada
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HAVU V, BRANDT H, HEIKKILÄ H, HOLLMEN A, OKSMAN R, RANTANEN T, SAARI S, STUBB S, TURJANMAA K, PIEPPONEN T. A double-blind, randomized study comparing itraconazole pulse therapy with continuous dosing for the treatment of toe–nail onychomycosis. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb14902.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- E Silva-Lizama
- Departments of Dermatology, Guatemalan Social Security Institute and Military Medical Center, Guatemala City, Guatemala, Central America
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Affiliation(s)
- O Köse
- Corlu Military Hospital, Tekirdağ, Turkey
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Abstract
The recent introduction of a new generation of antifungal drugs promises to alter significantly therapy for both systemic and superficial mycoses, in particular, onychomycosis. This article presents an in-depth review of the azoles (the triazoles itraconazole and fluconazole), the allylamines (naftifine and terbinafine), and the morpholine derivative amorolfine.
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Affiliation(s)
- A K Gupta
- Department of Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
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Zuckerman JM, Tunkel AR. Itraconazole: A New Triazole Antifungal Agent. Infect Control Hosp Epidemiol 1994. [DOI: 10.2307/30145593] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Suchil P, Gei FM, Robles M, Perera-Ramírez A, Welsh O, Male O. Once-weekly oral doses of fluconazole 150 mg in the treatment of tinea corporis/cruris and cutaneous candidiasis. Clin Exp Dermatol 1992; 17:397-401. [PMID: 1486705 DOI: 10.1111/j.1365-2230.1992.tb00246.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ninety-five adult out-patients with tinea corporis and/or tinea cruris participated in a multicentre open non-comparative study investigating the safety and efficacy of 1-4 once-weekly doses of oral fluconazole 150 mg. Trichophyton rubrum was isolated most frequently (67 of 86 mycologically evaluable patients). A mean of 2.6 doses of fluconazole was administered; patients infected with Candida albicans or Epidermophyton floccosum required an average of 2 doses compared to 3-4 doses in patients infected with other organisms. Clinical cure was obtained in 85 of 92 (92%) patients at the last post-treatment evaluation, with the remaining seven patients being substantially improved. At long-term follow-up, 28-30 days after the last dose, 80 of 91 (88%) patients were assessed as clinically cured, three (3%) patients were improved and eight (9%) patients failed. Among the long-term clinical failures, there was one diagnosis of tinea corporis (3% failure rate) and seven diagnoses of tinea cruris (12% failure rate). Mycological evidence of infection occurred in only 1 of 86 patients assessed at the last post-treatment follow-up. Mycological relapse occurred in nine (11%) patients at long-term follow-up; one patient was infected with Trichophyton mentagrophytes and eight patients were infected with T. rubrum. Relapse occurred in 2 of 29 (7%) patients with tinea corporis and eight of 57 (14%) patients with tinea cruris (one patient who relapsed had both tinea corporis and cruris). There was no correlation between the number of doses received and the mycological response or relapse rates at long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Suchil
- Centro Dermatológico Pascua, Mexico City, Mexico
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Willemsen M, De Doncker P, Willems J, Woestenborghs R, Van de Velde V, Heykants J, Van Cutsem J, Cauwenbergh G, Roseeuw D. Posttreatment itraconazole levels in the nail. New implications for treatment in onychomycosis. J Am Acad Dermatol 1992; 26:731-5. [PMID: 1316389 DOI: 10.1016/0190-9622(92)70102-l] [Citation(s) in RCA: 122] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND A problem in the treatment of onychomycosis is the lengthy duration of therapy. The pharmacokinetics of itraconazole suggest a potential for briefer treatment. OBJECTIVE This study was designed to investigate itraconazole nail kinetics in 39 patients with onychomycosis in relation to their therapeutic outcome. METHODS All patients received itraconazole for 3 months at a dose of 100 or 200 mg daily. Itraconazole levels of distal nail clippings were determined during a 6-month posttherapy period. RESULTS Therapeutic itraconazole concentrations were found in the nail plates of fingernails and toenails for up to 6 months after treatment. Cure of the toenails was observed in 79% of the patients treated with the 200 mg dosage and in 26% of those treated with 100 mg at 6 months after therapy. CONCLUSION The data suggest that the drug reaches the nail via incorporation into the matrix and by diffusion from the nail bed and is eliminated with regrowth of the nail after discontinuation of treatment.
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Affiliation(s)
- M Willemsen
- Department of Dermatology, Free University of Brussels, Jette, Belgium
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Coskey RJ. Dermatologic therapy: 1990. J Am Acad Dermatol 1991; 25:271-80. [PMID: 1918466 DOI: 10.1016/0190-9622(91)70195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This article reviews significant therapeutic advances that have been reported in the English-language literature during 1990. Readers should review the original article in full before attempting any new experimental or controversial therapy.
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Affiliation(s)
- R J Coskey
- Dermatology Department, Wayne State University School of Medicine, Detroit, Michigan
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Abstract
Itraconazole, a new orally active triazole antifungal, has been tested in patients with pityriasis versicolor. A number of studies have shown that itraconazole is effective for this mild fungal skin disease. The total dose required for effective treatment is 1000 mg, and it has been given as 200 mg for 5 days or 7 days. The organisms disappear slowly from the skin, even when dead, and the results should be assessed clinically and mycologically at around 3 to 4 weeks after treatment. Numerous studies have shown that itraconazole is superior to placebo and as effective as selenium sulfide, clotrimazole, and ciclopirox olamine. It is also better tolerated by patients than selenium sulfide.
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Affiliation(s)
- J Delescluse
- Department of Dermatology, Clinic Cesar De Paepe, Brussels, Belgium
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