Journal Information
Vol. 108. Issue 6.
Pages 583-584 (July - August 2017)
Vol. 108. Issue 6.
Pages 583-584 (July - August 2017)
Resident's Forum
DOI: 10.1016/j.adengl.2017.01.002
Full text access
RF-Itraconazole Pulse Therapy for Seborrheic Dermatitis: A Treatment Approach to Consider
FR-Pulsos de itraconazol en dermatitis seborreica. Una opción terapéutica a tener en cuenta
Visits
...
V. Fatsini-Blanch
Corresponding author
vanesafatsini@gmail.com

Corresponding author.
, M.I. Martínez-González, S. Heras-González, A. de Quintana-Sancho
Servicio de Dermatología, Hospital Universitario Araba, Vitoria-Gasteiz, Araba, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text

In our routine clinical practice, seborrheic dermatitis (SD) is a common reason for seeking care. The prevalence of this condition is as high as 5% of the adult population. SD is a chronic and recurrent disease. It is common to see patients who have SD outbreaks with a certain degree of regularity, despite the availability of suitable topical treatment. As a general rule, oral treatment is reserved for more severe or resistant cases.

Gupta et al.1 conducted a systematic review of the oral treatments described for SD. The study included 21 publications that encompassed a diverse range of treatments, including 8 different oral medications. Most of the studies described the use of antifungal agents. Itraconazole was the most frequently used drug, because of the role of colonization by Malassezia species in the pathogenesis of SD.

Notable studies include those by Kose et al.2 and Baysal et al.,3 who initially administered itraconazole at a dose of 200mg/d for 7 days followed by pulses of itraconazole at a dose of 200mg on the first 2 days of each month, with follow-up at 3 and 12 months, respectively. In both studies, statistically significant clinical improvement was obtained. However, in a study by Shemer et al.4 the maintenance therapy was a single dose of 200mg itraconazole every 2 weeks, and significant improvement in the parameters of erythema, scaling, and pruritus was achieved. However, the quality of the scientific methodology of these studies is generally low and they do not include control groups or double-blind protocols.

It was not until the year 2015 that a randomized, double-blind clinical trial was carried out in 68 patients with moderate to severe SD. All patients in the study applied 1% hydrocortisone cream and 2% ketoconazole and were subsequently randomly assigned to a placebo group or a group that received oral itraconazole at a dose of 200mg/d for 7 days in the first phase, followed by pulse therapy at a dose of 200mg/d on the first 2 days of each month (400mg/mo) for the following 3 months in the second phase. A statistically significant decrease in the Seborrheic Dermatitis Area and Severity Index (SDASI) was found in the itraconazole group, as well as a lower recurrence rate. Clinical improvement was observed in 93.8%, 87.5%, and 93.1% of the patients treated with itraconazole at 2, 4, and 16 weeks, respectively, versus 82.1%, 64.3%, and 53.6% of patients in the placebo group. The treatment was well tolerated in all cases and no blood test anomalies were observed in any patients.5

In conclusion, the chronic and recurrent nature of SD can lead to the therapeutic failure of the topical treatments used to date and/or a low rate of adherence to treatment. A treatment that allows better long-term management of SD in these patients is therefore needed. Recent studies support the use of pulses of systemic itraconazole as a safe and effective treatment for controlling SD during outbreaks and also as maintenance therapy, with the aim of avoiding recurrences. Treatment with pulses of oral itraconazole could therefore be considered an interesting therapeutic tool, especially in patients who show poor adherence to topical treatment or have multiple recurrences despite following an appropriate topical treatment regimen.

References
[1]
A.K. Gupta, M. Richardson, M. Paquet.
Systematic review of oral treatments for seborrheic dermatitis.
J Eur Acad Dermatol Venereol, 28 (2014), pp. 16-26
[2]
O. Kose, H. Erbil, A.R. Gur.
Oral itraconazole for the treatment of seborrheic dermatitis: An open, noncomparative trial.
J Eur Acad Dermatol Venereol, 19 (2005), pp. 172-175
[3]
V. Baysal, M. Yildirim, C. Ozcanli, A.M. Ceyhan.
Itraconazole in the treatment of seborrheic dermatitis: A new treatment modality.
Int J Dermatol, 43 (2004), pp. 63-66
[4]
A. Shemer, B. Kaplan, N. Nathansohn, M.H. Grunwald, B. Amichai, H. Trau.
Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: An open non-comparative study.
Isr Med Assoc J, 10 (2008), pp. 417-418
[5]
S.Z. Ghodsi, Z. Abbas, R. Abedeni.
Efficacy of oral itraconazole in the treatment and relapse prevention of moderate to severe seborrheic dermatitis: A randomized, placebo-controlled trial.
Am J Clin Dermatol, 16 (2015), pp. 431-437

Please cite this article as: Fatsini-Blanch V, Martínez-González MI, Heras-González S, de Quintana-Sancho A. FR-Pulsos de itraconazol en dermatitis seborreica. Una opción terapéutica a tener en cuenta. Actas Dermosifiliogr. 2017;108:583–584.

Copyright © 2017. Elsevier España, S.L.U. and AEDV
Idiomas
Actas Dermo-Sifiliográficas (English Edition)

Subscribe to our newsletter

Article options
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
    NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
  • Additional material
Tools
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
NOTICE Undefined index: tipo (includes_ws_v2/librerias/html/item.php[1273])
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.