|Year : 1991 | Volume
| Issue : 3 | Page : 157-158
Oral ketoconazole in tinea versicolor
Inderjeet Kaur, Bhushan Kumar, VK Sharma
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kaur I, Kumar B, Sharma V K. Oral ketoconazole in tinea versicolor. Indian J Dermatol Venereol Leprol 1991;57:157-8
Tinea versicolor is a chronic superficial fungal infection caused by Malassezia furfur which is a component of normal skin flora in 90-100% of adults living in tropical areas. The filamentous form is thought to change to pathogenic mycelial form under the influence of several factors viz.; hyperhidrosis, genetic factors, systemic corticosteroids, malnutrition and immunosuppressive therapy. It presents as hyper or hypopigmented scaly patches predominantly affecting the trunk and upper limbs.
Although it is usually asymptomatic, the desquamation and discoloration of the skin are troublesome. Most patients require treatment as spontaneous remission is uncommon. However patients can experience considerable difficulty in regularly applying the available creams 'or lotions which may be odorous and messy. Oral ketoconazole, an imidazole with broad-spectrum antifungal activity has offered an effective, easily administered and rapid treatment alternative.
The study was carried out to determine the efficacy and, safety of oral ketoconazole in wide spread tinea versicolor.
| Materials and Methods|| |
Thirty two patients (22 men and 10 women) with extensive tinea versicolor of long duration showing typical hyphae and spores on microscopy in KOH preparation were included in the study. Patients on any interfering drugs or-disease were excluded from the study.
Previous topical antifungal therapies were unsatisfactory and majority of patients have had frequent recurrences. Routine laboratory investigations including liver function tests were done prior to and after the cessation of treatment. Patients ranged in age from 16 to 38 years. Duration of the disease was from 1 to 14 years.
Ketoconazole was given in a daily oral dose of 200 mg for 10 days. No concomitant therapy (topical or systemic) was permitted. Patients were seen after 10 days and then every month for upto 10 months for clinical and mycological evaluation. Adverse reactions if any were recorded.
| Results|| |
Of the 32 patients, 2 were lost to follow up and 7 came for follow up only once. Twenty three patients were followed up for periods ranging from 4-40 weeks. Except one patient who complained of mild headache, all others tolerated the drug very well.
Of 11 patients complaining of pruritus, it disappeared after 7, 11 and 14 days in 4,2 and 5 patients respectively.
Hypopigmentation started fading after 2-4 weeks of therapy. In one patient each, hypopigmented lesions vanished completely at 1, 2, 3 and 5 months of follow up. In another patient, normal color came back to face and neck in 2 months but minimal hypopigmentation persisted on the trunk.
Mycological cure occurred in 29(96.6%) patients, within 4 days after completion of therapy while in one patient it came 7 days later.
In 7 (30.0%) patients out of 23 available for long follow up, mycological relapse associated with itching and scaling occurred after variable periods of 12,20,24,30 and 40 weeks. Sixteen patients were still in clinical and mycological cure at 12 weeks.
| Comments|| |
Ketoconazole was first used successfully in the treatment of pityriasis versicolor in 1980 The duration of treatment in different studies varied from 5 days to about 4 weeks., The usually recommended dose of ketoconazole is 200 mg once daily but in immunodeficient patients the requirement is higher.
Response to systemic ketoconazole therapy in our patients was good as previously reported, The most serious side effect is hepatotoxicity and effect on androgen metabolism. No serious side effects occurred in any of our patients.
The relapses after, discontinuation of treatment are not uncommon and occur in increasing frequency as time elapses, being 13%, 20%, 43% and 60% at 3, 6, 12 and 24 months respectively.
Through, ketoconazole appeared to be effective, safe and produced rapid mycological cure for at least 3 months, it should be preferably reserved for frequently relapsing, extensive and resistant cases.
| References|| |
|1.||Roberts SOB . Pityosporum Orbiculare, incidence and distribution on clinically normal skin, Brit J Dermatol, 1969; 81 : 264-269 |
|2.||Van Custem J ,: The antifungal activity of ketoconazole, Amer J Med 1983; 74(18) : 9-15. |
|3.||Borelli D : Treatment of pityriasis versicolor with ketoconazole, Rev Infect Dis, 1980; 2 : 592-595. |
|4.||Hay RJ and Midgeley G : Short Course ketoconazole therapy in pityriasis versicolor, Clin Exp DErmatol, 1984; 9 : 571-573. |
|5.||Janseen PA and Symoens JE : Hepatic reactions during ketoconazole treatment, Amer J Med, 1983; 74 : 80-85 |
|6.||Alteras I, Sandbank M and Segal R : Two years of follow up of oral ketoconzole therapy in 60 cases of Pityriasis versicolor, Dermatologica, 1987; 175 142-144. |
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