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ORIGINAL ARTICLE
  
Year : 2001  |  Volume : 67  |  Issue : 5  |  Page : 240-241

Efficacy of itraconazole in the treatment of tinea versicolor

Juthika Mohanty, J Sethi, MK Sharma 
 Department of Skin, STD & Leprosy S.C.B. Medical College, Cuttack, Orissa, India

Correspondence Address:
Juthika Mohanty
Qtr. No. 4R/2, Near Cancer Institute, S.C.B. Medical College, Cuttack - 753 007
India

Abstract

Twenty adult patients (15 males and 5 females) with extensive, clinically diagnosed tinea versicolor (TV.) resistant to topical agents, of long duration were selected. Laboratory investigations like KOH smear, routine haemogram, LFT, and RFT were done. They were given itraconazole (100 mg) orally twice daily for 5-7 days and followed up at the end of 1 week and again three weeks later. After one week itching, erythema and scaling subsided in 80% of cases. There was no recurrence during one year follow up.



How to cite this article:
Mohanty J, Sethi J, Sharma M K. Efficacy of itraconazole in the treatment of tinea versicolor.Indian J Dermatol Venereol Leprol 2001;67:240-241


How to cite this URL:
Mohanty J, Sethi J, Sharma M K. Efficacy of itraconazole in the treatment of tinea versicolor. Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2018 Jan 19 ];67:240-241
Available from: http://www.ijdvl.com/text.asp?2001/67/5/240/11257


Full Text

 Introduction



Tinea versicolor is caused by Malassezia furfur, the filamentous form of Pityrosporum orbiculare aye and P. ovale. Both are lipophilic members of the normal human cutaneous flora in the adult.[1]

Despite the use of numerous newer therapeutic regimens, TV has remained an enigma only because of recurrence and resistance of the yeast.[2] Itraconazole is newer orally active azole of the triazole series and the latest dimension to oral antifungal therapy with broad spectrum activity and favourable pharmacokinetic profile.[2],[3]

Itraconazole was tried to assess its efficacy in 20 patients with T versicolor who attended the department of Skin, STD and Leprosy, S.C.B. Medical College and Hospital, Cuttack.

 Materials and Methods



Twenty adult patients (15 male, 5 female) with clinically diagnosed extensive TV. with duration of 6 months to 2 years were included in the trial.

Blood haemogram, LFT, RFT, were all normal. KOH smear was done and found positive in 15 cases. They were given itraconazole 100 mg orally twice daily for 5 to 7 days, for ten patients for 5 days and ten for 7 days. The patients were reviewed after 2 weeks and 4 weeks from the beginning of treatment and followed up for one year.

 Results



Fifteen patients were males and five females. Their age varied from 17 to 55 years. Out of 20 patients one showed no change at all and 3 patients did not turn up. Parameters of clinical disease activity (itching, scaling, erythema, hypopigmentation and brownish colour or hyperpigmentation) were assessed and scored as 0 = none, 1 = mild, 2 = moderate, 3= severe. [Table:1]

Out of 20, five patients did not complain of itching or irritation. Ten had mild to moderate itching and irritation, five patients presented with severe itching. Mild to moderate scaling was present in all the patients. Moderate erythema with hypopigmentation was present in 15, and five patients had a moderately brownish black pigmentation. KOH smear was positive in 15 patients.[Table:2]

Two weeks after starting treatment, all the clinical features subsided in 60% of cases. After 3 weeks, scaling had disappeared in all the cases. All the features subsided in 80% of cases. KOH smear bacame negative in 60% of cases after the 2nd week, and in 80% of cases after the 4th week of treatment.

 Discussion



In our study of 20 patients, itraconazole was effective in 60% of cases two weeks after treatment and in 80% of cases after three weeks.

Del Palacio Hernanz et al reported 82% of healing in their study group of 30 patients which is almost comparable with our result.[4] Scaling disappeared in all the cases after three weeks of treatment whereas itching and erythema with hypopigmentation subsided in 80% of cases. KOH smear was negative in 60% of cases after second week and in 80% of cases after 4th week of treatment. Hickman's study showed a clinical cure rate of 89%, a little higher than our result, in 36 patients with 100mg itraconazole daily for 15 days.[5] Side effects like headache and gastrointestinal distress were very minimal, in 10% of cases. There was no recurrence during one year follow up.

These findings make the evaluation of treatment of pityriasis versicolor rather difficult. We could not depend on culture because it gives no definitive answer since pityrosporum sp lives on the skin of many normal people in a saprophytic form. KOH findings are not valid criteria to assess the efficacy of an orally active anti-fungal immediately after treatment since dead fungal elements remain on skin. Hypopigmentation also cannot be regarded as a primary symptom of the infection since the melanocytes need some time to recover even after disappearance of the fungus from the skin. However as topical treatment is time consuming and some topical preparations are greasy and have a bad odour, systemic therapy with itraconazole may be preferred. But to avoid high rate of relapse, prophylactic therapy should be mandatory. Its efficacy and safety should also be compared with double blind studies with alternative agents.

References

1Robert SOB, Maekenzie DWR. Pityriasis versicolor. In: Textbook of Dermatology ed. by Rook A, Wilkinson DS, Ebling FJG 3rd ed. Vol. 1, P - 825.
2Delescluse J, Cauwenberg G, Degreef H. Itraconazole: a new orally active antifungal in the treatment of pityriasis versicolor. Br J Dermatol 1986;114:701-703.
3Faergemann 1. Treatment of pityriasis versicolor with itraconazoleA double blind placebo controlled study. Mycosis 1988;31:377-379.
4Delpalacio Hernanz, Frias - Iniesta J. Itraconazole therapy in pityriasis versicolor. Br J Dermatol 1986;115:217-225.
5Hickman JG. A double blind randomised, placebo, controlled evaluation of short term treatment with oral itraconazole in patients with tinea versicolor. J Am Acad Dermatol 1996;34:785-787.

 

Friday, January 19, 2018
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