Efficacy of Itraconazole in the Prophylactic Treatment of Pityriasis (Tinea) Versicolor
JAMA DERMATOLOGY:
Pityriasis (tinea) versicolor often
reoccurs even after successful treatment, with relapse rates ranging from 60%
to 90% within two years. Therefore, it is important to
evaluate a prophylactic regimen that may be effective and safe in preventing
the recurrence of pityriasis versicolor.
Treatment options for pityriasis
versicolor include topical and oral agents, with systemic medications like
itraconazole, ketoconazole, and fluconazole being utilized for extensive or
unresponsive cases.
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In this study, the researchers
investigated the efficacy of itraconazole in both therapeutic and prophylactic
settings for the management of pityriasis versicolor.
During the open treatment phase,
where itraconazole was administered at a daily dose of 200 mg for seven days, a
mycological cure rate of 92% was achieved.
Subsequently, in the prophylactic
treatment phase, participants received either itraconazole 200 mg or a placebo
taken twice daily once a month for 6 consecutive months. At the end of the
prophylactic 6 months treatment period, the mycological cure rate was 88% in the
itraconazole group compared to 57% in the placebo group.
Conclusions Prophylactic itraconazole treatment is efficacious for pityriasis versicolor after 6 months.
The prophylactic regimen of itraconazole, 400 mg administrated once a month
was not only effective but also safe and had high compliance.
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Background Pityriasis (tinea) versicolor has a high tendency to recur after being treated successfully. Prophylactic treatment to reduce recurrence is needed.
Objective To determine whether the recurrence of pityriasis versicolor could be prevented by prophylactic itraconazole treatment.
Design Open treatment followed by a randomized, double-blind, placebo-controlled phase.
Setting Multinational outpatient centers.
Patients A total of 239 consecutive patients were included; 238 started open treatment. A total of 209 patients started prophylactic treatment: 106 in the itraconazole group and 103 in the placebo group.
Interventions Open treatment: itraconazole, 200 mg once daily for 7 days. Prophylactic treatment: itraconazole, 200 mg, or placebo twice daily 1 day per month for 6 consecutive months.
Main Outcome Measures Mycological cure rates at the end of open treatment and at the end of prophylactic treatment.
Results Mycological cure at the end of open treatment was 92% (205/223). At the prophylactic treatment endpoint (6 months), mycological cure was 88% (90/102) in the itraconazole group and 57% (56/99) in the placebo group (P<.001). In open treatment, 11 patients were not able to be evaluated for efficacy. In prophylactic treatment, 4 patients in the itraconazole group and 4 in the placebo group were not able to be evaluated. Adverse events were reported during open treatment by 26 patients (11%) and during prophylactic treatment by 17 (16%) in the itraconazole group and 14 (14%) in the placebo group. No patients experienced any serious adverse events.
Conclusions Prophylactic itraconazole treatment is efficacious for pityriasis versicolor after 6 months, as is itraconazole in the treatment of pityriasis versicolor.
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