Topical ketoconazole: a systematic review of current dermatological applications and future developments

Ketoconazole is in a class of antifungal medications called imidazoles. It works by inhibiting the growth of fungi that cause the infection.

Topical ketoconazole is indicated for the treatment of cutaneous candidosis (including vulvitis), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp.

Take Home Message:

Seborrheic dermatitis (SD) is a common inflammatory skin disease presenting with papulosquamous morphology in areas rich in sebaceous glands, particularly the scalp, face, and body folds. The pathogenesis of seborrheic dermatitis is unclear, but its activity has been linked to the number of Malassezia yeasts present on the skin and to the inflammatory reaction to them.

Tinea versicolor is a common, benign, superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the trunk, neck chest and the back. Tinea versicolor is caused by Malassezia, formerly known as Pityrosporum.

Topical KTZ is generally thought to be effective and safe for the treatment of superficial fungal infections such as cutaneous candidosis (including vulvitis), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp.

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New dermatologic indications for the use of topical KTZ have arisen such as onychomycosis, blepharitis, and hair loss.

Topical KTZ is clinically effective for the treatment of Malassezia-related conditions such as seborrheic dermatitis (SD) and pityriasis versicolor (PV) with a reported efficacy of 63-90% and 71-89%, respectively.

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Abstract

Objectives: This article aims to review the literature on topical KTZ's efficacy and AEs, as well as provide an overview on current insights regarding its mechanism of action and upcoming developments.

Methods: A PubMed search was done to include randomized controlled trials (RCTs) focusing on the use of topical KTZ in human subjects.

Results: Forty studies with 4566 patients were included in this review. Topical KTZ is clinically effective for the treatment of Malassezia-related conditions such as seborrheic dermatitis (SD) and pityriasis versicolor (PV) with a reported efficacy of 63-90% and 71-89%, respectively.

Conclusions: Topical KTZ demonstrates high clinical efficacy for Malassezia-related conditions. More efficacious alternatives are now available for Tinea and Candida. Although topical KTZ is safe, clinicians should be aware that allergic contact dermatitis may occur. Further studies should be completed to investigate the use of topical KTZ for hair loss and inflammatory dermatoses.