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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
V. Fatsini-Blanch
, M.I. Martínez-González, S. Heras-González, A. de Quintana-Sancho
Corresponding author
Servicio de Dermatología, Hospital Universitario Araba, Vitoria-Gasteiz, Araba, Spain
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Fatsini-Blanch, M.I. Martínez-González, S. Heras-González, A. de Quintana-Sancho" "autores" => array:4 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Fatsini-Blanch" "email" => array:1 [ 0 => "vanesafatsini@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.I." "apellidos" => "Martínez-González" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Heras-González" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "de Quintana-Sancho" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Araba, Vitoria-Gasteiz, Araba, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR-Pulsos de itraconazol en dermatitis seborreica. Una opción terapéutica a tener en cuenta" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">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.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Gupta et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> 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 <span class="elsevierStyleItalic">Malassezia</span> species in the pathogenesis of SD.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Notable studies include those by Kose et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and Baysal et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> who initially administered itraconazole at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg/d for 7 days followed by pulses of itraconazole at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg 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.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> the maintenance therapy was a single dose of 200<span class="elsevierStyleHsp" style=""></span>mg 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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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 200<span class="elsevierStyleHsp" style=""></span>mg/d for 7 days in the first phase, followed by pulse therapy at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg/d on the first 2 days of each month (400<span class="elsevierStyleHsp" style=""></span>mg/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.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec852714" "palabras" => array:3 [ 0 => "Seborrheic dermatitis" 1 => "Itraconazole" 2 => "Drug pulse therapy" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of oral treatments for seborrheic dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.K. Gupta" 1 => "M. Richardson" 2 => "M. 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