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    Journal Reading Antifungal Treatment For Pityriasis Versicolor

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    elok ainika prautami
    Pityriasis versicolor is a fungal infection of the skin caused by Malassezia species. It is difficult to cure and relapse is common. Diagnosis involves examining skin scrapings under a microscope. Topical treatments including ketoconazole and terbinafine are effective options. Ketoconazole applied daily for 3 days or as a single application is effective. Terbinafine applied twice daily for 7 days also achieves high cure rates. Oral antifungals like itraconazole and fluconazole are alternatives when topical treatments are not suitable, with fluconazole achieving high cure rates with weekly doses.

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    Journal Reading Antifungal Treatment For Pityriasis Versicolor

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    elok ainika prautami
    34 views22 pages
    Pityriasis versicolor is a fungal infection of the skin caused by Malassezia species. It is difficult to cure and relapse is common. Diagnosis involves examining skin scrapings under a microscope. Topical treatments including ketoconazole and terbinafine are effective options. Ketoconazole applied daily for 3 days or as a single application is effective. Terbinafine applied twice daily for 7 days also achieves high cure rates. Oral antifungals like itraconazole and fluconazole are alternatives when topical treatments are not suitable, with fluconazole achieving high cure rates with weekly doses.

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    Pityriasis versicolor is a fungal infection of the skin caused by Malassezia species. It is difficult to cure and relapse is common. Diagnosis involves examining skin scrapings under a microscope. Topical treatments including ketoconazole and terbinafine are effective options. Ketoconazole applied daily for 3 days or as a single application is effective. Terbinafine applied twice daily for 7 days also achieves high cure rates. Oral antifungals like itraconazole and fluconazole are alternatives when topical treatments are not suitable, with fluconazole achieving high cure rates with weekly doses.

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    34 views22 pages

    Journal Reading Antifungal Treatment For Pityriasis Versicolor

    Uploaded by

    elok ainika prautami
    Pityriasis versicolor is a fungal infection of the skin caused by Malassezia species. It is difficult to cure and relapse is common. Diagnosis involves examining skin scrapings under a microscope. Topical treatments including ketoconazole and terbinafine are effective options. Ketoconazole applied daily for 3 days or as a single application is effective. Terbinafine applied twice daily for 7 days also achieves high cure rates. Oral antifungals like itraconazole and fluconazole are alternatives when topical treatments are not suitable, with fluconazole achieving high cure rates with weekly doses.

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    JOURNAL READING

    ANTIFUNGAL TREATMENT FOR


    PITYRIASIS VERSICOLOR

    Oleh :
    Elok Ainika Prautami
    INTRODUCTION

    Pityriasis versicolor (PV) is a chronic cutaneous fungal infection


    caused by proliferation of lipophilic yeast (Malassezia species) in the
    stratum corneum. The most common Malassezia species associated with
    PV is M. globosa, with M. sympodialis and M. furfur also frequently
    seen.
    PV occurs more frequently in tropical climates (as much as 40%) as
    compared to temperate climates. PV is difficult to cure, as relapse following
    treatment can be as high as 80% within 2 years .
    Diagnosis of PV is confirmed by microscopy using skin scrapings from
    the borders of lesions, or, if this is not possible, obtaining samples using the
    transparent tape method. Wood’s light examination may also aid in
    diagnosis, with lesions appearing yellow or gold.
    TROPICAL TREATMENT FOR PITYRIASIS
    VERSICOLOR

    1. KETOCONAZOLE

    Was the first broad-spectrum antifungal used in the treatment of


    superficial and systemic mycoses. Through inhibition of the enzyme
    lanosterol 14α-demethylase, ketoconazole disrupts ergosterol
    biosynthesis to limit cell function and growth.
    Lange et al. (1998) conducted a multi-center, double-blind,
    randomized, placebo-controlled clinical trial evaluating the efficacy of a
    single application of ketoconazole shampoo vs. daily application for 3 days.
    Thirty-one days from the start of treatment, there were no significant
    differences between the two ketoconazole regimens in mycological or
    complete cure rates. Both ketoconazole regimens, daily application for 3
    days and one application, were significantly more effective than placebo
    shampoo for mycological cure (84% vs. 78% vs. 11% respectively, p <
    0.001) and complete cure (73% vs. 69% vs. 5% respectively, p < 0.001).
    In the latest study, patients applied either a combination of 2%
    ketoconazole cream and 0.1% adapalene gel once daily for 14 days or 2%
    ketoconazole cream twice daily for 14 days. Combination treatment
    produced clinical improvement and mycological cure faster (within 2
    weeks) than monotherapy. By week 4, the treatment with the combination
    of ketoconazole and adapalene produced significantly greater clinical
    improvement and mycological cure as compared to ketoconazole
    monotherapy (92% vs. 72%, p = 0.009).
    2. Terbinafine

    Terbinafine acts by inhibiting squalene epoxidase, thereby blocking


    sterol biosynthesis and altering fungal cell membrane integrity.
    Multiple double blind, randomized, placebo-controlled studies have
    investigated the efficacy of 1% terbinafine solution applied twice daily for
    7 days. Seven weeks following a 7-day course of twice daily terbinafine
    solution, both Vermeer et al. and Savin et al. reported a mycological cure
    rate of 81%, significantly greater than placebo (41%, p < 0.001; 30%, p <
    0.001, respectively).
    Budimulja and Paul (2002) conducted two double blind, randomized,
    placebo-controlled trials of 1% terbinafine solution. Both trials
    administered terbinafine for 7 days, with one requiring twice daily
    application and the other once daily application. Eight weeks following the
    start of treatment, twice daily application of terbinafine produced a
    mycological cure rate of 64% and once daily application a mycological
    cure rate of 49%.
    ORAL TREATMENT FOR PITYRIASIS
    VERSICOLOR

    1. ITRACONAZOLE

    a triazole antifungal, alters fungal cell function similarly to


    ketoconazole, through inhibition of cytochrome P450-dependent ergosterol
    synthesis.
    Galimberti et al. (1987) showed that 7 days of itraconazole produced
    slightly higher cure rates than 5 days, but statistical analysis was not
    performed.

    Kose et al. (2002) demonstrated that a single 400 mg dose was


    equivalent to 200 mg for 7 days [51], Kokturk et al. (2002) found a single
    400 mg dose to be ineffective, with itraconazole regimens of 400 mg for 3
    days and 200 mg for 5 days both producing significantly greater
    mycological and complete cure (p = 0.001)
    2. Fluconazole

    Fluconazole is a triazole antifungal, inhibiting cytochrome P450-


    dependent ergosterol synthesis similarly to itraconazole and ketoconazole.
    A large randomized trial conducted by Amer (1997) demonstrated the
    efficacy of weekly regimens of fluconazole: 150 mg or 300 mg weekly for
    4 weeks, or 300 mg bi-weekly for 4 weeks. Four weeks after the last
    treatment, mycological cure for the regimens of 300 mg fluconazole
    (weekly 93%, bi-weekly 87%) were significantly higher than 150 mg
    fluconazole (73%, p < 0.0001).
    3. Pramiconazole

    Pramiconazole is a relatively new triazole that disrupts ergosterol


    synthesis in fungal cells.
    CONCLUSION

    Topical therapy is the first line of treatment for PV and may include
    selenium sulphide, zinc pyrithione, ketoconazole, and terbinafine. When
    topical treatment is not feasible or desired, itraconazole and fluconazole are
    viable options, with pramiconazole a potential new therapy.
    Terima Kasih

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