Document Detail

Framing the future of antifungals in atopic dermatitis.
MedLine Citation:
PMID:  12771497     Owner:  NLM     Status:  MEDLINE    
Atopic dermatitis (AD) is a frequent chronic inflammatory skin disease. Some fungal colonization or infection of the skin may exacerbate AD severity, particularly the so-called head and neck variant. In addition, excessive intestinal colonization by Candida albicans may represent an additional triggering factor. Hence, there is a rationale to use antifungals in selected AD patients. Early trials with topical ketoconazole in head and neck AD showed a decrease in Malassezia colonization, but no significant improvement was observed in the clinical severity. In contrast, clinical improvement and decreased serum IgE were obtained in patients with positive Malassezia radioallergosorbent tests (RASTs) who were treated by oral ketoconazole. Some preliminary data suggested that oral itraconazole treatment in AD patients reduced the need for topical corticosteroids, provided clinical improvement particularly in head and neck AD, reduced the cutaneous and intestinal fungal colonization that may trigger AD, reduced the percentage of positive Malassezia cultures and demonstrated a decrease in C. albicans and Malassezia RAST values. Furthermore, beside its antifungal action, itraconazole in part relieves pruritus and inflammation. In conclusion, oral itraconazole treatment can alleviate AD severity in selected patients. Fluconazole is also effective. Further research is warranted to identify whether the load in skin surface fungal agents, the fungal RAST values and specific prick testing should be assessed in order to optimize the antifungal management in AD patients.
Arjen F Nikkels; Gérald E Piérard
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Dermatology (Basel, Switzerland)     Volume:  206     ISSN:  1018-8665     ISO Abbreviation:  Dermatology (Basel)     Publication Date:  2003  
Date Detail:
Created Date:  2003-05-28     Completed Date:  2003-10-15     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9203244     Medline TA:  Dermatology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  398-400     Citation Subset:  IM    
Copyright Information:
Copyright 2003 S. Karger AG, Basel
Department of Dermatopathology, University Medical Center of Liège, Belgium.
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MeSH Terms
Antifungal Agents / therapeutic use*
Dermatitis, Atopic / drug therapy*
Fluconazole / therapeutic use
Itraconazole / therapeutic use
Ketoconazole / therapeutic use
Treatment Outcome
Reg. No./Substance:
0/Antifungal Agents; 65277-42-1/Ketoconazole; 84625-61-6/Itraconazole; 86386-73-4/Fluconazole

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