Systematic Review of Systemic Treatments for Tinea Versicolor and Evidence-Based Dosing Regimen Recommendations

Abstract

French

Background:

Extensive or recurrent tinea versicolor (TV) can be treated with systemic antifungal therapies, but no dosing regimens have been approved for this indication.

Objective:

To provide evidence-based recommendations for dosing regimens.

Methods:

A systematic literature search was performed to identify trials reporting mycologic cure. All trials were included and assessed for quality. Correlation and statistical analyses were used to evaluate the effects of different dosing regimen parameters on efficacy.

Results:

Fifty-seven trials investigating itraconazole, ketoconazole, fluconazole, and pramiconazole were included. Cumulative dose, treatment duration, and daily/weekly concentrations were shown to significantly influence mycologic cure rates for ketoconazole and pramiconazole but not for itraconazole and fluconazole.

Conclusion:

Based on the efficacy evidence and potential safety concerns, this review supports the following dosing regimens: 200 mg/d for 5 or 7 days of itraconazole, 300 mg/wk for 2 weeks of fluconazole, and 200 mg/d for 2 days of pramiconazole.

Get full access to this article

View all access options for this article.

References

Faergemann

Fredriksson

. Tinea versicolor: some new aspects on etiology, pathogenesis, and treatment. Int J Dermatol 1982;21: 8–11, doi:10.1111/j.1365-4362.1982.tb00476.x.

Gordon

. The lipophilic mycoflora of the skin. Mycologia 1951; 43:524–35, doi:10.2307/3755426.

Borelli

Jacobs

Nall

. Tinea versicolor: epidemiologic, clinical, and therapeutic aspects. J Am Acad Dermatol 1991;25: 300–5, doi:10.1016/0190-9622(91)70198-B.

Gupta

Bluhm

Summerbell

. Pityriasis versicolor. J Eur Acad Dermatol Venereol 2002;16:19–33, doi:10.1046/j.1468-3083. 2002.00378.x.

Hafez

El-Shamy

. Genetic susceptibility in pityriasis versicolor. Dermatologica 1985;171:86–8, doi:10.1159/000249397.

Faergemann

. Pityriasis versicolor. Semin Dermatol 1993;12:276–9.

Caprilli

Nazzaro Porro

Passi

. Pityraisis versicolor. Stud Clin Bull Inst Dermatol 1971;7:71–89.

Faergemann

. Tinea versicolor (Pityriasis versicolor). In: Demis

, editor. Clinical dermatology. Philadelphia: Lippincott-Raven; 1995. p. 1–9.

Faergemann

. Management of seborrheic dermatitis and pityriasis versicolor. J Clin Dermatol 2000;1:75–80, doi:10.2165/00128071-200001020-00001.

10.

Tate

. Pityriasis versicolor. Med Today 2008;9:60–2.

11.

Bigby

. Pityriasis versicolor: a systematic review of interventions. Arch Dermatol 2010;146:1132–40, doi:10.1001/archdermatol.2010.259.

12.

van Valkenhoef

Tervonen

Zwinkels

. ADDIS: a decision support system for evidence-based medicine. 2012. Available at: http://drugis.org/files/addis-dss.pdf (accessed August 29, 2012).

13.

Downs

Black

. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–84, doi:10.1136/jech.52.6.377.

14.

Savin

. Systemic ketoconazole in tinea versicolor: a double-blind evaluation and 1-year follow-up. J Am Acad Dermatol 1984; 10:824–30, doi:10.1016/S0190-9622(84)70098-3.

15.

Roseeuw

Willemsen

Kint

. Itraconazole in the treatment of superficial mycoses—a double-blind study vs. placebo. Clin Exp Dermatol 1990;15:101–4, doi:10.1111/j.1365-2230.1990.tb02041.x.

16.

Hickman

. A double-blind, randomized, placebo-controlled evaluation of short-term treatment with oral itraconazole in patients with tinea versicolor. J Am Acad Dermatol 1996;34:785–7, doi:10.1016/S0190-9622(96)90014-6.

17.

Balachandran

Thajuddin Ravikumar

. Comparative evaluation of single dose regimen with two dose regimen of fluconazole in the treatment of tinea versicolor: a double blind placebo controlled study. Indian J Dermatol Venereol Leprol 1999;65:20–2.

18.

Farschian

Yaghoobi

Samadi

. Fluconazole versus ketoconazole in the treatment of tinea versicolor. J Dermatolog Treat 2002;13:73–6, doi:10.1080/095466302317584421.

19.

Faergemann

Todd

Pather

. A double-blind, randomized, placebo-controlled, dose-finding study of oral pramiconazole in the treatment of pityriasis versicolor. J Am Acad Dermatol 2009;61:971–6, doi:10.1016/j.jaad.2008.08.033.

20.

del Palacio Hernanz

Frias-Iniesta

Gonzalez-Valle

. Itraconazole therapy in pityriasis versicolor. Br J Dermatol 1986; 115:217–25, doi:10.1111/j.1365-2133.1986.tb05721.x.

21.

del Palacio Hernanz

Delgado Vicente

Menéndez Ramos

. Randomized comparative clinical trial of itraconazole and selenium sulfide shampoo for the treatment of pityriasis versicolor. Rev Infect Dis 1987;9 Suppl 1:S121–7, doi:10.1093/clinids/9. Supplement_1.S121.

22.

Estrada

. Itraconazole in pityriasis versicolor. Rev Infect Dis 1987;9 Suppl 1:S128–30, doi:10.1093/clinids/9.Supplement_1.S128.

23.

Morales-Doria

. Pityriasis versicolor: efficacy of two five-day regimens of itraconazole. Rev Infect Dis 1987;9 Suppl 1:S131–3, doi:10.1093/clinids/9.Supplement_1.S131.

24.

Fiorioni

Cilli

Altomare

. Itraconazole: a new orally active antimyotic in the treatment of pityriasis versicolor. Comparative clinical study of two treatment regimens. Micol Dermatol 1992;6:43–6.

25.

Amer

. Fluconazole in the treatment of tinea versicolor. Int J Dermatol 1997;36:940–2, doi:10.1046/j.1365-4362.1997.00213.x.

26.

Fernandez-Nava

Laya-Cuadra

Tianco

EAV

. Comparison of single dose 400 mg versus 10-day 200 mg daily dose ketoconazole in the treatment of tinea versicolor. Int J Dermatol 1997;36:64–6, doi:10.1046/j.1365-4362.1997.00023.x.

27.

Silva

Gibbs

Arguedas

. A comparison of fluconazole with ketoconazole, itraconazole, and clotrimazole in the treatment of patients with pityriasis versicolor. Curr Ther Res 1998;59:203–14, doi:10.1016/S0011-393X(98)85073-X.

28.

Montero-Gei

Robles

Suchil

. Fluconazole vs. itraconazole in the treatment of tinea versicolor. Int J Dermatol 1999;38:601–3, doi:10.1046/j.1365-4362.1999.00733.x.

29.

Shemer

Nathansohn

Kaplan

. Itraconazole versus ketoconazole in the treatment of tinea versicolor. J Dermatolog Treat 1999;10:19–23, doi:10.3109/09546639909055906.

30.

Bhogal

Singal

Baruah

. Comparative efficacy of ketoconazole and fluconazole in the treatment of pityriasis versicolor: a one year follow-up study. J Dermatol 2001;28:535–9.

31.

Kokturk

Kaya

Ikizoglu

. Efficacy of three short-term regimens of itraconazole in the treatment of pityriasis versicolor. J Dermatolog Treat 2002;13:185–7, doi:10.1080/09546630212345676.

32.

Partap

Kaur

Chakrabarti

. Single-dose fluconazole versus itraconazole in pityriasis versicolor. Dermatology (Basel) 2004;208:55–9, doi:10.1159/000075047.

33.

Köse

Bülent Taştan

Riza Gür

. Comparison of a single 400 mg dose versus a 7-day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. J Dermatolog Treat 2002;13:77–9, doi:10.1080/095466302317584430.

34.

Giam

Tham

. Ketoconazole in tinea versicolor: is ten day therapy adequate? Singapore Med J 1987;28:13–7.

35.

Köse

. Fluconazole versus itraconazole in the treatment of tinea versicolor. Int J Dermatol 1995;34:498–9, doi:10.1111/j.1365-4362. 1995.tb00623.x.

36.

Anwer

Iqbal

Aghai

. The treatment of dermatophytoses and pityriasis versicolor with one week orally administered itraconazole. J Pak Assoc Derma 2001;11:60–3.

37.

Jolliffe

. Preliminary results of a multicentre open trial showing the effect of ketoconazole treatment on pityriasis versicolor. In: Meinhof

, editor. Oral therapy in dermatomycoses: a step forward. Proceedings of a Symposium Held in Frankfurt Feb 1984. Medical Publishing Foundation; 1985. 107–10.

38.

Alteras

Sandbank

Segal

. Two years of follow-up of oral ketoconazole therapy in 60 cases of pityriasis versicolor. Dermatologica 1987;175:142–4, doi:10.1159/000248812.

39.

Sankara

Rajashekhar

. Oral fluconazole in tinea versicolor. Indian R Dermatol Venereol Leprol 1997;63:166–7.

40.

Kaur

Kumar

Sharma

. Oral ketoconazole in tinea versicolor. Indian J Dermatol Venereol Leprol 1991;57:157–8.

41.

Difonzo

. Italian multicentre study with oral itraconazole in recurrent pityriasis versicolor. Preliminary report. J Eur Acad Dermatol Venereol 1992;Suppl 1:S19–20, doi:10.1111/j.1468-3083. 1992.tb00679.x.

42.

Shahid

Ihsan

Khan

. Oral fluconazole in the treatment of pityriasis versicolor. J Dermatolog Treat 2000;11:101–3, doi:10. 1080/09546630050517496.

43.

Mohanty

Sethi

Sharma

. Efficacy of itraconazole in the treatment of tinea versicolor. Indian J Dermatol Venereol Leprol 2001;67:240–1.

44.

Faergemann

Ausma

Vandeplassche

. The efficacy of oral treatment with pramiconazole in pityriasis versicolor: a phase II trial. J Dermatol 2007;156:1385–8, doi:10.1111/j.1365-2133.2007.07888.x.

45.

Georgiou

Monastirli

Pasmatzi

. Oral itraconazole therapy for pityriasis versicolor. J Eur Acad Dermatol Venereol 1997;8:203–7, doi:10.1111/j.1468-3083.1997.tb00479.x.

46.

Caterall

. Ketoconazole therapy for pityriasis versicolor. Clin Exp Dermatol 1982;7:679–81, doi:10.1111/j.1365-2230.1982.tb02494.x.

47.

Goodless

. Ketoconazole for the treatment of tinea versicolor. J Dermatol 1998;37:76–9.

48.

Gupta

Kogan

Batra

. Pityriasis versicolor: a review of pharmacological treatment options. Expert Opin Pharmacother 2005;6:165–78, doi:10.1517/14656566.6.2.165.

49.

Faergemann

. Pityrosporum infections. J Am Acad Dermatol 1994;31:S18–20, doi:10.1016/S0190-9622(08)81261-3.

50.

Framil

VM de S

Melhem

MSC

Szeszs

. New aspects in the clinical course of pityriasis versicolor. An Bras Dermatol 2011; 86:1135–40, doi:10.1590/S0365-05962011000600011.

51.

Faergemann

Gupta

Al Mofadi

. Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor. Arch Dermatol 2002;138:69–73, doi:10.1001/archderm.138.1.69.

52.

Health Canada, Ketoconazole-Risk of potential fatal liver toxicity-For health professionals. June 19, 2013. Available at: http://healthcanadians.gc.ca/recall-alert-rappe-avis/hc-sc/2013/34173a-eng.php (accessed September 27 2013).

53.

Cauwenbergh

De Doncker

Stoops

. Itraconazole in the treatment of human mycoses: review of three years of clinical experience. Rev Infect Dis 1987;9:S146–52, doi:10.1093/clinids/9.Supplement_1.S146.