More on Itraconazole (Sporanox)
Drug effective against underlying fungal infection
September 15, 2002 By: Paula Moyer Dermatology Times
Patient at baseline (left) and one week itraconazole posttreatment.
New Orleans - Disorders that seemingly have no mycotic component
could respond
to a course of itraconazole (Sporanox), according to Ruggero Caputo,
M.D. In
fact, for certain patients, it may have a role in the treatment of
inflammatory
diseases such seborrheic dermatitis, atopic dermatitis, and rosacea,
as well as
palmo plantar amicrobic pustulosis.
"The oral administration of itraconazole may be useful in different
diseases
and in selected patients resistant to other treatments," he reported
at the
annual meeting of the American Academy of Dermatology. The reason may
be an
underlying fungal infection of various species of Malassezia, such as
Pityrosporum orbiculare, he said.
In a study following 160 patients with seborrheic dermatitis for six
months, he
and colleagues found that a seven-day course of itraconazole, at a
dose of 200
mg/day, resulted in a "marked reduction of signs and symptoms" of the
targeted
disorder, and often resulted in a reduction in relapses.
Other disorders addressed in the study included Malassezia
folliculitis,
perioral dermatitis, rosacea, and atopic dermatitis. However, he said
that
atopic dermatitis only responds to itraconazole if the patients test
positive
for P. orbiculare; otherwise, antimycotic treatment is ineffective.
Role of MalasseziavertSpacer(’lessThanP’,'/dermatologytimes’) Dr.
Caputo
discussed some of the rationale behind the use of itraconazole on
diverse
inflammatory disorders. He is professor and chair of dermatology at
the
University of Milan.
Patient at baseline (left) and one week itraconazole posttreatment.
"As demonstrated in previous research, Malassezia species may play an
important
role in the pathogenesis of several inflammatory diseases …
stimulating
cytokines production by keratinocytes," he said. "The production of
cytokines
is different among these species. This difference could explain the
different
clinical and pathologic manifestations of the dermatoses triggered by
Malassezia species.
Earlier research had demonstrated that itraconazole was anti-
inflammatory,
primarily due to its inhibiting effect on the synthesis of 5-
hypooxygenase
metabolites involved in several allergic, inflammatory, and
immunoreactive
processes. In his clinical experience, Dr. Caputo and colleagues had
observed
that patients with Pityriasis versicolor and seborrheic dermatitis
had shown
substantial reduction in inflammation when treated with itraconazole.
"Itraconazole may be considered a first choice in Malassezia-linked
dermatoses,
like Malassezia folliculitis," Dr. Caputo said. "This is a very
interesting
drug in severe cases of seborrheic dermatitis. It is an important
alternative
drug to consider for types of dermatitis such as atopic dermatitis,
rosacea,
perioral dermatitis, and palmo plantar amicrobic pustulosis."
Dermatologists need to determine whether several criteria have been
met that
would indicate a possible benefit to treatment with itraconazole. "It
is
particularly useful in seborrheic dermatitis when the disease is
widely
diffuse; when resistance to topical treatment has been observed; and
when the
disease gives rise to psychological reactions that have an impact on
the
patient’s lifestyle," he said. Now that topical steroids are an
established
over-the-counter treatment, patients should be discouraged from
chronic use of
them for any of these conditions, Dr. Caputo said.
An expanded role for itraconazole meets a need of which
dermatologists are well
aware: the continuous need for new therapeutic approaches to skin
diseases, Dr.
Caputo said. In particular, there is a need for new treatments for
inflammatory
disorders, because of the limitations of topical and oral
glucocorticosteroids.
"Now there is the possibility that, with itraconazole, we have at our
disposal
a new way to manage a number of inflammatory skin disorders that are
difficult
to treat," he said. When patients have had a relapse or poor response
to a
treatment, they need to know that the dermatologist has not exhausted
the
therapeutic options. By suggesting a course of itraconazole, the
dermatologist
will be able to demonstrate to the patient that he or she is informed
about new
treatment strategies, he said.