Tony and Penov - continue this discussion, if you must, via e-mail
and not here.

/The almighty moderator

Tony,continue this sequence:

If you have something to say, please do not use this group. Political
issues are not the name of the game here. Instead, you are more than
welcomed to join these forums:

Best wishes.

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On one of my previous posts I have reported my success with
ciclopiroxolamine creme. I use a local version (I’m from Macedonia), but
it works great. It is effective cream with minimal side-effect profile. I
have tried Elidel, works great also, but the ciclopirox creme is 20 times
cheaper from 15g Elidel tube. At least, you can use it as maintenance
therapy between "Elidel weekends". My SD hasn’t been an issue for quite
some time now, thanks to this group.
I joined it 4 months ago, recovering from hydrocortisone-rebound, and now
I control my SD very well with a simple&safe "one-time a day
application".I do not have rosacea so I cannot say how rosaacea will react
to this creme, I did no had any side-effects.
I hope this works for you, I highly recomend it!

Here an interesting article on the subject:
Introduction

Ciclopirox is a hydroxylated pyridone, a unique substance in our topical
treatment armamentarium. It first came to market in Europe and has been in
use for a number of years (1). Worldwide it is or has been available as a
spray, vaginal cream, powder, solution, cream, lotion, gel, and nail
lacquer. The latter four are available in the United States at the time of
this article. Ciclopirox gel differs from other formulations. It contains
ciclopirox as a free acid, as opposed to an olamine salt. Superficial
fungal infections and seborrheic dermatitis are two of the most common
disorders seen in dermatology and indeed in medicine in general;
ciclopirox is active against both, and literally may be used head to foot.

Mechanism

Ciclopirox differs structurally from other available anti-fungals and
works differently. It has a unique and complex mode of action which mainly
affects iron dependent enzyme systems (e.g. cytochromes, catalase,
peroxidase) and cytoplasmic membranes (e.g. transport mechanisms) (2). It
penetrates well into the stratum corneum (3). Ciclopirox may affect
Malassezia furfur via damage to the cell membranes and disorganization of
internal structures (2). Furthermore, with Candida albicans and
Saccharomyces cerevisiae, ciclopirox may block the transmembrane transport
of radiolabeled leucine (2). The other main classes of topical antifungals
are the imidazoles, polyenes, allylamines, and benzylamines.

1) Imidazoles. Ciclopirox does not affect sterol biosynthesis, as do the
azoles. The later are primarily fungistatic and work by inhibiting,
ergosterol synthesis primarily affecting the cell wall.

2) Polyenes. These also work by binding to ergosterol, therefore
disrupting the fungal cell membranes primarily in Candida.

3) Allylamines / benzylamines. These are closely related substances that
suppress ergosterol at an earlier point than the azoles by inhibiting
squalene epoxidase.

Spectrum of Activity

Antimicrobial Activity

Its uniformity of antimycotic activity distinguishes ciclopirox from most
other topical antifungals (4). It has fungicidal and sporicidal activity
in vitro (5). It can also be fungistatic at times (2). It is active
against dermatophytes, yeasts and non-dermatophyte molds MIC range 0/9-3/9
g/ml (6,7). It has in vitro activity against many grain positive and gram
negative bacteria including Proteus species, Psuedomonas species,
Proprionibacteria aches, and Corynebacterium minutissimum (6).

Antiinflammatory Activity

Ciclopirox olamine may exhibit better antiinflammatory activity than 2.5%
hydrocortisone (8). It may inhibit prostaglandin and leukotriene synthesis
in human polymorphonuclear cells (2).

Clinical Uses

Seborrheic Dermatitis

About 3-4% of the population has or has had seborrheic dermatitis.
Sebum-rich areas promote growth of lipophilic yeast like Pityrosporum
ovale and Malassezia. It is effective against seborrheic dermatitis of the
face and the scalp (9). It has been used in a shampoo form outside of the
USA. Although there are no good studies to prove this, ciclopirox shampoo
could be used empirically to decrease the chance of relapse and
reinfection after tinea capitis is treated orally, as has been done
empirically by clinicians with ketoconazole shampoo.

Tinea Versicolor

Clinical and mycologic cure rates have been recorded as high as 77% after
two weeks of treatment (11).

Tinea Corporis/Cruris

At the end of 28 days with twice a day treatment, 2/3 of patients were
clinically and mycologically cured (4).

Candidosis

Cutaneous candidosis was 83% clinically cured and 82% to 90% mycologically
cured in one study (12). Vaginal candidosis was treated as an inserted
cream, which cleared the condition 72% in one study (13) and as high as
91% in another (12).

Tinea Pedis

The drug is active against the common mycological causes of tinea pedis,
Trichophyton rubrum and Trichophyton mentagrophytes. It also has
antibacterial and anti-inflammatory properties that make it especially
helpful in inflammatory conditions such as inflamed tinea pedis. One may
experience mild transient burning after application. Ciclopirox powder may
be used for drying as well as for its antimicrobial effect.

Onychomycosis

Lacquer is applied nightly to toenails. It has been shown to penetrate the
nail plate. Cure is less than 10% (17). Other studies have been done with
different formulations with varying results (15,16). Theoretically,
especially in the lacquer form, it may be used to decrease relapse and
reinfection of onychomycosis (18,19).

Safety

Ciclopirox olamine is pregnancy Category B (5). Safety and efficacy are
unproven in lactating women (5). Ciclopirox olamine 1% cream is not
associated with delayed hypersensitivity type contact sensitization,
contact sensitizers, phototoxicity, or photo contact sensitization (2).

Discussion

The pedal complex (foot and nails) often acts as the reservoir for fungus
to spread elsewhere. The author feels strongly that when seeing tinea on
the body other than on the scalp, the pedal complex needs to be examined.

Some of the drawbacks of ciclopirox:

1) occasional contact burning

2) twice-a-day application

An ideal topical agent is broad spectrum, efficacious in low
concentration, keratinophilic, and lipophilic, with a convenient dosing
schedule, fungicidal activity, a reservoir effect in the stratum corneum,
high mycologic and clinical cure rates, a lack of microbial resistance,
low relapse rate, low incidence of adverse effects, and low cost (19).
Cosmetic acceptability is another important criterion.

Conclusion

Ciclopirox olamine in its various forms is safe and effective. It appears
to fulfill the criteria mentioned above as well as any other product on
the market.

References

(1.) Dittmar W, Lohan G. HOE 296, a New Antifungal compound with a broad
antimicrobial spectrum. Laboratory Results. Arzneim–Forsch Drug Res 1973;
23:670-676.

(2.) Gupta AK. Ciclopirox: An Overview. Intern J Dermatol 40:1-7, 2001.

(3.) Ceschin-Roques CG, Hanel H, Pruja-Bougaret SM, et al. Ciclopirox
olamine cream 1%: In vitro and in vivo Penetration into the Stratum
corneum. Skin Pharmacology 1991; 4:95-99.

(4.) Bogaert H, Cordero C, Ollague W, Sayin RC, et al. Multicentre
Double-Blind Clinical Trials of Ciclopirox Olamine Cream 1% in the
Treatment of Tinea Corporis and Tinea Cruris. J Int Med Res 1986;
14:210-216.

(5.) Loprox Cream package insert, 2002.

(6.) Gupta A. The Spectrum of Utility of Ciclopirox for the Treatment of
Superficial Fungal &. Bacterial infection. Ann Dermatol Venereol 2002;
129:IS607-IS842.

(7.) Gupta A. Antifungal Susceptibility Testing of Dermatophytes, Yeasts
and Non-Dermatophyte to Ciclopirox and other Antifungal agents. Ann
Dermatol Venereol 2001; 129:IS607IS84201.

(8.) Rosen T, Schell BJ, Orengo I. Anti-inflammatory Activity of
Antifungal Preparations. Internat J Dermatol 1997; 36:788-792.

(9.) Dupuy R, Maurette C, Amoric JC, et al. Randomized placebo-controlled,
double-blind study on clinical efficacy of ciclopirox olamine 1% cream in
facial seborrheic dermatitis. BR J Dermatol 2001; 144:1033-1036.

(10.) Wu YC, Chuan Mt, Lu YC. Efficacy of ciclopirox 1% cream in
onychomycosis and tinea pedis. Mycoses 1991; 34:93-95.

(11.) Cailen SI, Frost P, Jacobson C. Treatment of Tinea Versicolor with a
new antifungal agent, Ciclopirox Olamine Cream 1%. Clin Therapeutics 1985;
7:574-583.

(12.) Bagatell, FK, Bogaert, H, Cullen SL, et al. Evaluation of a New
Antifungal Cream, Ciclopirox Olamine 1% in the Treatment of Cutaneous
Candidosis. Clin Therapeutics 1985; 8:41-48.

(13.) Quciorz JL and Cymbalista NB. Estudo clinico com ciclopirox creme
vaginal na candidiase vulvovaginal. Revista Brasileira Clinica e
Terapuetica 1980; 37:479-483.

(14.) Peil HG. Offene Studie zur Wirksam Keit and vertragilich Keit
cicloprox olamine bei vulvovaginaler candidose. Arzeimittel–Forshung
1981; 31: 1366-1372.

(15.) Jue SG. Dawson GW, Brogden RN. Ciclopirox Olamine 1% cream: A
Preliminary Review of its antimicrobial activity and Therapeutic Use.
Drugs 1985; 330-341.

(16.) Quadipur SA, Horn G, Hoehler T. Zur Lokalvirksamkeit von
cicloproxolamin bei Naglemy Kosen. Arzneimittel–Forsch 1981; 31:1369-1372.

(17.) Penlac lacquer package insert, 2002.

(18.) Gupta AK, Daniel CR. Factors that may affect the response of
onychomycosis to oral antifungal therapy. Australasian J Dermatol 1998;
59:222-224.

(19). Gupta AK, Daniel CR. Onychomycosis: Strategies to reduce treatment
failure and recurrence. Curtis 1998; 62:189-101.

ADDRESS TO CORRESPONDENCE:

C. Ralph Daniel, MD

971 Lakeland Dr #659

Jackson, MS 39216

USA

F. EMILY BELL, MD, C. RALPH DANIEL, MD, MELISSA P. DANIEL, MCS

DEPARTMENT OF DERMATOLOGY, UNIVERSITY OF MISSISSIPPI MEDICAL CENTER,
JACKSON, MS

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2003 Gale Group

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