Efficacy of One-week Regimen of Itraconazole for Pityriasis Versicolor

Ahn, Kyu Joong; Kim, Kyoung Jin; Yi, Gil Ju

Abstract

BACKGROUND
Pityriasis versicolor is often found following pathologic transformation of Malassezia fungi from yeast to mycelial forms by a poorly understood mechanism and is characterized by squamous skin lesions manifesting hyper- or hypo-pigmentation. Itraconazole is a synthetic oral antifungal agent of triazole family, which acts as a selective inhibitor of the cytochrome P-450-dependent synthesis of ergosterol and is reported to demonstrate a potent antifungal efficacy against Malassezia yeasts. OBJECT: The present clinical study was designed to evaluate the therapeutic efficacy of one- week regimen of itraconazole by studying 20 patients with pityriasis versicolor, who were diagnosed both clinically and mycologically. In addition, we wished to identify Malassezia species from skin lesions of pityriasis versicolor and examine the possible correlation of a certain Malassezia(M.) species and pityriasis versicolor.
METHODS
Twenty patients (ages, 18 to 49) were included in the study, following the diagnosis of pityriasis versicolor, which was based on clinical examinations and mycological studies (microscopy and culture). Patients received a single 200 mg dose of itraconazole (Sporanox? capsules daily with a full meal for one week. For all patients, clinical examinations and culture and microscopic studies were done before treatment, at the end of treatment, and 4 weeks later. Scales obtained from skin lesions were studied by Parker-KOH smear examination and culture studies to identify Malassezia yeasts. Cultures were done using agar media of Leeming & Notman.
RESULTS
By comparing skin lesions before and immediately after treatment, marked improvement was observed in 7 patients (35%) and moderate improvement in 12 patients (60%) among a total of 20 patients, and 1 patient (5%) showed no response. On the other hand, by comparing skin lesions examined before treatment and 4 weeks after completing medication, complete cure was observed in 13 cases (65%), marked improvement in 5 (25%), and moderate improvement in 2 (10%). With culture studies before treatment, M. globosa, M. furfur, and M. restricta were isolated as a major fungal species in 18, 1, and 1 patients, respectively.
CONCLUSION
The result suggested that administration of a single dose of 200 mg itraconazole (Sporanox? capsules daily for a week is a very effective treatment for pityriasis versicolor and also indicated that pityriasis versicolor is very closely related with the infection of M. globosa.