Comparison of sertaconazole 2% cream versus hydrocortisone 1% ointment in the treatment of atopic dermatitis

Treatment of atopic dermatitis using topical antifungal drugs: A meta-analysis

Several studies have focused on treating atopic dermatitis (AD) using topical antifungal drugs. However, their findings are inconsistent. This meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the safety and efficacy of topical antifungal drugs for the treatment of AD. We searched prominent databases such as EMBASE, PubMed, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wanfang Database to retrieve all RCTs on the use of topical antifungal drugs for the treatment of AD. The two authors independently performed screening, extraction, and quality evaluation of data based on inclusion and exclusion criteria. In addition, quantitative synthesis and qualitative description of the results were performed using Review Manager 5.3. Nine studies with a total of 785 subjects were included in the meta-analysis. Based on intervention measures, data were divided into three groups: topical antifungal drugs versus placebo, topical antifungal drugs versus topical glucocorticoids, and topical antifungal drugs plus topical glucocorticoids versus topical glucocorticoids. Risk-of-bias assessments revealed that the random distribution methods and allocation concealment were not ideal; further, some studies had incomplete data and reported selective results. Quantitative analysis revealed that in terms of effective rate, topical antifungal drugs are superior to topical glucocorticoids (p = 0.003), and topical antifungal drugs plus topical glucocorticoids are superior to topical glucocorticoids (p = 0.001). However, no significant differences in adverse reactions were observed between the three groups (p > 0.05). The safety and efficacy of topical antifungal drugs for treating AD cannot be accurately evaluated with existing data. Therefore, additional high-quality and large-sample prospective RCTs are required for further validation to determine the appropriateness of topical antifungal drug use for the treatment of AD in clinical settings.

Evaluation of the effectiveness of triamcinolone solution diluted with normal saline for the treatment of seborrheic dermatitis

Background and Aim

Seborrheic dermatitis is a common inflammatory disease for which various treatments have been proposed. The main purpose of this study was to determine the effectiveness of 80-mg Triamcinolone solution diluted with 0.1% normal saline for the treatment of seborrheic dermatitis in adults.

Methods

For this study, 120 patients with seborrheic dermatitis were considered. After obtaining written and informed consent, patients were treated with 80 mg of Triamcinolone diluted with 0.1% normal saline. To evaluate the effectiveness of Triamcinolone treatment, the scoring index (SI) and the level of patient satisfaction were evaluated at 2 and 4 weeks after the start of treatment and also 4 weeks after the end of treatment.

Results

The results of the study showed that 61.67% (74 patients) were satisfied with "good" to "very good" for the Triamcinolone treatment to seborrheic dermatitis. Based on the findings of the study, it was found that the SI before treatment was equal to 2.45 ± 7.45, which after 2 weeks after treatment, this index decreased by 61.6% (SI: 2.86 ± 1.94). In addition, the SI decreased to 88.6% (SI: 0.85 ± 1.02) after 4 weeks.

Conclusion

Considering the high decrease in SI, increasing patient satisfaction and observing a low number of cases with recurrence of the disease by Triamcinolone treatment method, it can be concluded that injection of Triamcinolone 80 mg diluted with 0.1% normal saline can be effective and efficient for the treatment of seborrheic dermatitis.

A Meta-Analysis on the Effectiveness of Sertaconazole 2% Cream Compared with Other Topical Therapies for Seborrheic Dermatitis

Seborrheic dermatitis (SD) is a relapsing inflammatory skin disorder that affects the seborrheic areas of the body. Its etiology is not completely elucidated; however, the link between disease exacerbations and the proliferation of Malassezia spp., along with the good response to antifungal agents, indicate the role of fungi in its pathophysiology. Sertaconazole nitrate is a relatively new imidazole antifungal agent with a particular structure, consisting in a benzothiophene ring similar to the indole ring of tryptophan, and it acts mainly through the inhibition of ergosterol synthesis and the formation of pores in the fungal cell membrane. The aim of our study was to evaluate the efficiency of sertaconazole 2% cream compared with other topical treatments in patients with SD. We performed an extensive literature search by browsing the PubMed database with the keyword combination “sertaconazole AND seborrheic dermatitis AND clinical trial”, which retrieved eight controlled clinical trials evaluating the effects of sertaconazole in SD. All of the clinical trials included a standard scoring index (SI). At 28 days since the beginning of the treatment, the sertaconazole regimen was associated with a significantly higher percentage of patients with mild SI and a lower percentage of patients with moderate or severe SI (odds ratio 0.51) than the other investigated treatments—hydrocortisone, ketoconazole, clotrimazole, metronidazole, pimecrolimus, and tacrolimus (odds ratio 1.95). In conclusion, treatment with sertaconazole 2% cream may represent an efficient alternative therapy for patients with SD.

Dysbiosis of skin mycobiome in atopic dermatitis

Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin disease with an increasing prevalence worldwide. The aetiology and pathogenesis of AD have not been fully elucidated. Previous studies have suggested the role of fungi as a triggering factor in the development AD. Here we conducted a systematic review to investigate the skin mycobiome profiles in AD and to address whether there is an association between fungal dysbiosis and AD. We searched Medline/PubMed, Embase and Web of Science for research studies published in English between January 1st, 2010 and April 21st, 2021. A total of 11 human studies and 3 animal studies were included in this analysis. Fungal dysbiosis was observed in AD lesions with a depleted amount of Malassezia and a higher abundance of filamentous fungi. A positive correlation between Candida and Staphylococcus was also demonstrated in AD. We supposed that specific species of Malassezia spp. and Candida spp. may play a role in the pathogenesis of AD by interacting with the pathogenic bacteria. Topical application of emollients could improve the skin barrier function and restore the skin fungal flora by increasing the amount of Malassezia. Further studies focusing on the complex interplay between specific skin fungi and the host can provide better insight into the role of microorganisms in the pathogenesis of AD.

IgE-mediated sensitization to malassezia in atopic dermatitis: more common in male patients and in head and neck type

BACKGROUND

Atopic dermatitis (AD) is a common chronic inflammatory skin disease. Malassezia, the predominant skin microbiota fungus, is considered to exacerbate AD, especially in a subset of patients with head and neck type AD (HNAD). In the present study, the relationship between AD and sensitization to Malassezia antigens was investigated.

METHODS

We assessed 173 patients with AD. The severity of eczema was determined with Eczema Area and Severity Index (EASI); the type of AD, namely, head and neck type, was reported as well. The total serum IgE and specific IgE to Malassezia were determined and correlated with clinical picture of AD, sex, age, and the EASI.

RESULTS

Total IgE was elevated in 77.7% of patients. Specific IgE to Malassezia was positive (≥0.35 kU/L) in 49.1% of patients. Men were significantly more often sensitized to Malassezia antigen (58% of men vs 42% of women; P value, 0.04). Concurrently, 58% of patients with HNAD versus 42% non-HNAD patients had higher levels of specific IgE to Malassezia, this difference being nearly significant (P value, 0.06). Patients with atopy were also more frequently sensitized to Malassezia. No significant relationship between EASI and the level of total IgE or specific IgE to Malassezia was observed.

CONCLUSIONS

In our population, IgE-mediated sensitization was found in up to 49% of all patients with AD, most common in men and in head and neck type.