THE ROLE OF ANTIFUNGAL THERAPY IN THE TREATMENT OF ATOPIC DERMATITIS IN CHILDREN
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Keywords

ketoconazole, atopic dermatitis, Malassezia, children

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Mozyrska, O. (2022). THE ROLE OF ANTIFUNGAL THERAPY IN THE TREATMENT OF ATOPIC DERMATITIS IN CHILDREN . Medical Science of Ukraine (MSU), 18(4), 43-50. https://doi.org/10.32345/2664-4738.4.2022.07

Abstract

Relevance. Atopic dermatitis (AD) is a common multifactorial disease in which allergens from the yeast Malassezia can worsen the severity of the disease. Local application of antimycotic drugs can reduce the allergen load on the skin and improve its condition.

Objective: The aim of this study was to evaluate the effectiveness of ketoconazole 2% cream in the treatment of AD in children as an additional therapy, and the effect of sensitization to Malassezia and polymorphism rs7309123 in the Dectin-1 gene on the effectiveness of treatment.

Materials and methods. 54 patients with atopic dermatitis aged 6-18 years were included in the study. Patients were randomized into two groups: a group receiving ketoconazole cream 2% (n=28) and a control group (n=26). Specific IgE to Malassezia was analyzed in 28 patients of the main group. Genotyping of the rs7309123 polymorphism in the Dectin-1 gene was performed in a group of patients using real-time PCR. Atopic dermatitis disease activity was evaluated before and after treatment using the SCORAD.

Results. Improvement was observed in both groups of children in 3 weeks after treatment (p<0,001). Children who received ketoconazole in addition to therapy had significantly better dynamics of the severity indicator, compared to the control group (W=465,0, p<0,001). The rs7309123 polymorphism in the Dectin-1 gene affected the effectiveness of treatment: ΔSCORAD in the subgroup of children with the CC and CG genotypes was significantly higher than in the subgroup of children with the pathological GG genotype (20,2±11,5 and 13±6,5, respectively, T=2,12, p=0,044).

Conclusion. This study demonstrated the effectiveness of ketoconazole in the treatment of atopic dermatitis as an additional therapy.

https://doi.org/10.32345/2664-4738.4.2022.07
Article PDF (Українська)

References

Volosovets OP, Bolbot Yu.K, Beketova GV, Berezenko VS, Umanets TR, Rechkina OO, Міtiuriaeva-Korniyko IO, Volosovets TМ, Pochinok TV. [Allergic and non-allergic skin diseases in children of Ukraine: a retrospective study of the prevalence and incidence over the past 24 years]. Medicni perspektivi. 2021;26(3):188-196. [in Ukrainian]. DOI: 10.26641/2307-0404.2021.3.242319.

View at:

Publisher Site: https://medpers.dmu.edu.ua/2021-tom-xxvi/n-3#volosovets-op-bolbot-yuk-beketova-hv-berezenko-vs-umanets-tr-rechkina-oo-mitiuriaieva-korniiko-io-volosovets-tm-pochynok-tv-alerhichni-ta-nealerhichni-khvoroby-shkiry-v-ditei-ukrainy-retrospektyvne-doslidzhennia-za-ostanni-24-roky

URL: PubMed: https://medpers.dmu.edu.ua/issues/2021/N3/188-196.pdf

Volosovets O, Kryvopustov S, Mozyrskaya O. [The role of skin microbiome in the development of atopic dermatitis in children]. Child`s health. 2021; 16(3): 251-256. [in Ukrainian]. DOI: 10.22141/2224-0551.16.3.2021.233911

View at:

Publisher Site: https://childshealth.zaslavsky.com.ua/index.php/journal/article/view/1432

Navarro-Triviño FJ, Ayén-Rodríguez Á. Study of Hypersensitivity to Malassezia furfur in Patients with Atopic Dermatitis with Head and Neck Pattern: Is It Useful as a Biomarker and Therapeutic Indicator in These Patients? Life (Basel). 2022 Feb 16;12(2):299. DOI: 10.3390/life12020299

View at:

Publisher Site: https://www.mdpi.com/2075-1729/12/2/299

PubMed: https://pubmed.ncbi.nlm.nih.gov/35207586/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8876740/

Theelen B, Cafarchia C, Gaitanis G, Bassukas ID, Boekhout T, Dawson TL Jr. Malassezia ecology, pathophysiology, and treatment. Med Mycol. 2018 Apr 1;56(suppl_1):S10-S25. DOI: 10.1093/mmy/myx134

View at:

Publisher Site: https://academic.oup.com/mmy/article/56/suppl_1/S10/4925974?login=false

PubMed: https://pubmed.ncbi.nlm.nih.gov/29538738/

Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezia species in healthy skin and in dermatological conditions. Int J Dermatol. 2016; 55(5):494-504. DOI: 10.1111/ijd.13116

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/ijd.13116

PubMed: https://pubmed.ncbi.nlm.nih.gov/26710919/https://pubmed.ncbi.nlm.nih.gov/26710919/

Kohsaka T, Hiragun T, Ishii K, Hiragun M, Kamegashira A, Hide M. Different hypersensitivities against homologous proteins of MGL_1304 in patients with atopic dermatitis. Allergol Int. 2018 Jan;67(1):103-108. DOI: 10.1016/j.alit.2017.05.009

View at:

Publisher Site: https://www.sciencedirect.com/science/article/pii/S1323893017300631?via%3Dihub

PubMed: https://pubmed.ncbi.nlm.nih.gov/28655443/

Maarouf M, Saberian C, Lio PA, Shi VY. Head-and-neck dermatitis: Diagnostic difficulties and management pearls. Pediatr Dermatol. 2018 Nov;35(6):748-753. DOI: 10.1111/pde.13642

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/pde.13642

PubMed: https://pubmed.ncbi.nlm.nih.gov/30152560/

Glatz M, Bosshard PP, Hoetzenecker W, Schmid-Grendelmeier P. The Role of Malassezia spp. in Atopic Dermatitis. J Clin Med. 2015 May 29;4(6):1217-28. DOI: 10.3390/jcm4061217

View at:

Publisher Site: https://www.mdpi.com/2077-0383/4/6/1217

PubMed: https://pubmed.ncbi.nlm.nih.gov/26239555/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484996/

Hau CS, Kanda N, Watanabe S. Suppressive effects of antimycotics on thymic stromal lymphopoietin production in human keratinocytes. J Dermatol Sci. 2013 Sep;71(3):174-83. DOI: 10.1016/j.jdermsci.2013.04.023

View at:

Publisher Site: https://www.jdsjournal.com/article/S0923-1811(13)00143-6/fulltext

PubMed: https://pubmed.ncbi.nlm.nih.gov/23688403/

Bogiatzi SI, Guillot-Delost M, Cappuccio A, Bichet JC, Chouchane-Mlik O, Donnadieu MH, Barillot E, Hupé P, Chlichlia K, Efremidou EI, Aractingi S, Bayrou O, Soumelis V. Multiple-checkpoint inhibition of thymic stromal lymphopoietin-induced TH2 response by TH17-related cytokines. J Allergy Clin Immunol. 2012;130(1):233-40.e5. DOI: 10.1016/j.jaci.2012.04.038

View at:

Publisher Site: https://www.jacionline.org/article/S0091-6749(12)00714-2/fulltext

PubMed: https://pubmed.ncbi.nlm.nih.gov/22664159/

Wong AW, Hon EK, Zee B. Is topical antimycotic treatment useful as adjuvant therapy for flexural atopic dermatitis: randomized, double-blind, controlled trial using one side of the elbow or knee as a control. Int J Dermatol. 2008;47(2):187-91. DOI: 10.1111/j.1365-4632.2008.03414.x

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2008.03414.x

PubMed: https://pubmed.ncbi.nlm.nih.gov/18211496/

Kabashima-Kubo R, Nakamura M, Sakabe J, Sugita K, Hino R, Mori T, Kobayashi M, Bito T, Kabashima K, Ogasawara K, Nomura Y, Nomura T, Akiyama M, Shimizu H, Tokura Y. A group of atopic dermatitis without IgE elevation or barrier impairment shows a high Th1 frequency: possible immunological state of the intrinsic type. J Dermatol Sci. 2012;67(1):37-43. DOI: 10.1016/j.jdermsci.2012.04.004

View at:

Publisher Site: https://www.jdsjournal.com/article/S0923-1811(12)00136-3/fulltext

PubMed: https://pubmed.ncbi.nlm.nih.gov/22591815/

Ishibashi Y, Sugita T, Nishikawa A. Cytokine secretion profile of human keratinocytes exposed to Malassezia yeasts. FEMS Immunol Med Microbiol. 2006;48(3):400-9. DOI: 10.1111/j.1574-695X.2006.00163.x.

View at:

Publisher Site: https://academic.oup.com/femspd/article/48/3/400/506749?login=false

PubMed: https://pubmed.ncbi.nlm.nih.gov/17069617/

Choi FD, Juhasz MLW, Atanaskova Mesinkovska N. Topical ketoconazole: a systematic review of current dermatological applications and future developments. J Dermatolog Treat. 2019 Dec;30(8):760-771. DOI: 10.1080/09546634.2019.1573309

View at:

Publisher Site: https://www.tandfonline.com/doi/abs/10.1080/09546634.2019.1573309?journalCode=ijdt20

PubMed: https://pubmed.ncbi.nlm.nih.gov/30668185/

Tao R, Wang R, Wan Z, Song Y, Wu Y, Li R. Ketoconazole 2% cream alters the skin fungal microbiome in seborrhoeic dermatitis: a cohort study. Clin Exp Dermatol. 2022 Jun;47(6):1088-1096. DOI: 10.1111/ced.15115.

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/ced.15115

PubMed: https://pubmed.ncbi.nlm.nih.gov/35092701/

Galvis-Marín JC, Rodríguez-Bocanegra MX, Pulido-Villamarín ADP, Castañeda-Salazar R, Celis-Ramírez AM, Linares-Linares MY. [In vitro antifungal activity of azoles and amphotericin B against Malassezia furfur by the CLSI M27-A3 microdilution and Etest® methods]. Rev Iberoam Micol. 2017 Apr-Jun;34(2):89-93. [in Spanish]. DOI: 10.1016/j.riam.2016.05.004

View at:

Publisher Site: https://www.sciencedirect.com/science/article/abs/pii/S1130140616300560?via%3Dihub

PubMed: https://pubmed.ncbi.nlm.nih.gov/28214276/

Joo H, Upchurch K, Zhang W, Ni L, Li D, Xue Y, Li X-H, Hori T, Zurawski S, Liu Y-J, Zurawski G, Oh SK. Opposing Roles of Dectin-1 Expressed on Human Plasmacytoid Dendritic Cells and Myeloid Dendritic Cells in Th2 Polarization. J Immunol. 2015;195(4):1723-1731. DOI:10.4049/jimmunol.1402276

View at:

Publisher Site: https://journals.aai.org/jimmunol/article/195/4/1723/108970/Opposing-Roles-of-Dectin-1-Expressed-on-Human

PubMed: https://pubmed.ncbi.nlm.nih.gov/26123355/

PubMed Central: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530104/

Chen MJ, Hu R, Jiang XY, Wu Y, He Z-P, Chen J-Y, Zhan L. Dectin-1 rs3901533 and rs7309123 Polymorphisms Increase Susceptibility to Pulmonary Invasive Fungal Disease in Patients with Acute Myeloid Leukemia from a Chinese Han Population. Curr Med Sci. 2019;39(6):906-912. DOI:10.1007/s11596-019-2122-3

View at:

Publisher Site: https://link.springer.com/article/10.1007/s11596-019-2122-3

PubMed: https://pubmed.ncbi.nlm.nih.gov/31845221/

Ikezawa Z, Kondo M, Okajima M, Nishimura Y, Kono M. Clinical usefulness of oral itraconazole, an antimycotic drug, for refractory atopic dermatitis. Eur J Dermatol. 2004 Nov-Dec;14(6):400-6

View at:

PubMed: https://pubmed.ncbi.nlm.nih.gov/15564204/

Okiyama N, Nakamura Y, Ishitsuka Y, Inoue S, Kubota N, Saito A, Watanabe R, Fujisawa Y, Igawa K. Successful topical treatment with ketoconazole for facial rashes refractory to dupilumab in patients with atopic dermatitis: case reports. J Eur Acad Dermatol Venereol. 2020 Sep;34(9):e474-e476. DOI: 10.1111/jdv.16383

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/jdv.16383

PubMed: https://pubmed.ncbi.nlm.nih.gov/32215964/

Seckin D, Gurbuz O, Akin O. Metronidazole 0.75% gel vs. ketoconazole 2% cream in the treatment of facial seborrheic dermatitis: Arandomized, double-blind study. J Eur Acad Dermatology Venereol. 2007;21(3):345-350. DOI: 10.1111/j.1468-3083.2006.01927.x

View at:

Publisher Site: https://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2006.01927.x

PubMed: https://pubmed.ncbi.nlm.nih.gov/17309456/

Wannanukul S, Chiabunkana J. Comparative study of 2% ketoconazole cream and 1% hydrocortisone cream in the treatment of infantile seborrheic dermatitis. J Med Assoc Thai. 2004 Sep;87(Suppl 2):S68-71.

View at:

PubMed: https://pubmed.ncbi.nlm.nih.gov/16083165/

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