title: Scalp psoriasis: synergy between the Malassezia yeasts and skin irritation due to calcipotriol.
abstract: To investigate if there is a synergy between the presence of the Malassezia yeasts and the adverse reaction during treatment of scalp psoriasis with calcipotriol scalp solution, patients were treated with itraconazole to reduce the number of Malassezia yeasts. This study was a double-blind, placebo-controlled parallel group study between oral itraconazole or placebo for 8 weeks in patients with scalp psoriasis. After 2 weeks, calcipotriol scalp solution was applied twice daily for 6 weeks. Altogether 137 patients, 67 in the itraconazole group and 70 in the placebo group, comprised the intention-to-treat population. There were 13 (19.4%) patients with local skin irritation in the itraconazole group compared to 33 (47.1%) in the placebo group (p < 0.001). The skin irritation was significantly lower in patients with a low number of cultured Malassezia yeasts (p = 0.017). Thus, when Malasessia was eliminated or the numbers reduced, the irritation produced by calcipotriol was significantly diminished.
authors.affiliation: Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden. jan.faergemann@derm.gu.se
authors.forename: Jan
authors.initials: J
authors.lastname: Faergemann
authors.forename: Ulf
authors.initials: U
authors.lastname: Diehl
authors.forename: Louise
authors.initials: L
authors.lastname: Bergfelt
authors.forename: Astrid
authors.initials: A
authors.lastname: Brodd
authors.forename: Birgitta
authors.initials: B
authors.lastname: Edmar
authors.forename: Kjell
authors.initials: K
authors.lastname: Hersle
authors.forename: Barbro
authors.initials: B
authors.lastname: Lindemalm
authors.forename: Peter
authors.initials: P
authors.lastname: Nordin
authors.forename: Ingrid Rossman
authors.initials: IR
authors.lastname: Ringdahl
authors.forename: Jørgen
authors.initials: J
authors.lastname: Serup
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D002117:Calcitriol / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003881:Dermatomycoses / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004357:Drug Synergism; D005260:Female; D005500:Follow-Up Studies; D049671:History, 18th Century; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008290:Malassezia / Q000187:drug effects* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011336:Probability; D011565:Psoriasis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012536:Scalp Dermatoses / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: C055085:calcipotriene; D017964:Itraconazole; D002117:Calcitriol