Scalp psoriasis: synergy between the Malassezia yeasts and skin irritation due to calcipotriol.
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.
Faergemann
Jan
J
Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden. jan.faergemann@derm.gu.se
Diehl
Ulf
U
Bergfelt
Louise
L
Brodd
Astrid
A
Edmar
Birgitta
B
Hersle
Kjell
K
Lindemalm
Barbro
B
Nordin
Peter
P
Ringdahl
Ingrid Rossman
IR
Serup
Jørgen
J
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
C055085:calcipotriene; D017964:Itraconazole; D002117:Calcitriol