Comparison of the Efficacies of Topical Liposomal Amphotericin B and Topical Clotrimazole in the Treatment of Pityriasis Versicolor

Comparison of the Efficacies of Topical Liposomal Amphotericin B and Topical Clotrimazole in the Treatment of Pityriasis Versicolor

Authors

  • Mehdi Ghahartars Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
  • Hossein Hosseini Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
  • Malek Khedri Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran
  • Maryam Sadat Sadati Molecular Dermatology Research Center, Dermatology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

Keywords:

amphotericin B, clotrimazole, pityriasis versicolor, topical treatment

Abstract

Introduction: Pityriasis versicolor (PV) often exhibits recurrence even despite treatment, and a standardized therapy with a complete cure rate remains elusive. Given the fungicidal property of amphotericin B, its potential for PV treatment warrants investigation. 

Objectives: This study aimed to compare the efficacy of topical liposomal amphotericin B and clotrimazole cream in treating PV.

Methods: A randomized controlled trial was conducted with 44 PV patients, aged 15 to 70 years, who were equally assigned to either the amphotericin or clotrimazole group. The trial was registered at the Iranian Registry of Clinical Trials on March 7th, 2022. PV diagnosis was confirmed in all patients through positive microscopic results. The amphotericin group received topical gel containing liposomal amphotericin B 0.4%, while the other group received topical cream containing clotrimazole 1%. Both treatments were applied twice daily to the affected skin lesions for 14 days. The primary outcomes assessed were mycologic cure, clinical cure, and complete cure at day 14 post-treatment.

Results: Both drugs demonstrated successful treatment outcomes, with comparable rates of mycologic cure (77.3%), clinical cure (63.6%), and complete combined cure (63.6%). There was no significant difference between the groups in terms of the degree of cure (P=0.75).  Adjustments for age, sex, lesion extent, and lesion site yielded insignificant risk ratio and risk difference estimates for the complete cure rate (P>0.05).

Conclusions: The topical application of liposomal amphotericin B 0.4% is equally effective as topical clotrimazole 1% in treating pityriasis versicolor. These findings suggest that liposomal amphotericin B could be considered as a viable alternative treatment for PV. Further research is warranted to explore its long-term consequences and safety profile.

References

Gupta A K, Foley K A. Antifungal Treatment for Pityriasis Versicolor. J Fungi (Basel). 2015;1(1):13-29 DOI:10.3390/jof1010013. PMID: 29376896. PMCID: PMC5770013.

Shahid J, Ihsan Z, Khan S. Oral fluconazole in the treatment of pityriasis versicolor. J Dermatolog Treat. 2000;11(2):101-103. DOI:10.1080/09546630050517496.

Gupta A K, Kogan N, Batra R. Pityriasis versicolor: a review of pharmacological treatment options. Expert Opin Pharmacother. 2005;6(2):165-178 DOI:10.1517/14656566.6.2.165. PMID: 15757415.

Hay R. Antifungal drugs-an introduction. J Dermatolog Treat. 1990;1(sup2):1-3. DOI:10.3109/09546639009089020.

Carlile M J, Watkinson S C, Gooday G W. The Fungi. Elsevier Science; 2001;3:179.

Pazouki M, Panda T. Understanding the morphology of fungi. Bioprocess Biosyst eng. 2000;22:127-143. DOI:10.1007/s004490050022.

Heitman J, Carter D A, Dyer P S, Soll D R. Sexual reproduction of human fungal pathogens. Cold Spring Harb Perspect Med. 2014;4(8):a019281. DOI:10.1101/cshperspect.a019281. PMID: 25085958. PMCID: PMC4109574.

Bamford JTM, Flores‐Genuino RNS, Ray S, et al. Interventions for the treatment of pityriasis versicolor. Cochrane Database Syst Rev. 2018;2018(6):CD011208. DOI: 10.1002/14651858.CD011208.pub2. PMCID: PMC6513390.

Ahmed N, Kausar S, Shaikh Z, Malik S. Comparison of oral itraconazole versus topical clotrimazole in treatment of pityriasis versicolor. Pak Armed Forces Med J. 2017;67:458-461.

Shi T-W, Zhang J-A, Tang Y-B, Yu H-X, Li Z-G, Yu J-B. A randomized controlled trial of combination treatment with ketoconazole 2% cream and adapalene 0.1% gel in pityriasis versicolor. J Dermatolog Treat. 2015;26(2):143-146. DOI:10.3109/09546634.2014.921661. PMID: 24802530.

Mellen L A, Vallee J, Feldman S R, Fleischer A B. Treatment of pityriasis versicolor in the United States. J Dermatolog Treat. 2004;15(3):189-192. DOI:10.1080/09546630410032421. PMID: 15204154.

Balwada R P, Jain V K, Dayal S. A double-blind comparison of 2% ketoconazole and 1% clotrimazole in the treatment of pityriasis versicolor. Indian J Dermatol Venereol Leprol. 1996;62(5):298-300. PMID: 20948094.

Chopra V, Jain V K. Comparative study of topical terbinafine and topical ketoconazole in pityriasis versicolor. Indian J Dermatol Venereol Leprol. 2000;66(6):299-300. PMID: 20877107.

Mansoori P, Mortazavi M. A comparison between topical Griseofulvin and topical Clotrimazole in Tinea Versicolor. Tehran Univ Medical J. 1998;56(2):35-37.

Sharquie K E, Al-Hamamy H M, Noaimi A A, Al-Shawi I A. Treatment of pityriasis versicolor using 1% diclofenac gel and clotrimazole cream (comparative therapeutic study). Journal of the Saudi Society of Dermatology & Dermatologic Surgery. 2011;15(1):19-23.DOI: 10.1016/j.jssdds.2010.10.004.

Köse O, Taştan H B, Gür A R, Kurumlu Z. Comparison of a single 400 mg dose versus a 7-day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. J Dermatolog Treat. 2002;13(2):77-79. DOI:10.1080/095466302317584430. PMID: 12060506.

Dehghan M, Akbari N, Alborzi N, Sadani S, Keshtkar A A. Single-dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. J Dermatol. 2010;37(8):699-702. DOI:10.1111/j.1346-8138.2010.00908.x. PMID: 20649710.

Sepaskhah M, Sadat M S, Pakshir K, Bagheri Z. Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: A single blind, randomised clinical trial. Mycoses. 2017;60(5):338-342. DOI:10.1111/myc.12598. PMID: 28120351.

Khosravi A R, Shokri H, Darabi M H, Kashani A, Mansouri P, Naser A. Comparative study on the effects of a new antifungal lotion (Artemisia sieberi essential oil) and a clotrimazole lotion in the treatment of pityriasis versicolor. J Mycol Med. 2009;19(1):17-21. DOI: 10.1016/j.mycmed.2008.12.001.

Rezvani, SM, Sefid Gar S. Efficacy of Terbinafine 1% cream versus Clotrimazole 1% cream in the treatment of Pityriasis Versicolor. J Babol Univ Med Sci. 2006;8(2):42-46.

Budimulja U, Paul C. One-week terbinafine 1% solution in pityriasis versicolor: twice-daily application is more effective than once-daily. J Dermatolog Treat. 2002;13(1):39-40. DOI:10.1080/09546630252775243. PMID: 12006138.

LakshmiTatavarthiN, B., Ramachandra, B.V., Subbarao, D.V., Srinivasulu, G. Clinical Evaluation of Efficacy of Sertaconazole 2% Cream in Treatment of Pityriasis Versicolor and a Comparison with that of Clotrimazole 1% Cream. J Evol Med Dent Sci. 2015;4:4668-4675. DOI:10.14260/jemds/2015/675.

Hibbett D S, Donoghue M J. Integrating phylogenetic analysis and classification in fungi. Mycologia. 1998;90:347-356.

Zaini F, A. Mehbod, and M. Emami. Comprehensive Medical Mycology. Tehran: Tehran University publications; 2013;9:632-635 [Book in Persian].

Khatter NJ, Khan MAB. Clotrimazole. 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. PMID: 32809478.

Faustino C, Pinheiro L. Lipid Systems for the Delivery of Amphotericin B in Antifungal Therapy. Pharmaceutics. 2020;12(1):29. DOI: 10.3390/pharmaceutics12010029. PMID: 31906268. PMCID: PMC7023008.

Frézard F, Aguiar M M G, Ferreira L A M, Ramos G S, Santos T T, Borges G S M, et al. Liposomal Amphotericin B for Treatment of Leishmaniasis: From the Identification of Critical Physicochemical Attributes to the Design of Effective Topical and Oral Formulations. Pharmaceutics. 2022;15(1):99. DOI: 10.3390/pharmaceutics15010099. PMID: 36678729. PMCID: PMC9864876.

Muddasani S, Peck G, Fleischer A B. Systemic ketoconazole continues to be prescribed despite an FDA warning. J Dermatolog Treat. 2022;33(3):1787-1788. DOI:10.1080/09546634.2020.1836308. PMID: 33076731.

Leeming J P, Notman F H. Improved methods for isolation and enumeration of Malassezia furfur from human skin. J Clin Microbiol. 1987;25(10):2017-2019. DOI:10.1128/jcm.25.10.2017-2019.1987. PMID: 3667925. PMCID: PMC269393.

Downloads

Published

2024-01-31

Issue

Section

Original Article

How to Cite

1.
Comparison of the Efficacies of Topical Liposomal Amphotericin B and Topical Clotrimazole in the Treatment of Pityriasis Versicolor. Dermatol Pract Concept [Internet]. 2024 Jan. 31 [cited 2024 Jul. 13];14(1):e2024083. Available from: https://dpcj.org/index.php/dpc/article/view/3736

Share