Itraconazole versus ketoconazole in the treatment of tinea versicolor

Abstract

Tinea versicolor is a chronic superficial infection of the skin, caused by Malassezia furfur. The disease is recurrent and hard to eradicate with topical antifungal agents. In this study we compared the efficacy, safety and tolerability of three regimens of oral treatment for tinea versicolor: itraconazole 200 mg/day for 1 week, itraconazole 100 mg/ day for 2 weeks and ketoconazole 800 mg in 2 weekly doses of 400 mg. We randomly assigned 105 patients with extensive tinea versicolor to receive each of the three regimens and followed the patients for 16 weeks (a longer period than usual). At every visit, we checked the presence of tinea versicolor by direct KOH preparation and Wood's lamp, and the presence of signs and symptoms of infection were recorded. Of the 105 patients, 89 completed the study, and no major side-effects were noted with any of the treatment regimens. Our results show that there were no significant differences in efficacy (cure rate), safety and tolerability between the three treatment regimens. The maximal cure rate was achieved after 8 weeks from the start of treatment and decreased slightly afterwards. We also demonstrated a lack of correlation between mycological cure and hypopigmentation at the end of treatment (2 weeks) and the usefulness of Wood's lamp examination in detecting cure of tinea versicolor.