Ketoconazole Cream Research Articles

Novel therapeutic deep eutectic system for the enhancement of ketoconazole antifungal activity and transdermal permeability

In this study, we reported the investigation of a novel therapeutic deep eutectic system (THEDES) formed between capric acid (CA) and ketoconazole (KCZ) to enhance the permeability and efficacy of the antifungal drug KCZ. A THEDES was formulated by combining KCZ and CA at different molar ratios, with a 1:5 ratio (K5) representing the most stable and lowest melting point. Characterization of the interactions between CA and KCZ using NMR and FT-IR spectroscopy revealed a hydrogen bonding interaction between the amine group of KCZ’s imidazole ring and the carboxylic acid moiety of CA. This interaction resulted in converting the solid materials into liquid at room temperature, leading to a significant decrease in the melting points of the components, as confirmed by DSC. Next, the effectiveness of K5 as an antifungal agent against Candida albicans was evaluated. The results indicated a 2-fold reduction in the minimum inhibitory concentration (MIC). In addition, permeability studies conducted using a Franz diffusion cell revealed a significant enhancement in permeability with a 6.19-fold increase in flux compared to commercially available KCZ cream. The findings suggest that fatty acid-based deep eutectic systems, such as the KCZ THEDES, can serve as effective and green drug delivery systems, offering significant enhancements in drug permeability and therapeutic performance. This approach improves the efficacy of drugs and promotes the development of eco-friendly pharmaceutical formulations.

Tinea capitis caused by Microsporum canis: A case study of three family members in India, a non-endemic region

Tinea capitis, a common scalp infection primarily affecting children, is caused by keratinophilic dermatophytic fungi, notably Microsporum and Trichophyton species. Microsporum canis, primarily transmitted from cats and dogs to humans, is rarely reported in non-endemic regions like India. We report a cases involving three family members from Delhi, India, diagnosed with tinea capitis caused by Microsporum canis. The index case, a five-year-old boy, contracted the infection through contact with a cat, while his younger brother and sister acquired it through human-to-human transmission within the family. Clinical examination, microscopic analysis, and molecular identification techniques confirmed the diagnosis. Antifungal susceptibility testing revealed sensitivity to itraconazole and terbinafine but resistance to griseofulvin. Treatment with oral terbinafine and topical ketoconazole cream led to successful outcomes for all three patients. Molecular typing confirmed clonality of the isolates, indicating human-to-human transmission. This case study underscores the significance of considering atypical sources of infection and human-to-human transmission in the diagnosis and management of tinea capitis caused by Microsporum canis in non-endemic regions. It emphasizes the necessity of thorough contact history assessment and appropriate antifungal therapy for effective control of the infection.

Influence of nanocarrier additives on biomechanical response of a rat skin.

Skin health monitoring focuses on identifying diseases through the assessment of the mechanical properties of the skin. These properties may degrade with time, which can alter the skin's natural frequencies and the form of the modes associated with those frequencies. Exploring the skin's mechanical properties can enhance our understanding of its dynamics, improving clinical trials and diagnostics. In this work, the dynamics of the skin were measured using a laser-based non-invasive optical sensor experiment. We measured the skin's mechanical properties over time by analyzing its resonant frequencies and mode shapes. A nanocarrier gel and ketoconazole cream were topically applied to keep the skin hydrated and facilitate deeper penetration of the additives in the skin. Time-based research was used to assess the effect of different formulations on skin elasticity. Experimental results for the modulus of elasticity were compared with those obtained using Finite Element Analysis (FEA) simulations. We observed a reduction in frequencies of cream and gel-treated skin by 29.98% and 44.029% respectively compared to normal skin (frequency: 263.3 ± 1.18 Hz and Modulus of elasticity: 7.56 ± 2.60 MPa). A decrease in stiffness (function of frequency) attributed to increased water content, was observed in cream- and nanocarrier gel-treated skin compared to normal skin. Experimental and numerical results are found to be consistent with one another. This optical sensor-based approach has the potential for studying diseased skin mechanics and its response to gel and cream treatments, aiming to reduce skin disorder morbidity and severity.

DERMATOPHYTOSIS CAUSED BY TRICHOPHYTON SPP. IN A LOCAL KITTEN

A local male kitten aged 2 months, weighing 0.57 kg, experienced itching and hair loss for a week. Clinical examination showed that in several parts of the body there were ring-shaped lesions with alopecia and scale. To confirm the diagnosis, routine hematological examinations, Tape Acetate Smears, and Superficial Skin Scraping are carried out. Routine hematological examination showed that the cat had hypochromic anemia. The results of the Acetate Smear Tape examination showed the presence of Trychophyton spp., whereas in Superficial Skin Scraping no agents were found. Treatment given to case cat diagnosed with dermatophytosis due to Trychophyton spp. was by administering Ketoconazole cream 2% twice a day for four weeks topically, fish oil once a day one capsule for 14 days PO, multivitamin syrup supplement 0.2 mL once a day for seven days PO, and sulfur soap once a week topically. The treatment given gave good results. After 4 weeks of treatment, clinical signs of the skin showed significant improvement marked by the scale that has disappeared and hair around the lesion that has started to grow. Suggestions for giving topical drugs are given by cleaning the lesions first and then applying topical drugs so that the drugs can work more effectively to achieve good healing and the animals are routinely dried in the sun so they can be exposed to sunlight.

Generalized Demodicosis and Malasseziosis in a Pug Mix Dog

A 12-year-old female pug mix dog presented a skin problem with itching, and alopecia in the neck, facial, and extremity areas. Findings of scales, hyperpigmentation, and erythema are present almost throughout the body, along with crusts on the cranial and caudal extremities and a foul body odor. Wood's lamp examination revealed a yellowish-green fluorescence in the ear and ventral areas of the body. The skin tape examination revealed an infestation of Demodex sp. mites accompanied by Malassezia sp. hematological analysis indicated that the dog presented anemia. The dog was diagnosed with demodicosis with a secondary infection of Malassezia sp. The therapy provided consisted of antiparasitic drugs such as imidacloprid and moxidectin (Advocate®); the long-acting antibiotic enrofloxacin was administered at a dose of 200 mg intramuscularly, along with the oral antibiotic amoxicillin and clavulanic acid at a dose of 31.25mg/kg BW every 12 hours. Additionally, oral antifungal medication ketoconazole was given at 25mg/kg BW every 12 hours, along with ketoconazole cream. Oral antihistamine mebhydroline napsylate was administered at 25mg/kg BW every 12 hours. Furthermore, multivitamins and hair vitamins were given at a dose of 2 ml once every 24 hours. After seven days of treatment, an evaluation was conducted, and it was observed that the dog's condition had improved, indicated by a reduction in the intensity of scratching.

Unique green chromatographic method for the qualitative and quantitative analysis of ketoconazole, its impurities and preservatives from ketoconazole cream formulation: Identification of degradants by Q-ToF LCMS and Robustness by Design of Experiments

Current research portrays a simultaneous determination method for the qualitative and quantitative analysis of Ketoconazole, its impurities and preservatives from Ketoconazole cream formulation. The unique method was developed using the RP-UPLC technique with a gradient elution mode. The separation of isomeric preservative components was achieved on the Waters Acquity UPLC BEH C18 column using phosphate buffer as mobile phase A and a mixture of phosphate buffer and acetonitrile, 30:70 (v/v) as mobile phase B. The set flow rate, injection volume, column oven temperature, and detector wavelengths were 0.5 mL/min, 2.0 μL, 30 °C, and 225 nm, respectively. The method's stability indicating nature was achieved through forced degradation studies. The active drug was prone to acidic and oxidative conditions. The attained acidic and peroxide degradant peaks were identified using Q-ToF LCMS. The developed method was validated per regulatory guidelines, and the data showed superior precision with a %RSD of 0.7 for Ketoconazole, 0.8 for preservatives, and 1.6 for impurities. All the components showed excellent linearity (r > 0.999) within the 50–150% range for Ketoconazole and preservatives and from LOQ to 150% for impurities. The mean accuracy data resulted from 99.4% to 99.9% for Ketoconazole, 99.9%–106.0% for impurities, and 100.3%–101.4% for butylated hydroxyanisole. The robust method conditions were evaluated by the Design of Experiments. The greenness and eco-friendliness of the method were demonstrated by modern tools such as the analytical eco scale, GAPI and AGREE. The final UPLC method is specific and suitable for determining the preservatives, drug content and impurities of Ketoconazole simultaneously from its cream formulation, which saves analysis time and solvent consumption supporting towards the green chemistry principles.

Development and Evaluation of Nanoformulations Containing Timur Oil and Rosemary Oil for Treatment of Topical Fungal Infections.

The pervasiveness of fungal infections is an issue for skin health globally, and there are a reported 40 million cases in developed and developing countries. Novel drug delivery systems provide better therapeutic efficacy over conventional drug therapy due to their lower side effects and toxicity. Furthermore, combinations of essential oils can represent alternative therapies for fungal infections that are resistant to synthetic drugs. This study is aimed at developing Timur oil into a nanoemulgel and evaluating its antifungal effects. The development of the formulation involved the preparation of a nanoemulsion by the titration method, followed by its evaluation for various physicochemical properties. The antifungal activity of the nanoemulgel against Candida albicans was evaluated. The zone of inhibition was determined using the disk diffusion method. The results show that the developed nanoemulgel has a particle size of 139 ± 6.11 nm, a PDI of 0.309, and a zeta potential of -19.12 ± 2.73 mV. An in vitro drug release study showed a sustained release of 70 ± 0.289% of the drug over a period of 24 h. The % drug permeation across the skin was found to be 79.11 ± 0.319% over 24 h. However, the amount of drug retained in the skin was 56.45 µg/g. The flux for the nanoemulgel was found to be 94.947 µg/cm2/h, indicating a better permeability profile. The nanoemulgel formulation showed a zone of inhibition of 15 ± 2.45 mm, whereas the 1% ketoconazole cream (marketed preparation) exhibited a zone of inhibition of 13 ± 2.13 mm. The results of this study suggest that developed nanoemulgel containing Timur oil and rosemary oil has the potential to be used for treating topical fungal infections caused by Candida albicans.

Formulation and Evaluation of Herbal Excipients-Based Ketoconazole Cream for Fungal Infection

The goals of the current studies were to create herbal excipients-based ketoconazole cream to enhance the efficacy against chronic mucocutaneous candidiasis. Ketoconazole, coconut oil and other herbal excipients namely shea butter, bees wax, Lanolin and Rose oil were used for the formulation. Each formulation was prepared with various concentrations of coconut oil. Every prepared formulations were evaluated successfully. Among all the formulations F4 was the best that exhibiting a higher in vitro diffusion rate 59.6 ± 0.10 % CDR within 480 min with maximum antifungal efficacy, compared with the marketed formulation. We might therefore say that herbal excipients-based cream improved patient compliance and is a superior alternative to oral preparation, easier administration, local bioavailability, and better results for individuals with persistent mucocutaneous candidiasis who are afflicted with fungi.

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

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.

In Vitro, Ex Vivo, and In Vivo Evaluation of Nanoparticle-Based Topical Formulation Against Candida albicans Infection.

Ketoconazole is commonly used in the treatment of topical fungal infections. The therapy requires frequent application for several weeks. Systemic side effects, allergic reactions, and prolonged treatment are often associated with non-compliance and therapy failure. Hence, we developed an optimized topical antifungal gel that can prolong the release of drug, reduce systemic absorption, enhance its therapeutic effect, and improve patient compliance. Ketoconazole-loaded PLGA nanoparticles were prepared by the emulsion/solvent evaporation method and were characterized with respect to colloidal properties, surface morphology, and drug entrapment efficiency. The optimized ketoconazole-loaded PLGA nanoparticles and commercially available silver nanoparticles were incorporated into a Carbopol 934P-NF gel base. This arrangement was characterized and compared with commercially available 2% ketoconazole cream to assess physical characteristics of the gel, in vitro drug release, ex vivo skin permeation and retention, and in vivo studies on Wister male albino rats. The results showed that polymeric PLGA nanoparticles were very effective in extending the release of ketoconazole in our optimized formulation. Nanoparticles were smooth, spherical in shape, and below 200 nm in size which is consistent with the data obtained from light scattering and SEM images. The ex vivo data showed that our gel formulation could strongly reduce drug permeation through the skin, and more than 60% of the drug was retained on the upper surface of the skin in contrast to 38.42% of the commercial cream. The in vivo studies showed that gel formulation could effectively treat the infection. This study demonstrates that our topical gel could be effective in sustaining the release of drug and suggests its potential use as a possible strategy to combat antifungal-resistant Candida albicans.

Erythematous scaly plaques with erosions in a 4-month-old

A 4-month-old previously healthy full-term, exclusively breastfed male infant presented with a rash on the face, arms, and diaper area for 4 weeks. The patient was previously treated by his pediatrician with nystatin cream, ketoconazole cream, hydrocortisone 2.5% ointment, and oral clindamycin without significant improvement. The family history was unremarkable. There were well-demarcated erythematous crusted plaques with focal erosions of the perioral, genital, and acral skin and scattered scaly erythematous plaques on the extremities (Fig 1, A-C).

728 Chemical Burns and Eyebrow Tinting: An Unusual Case

IntroductionHere we present the case of chemical burns following professional eyebrow tinting, a phenomenon rarely described in the literature.MethodsA 50-year-old previously healthy female presented to our emergency department for evaluation and treatment of chemical burns to her eyebrows. Fifteen days prior, she underwent professional eyebrow tinting by a local esthetician. Blistering developed the following day, and progressive swelling prompted her to present to an outside hospital. There she was prescribed acyclovir, ketoconazole cream, and silver sulfadiazine, but despite these measures, her symptoms progressed, leading to her presentation to our facility. Both brows were remarkable for significant swelling with exudative crushing on the surface concerning for superficial infection of partial-thickness chemical burns. She was prescribed bacitracin, prednisone, and clindamycin and discharged with instructions to follow up in burn clinic. Six days later, both brows had developed 2x3 cm scabs, but no signs of infection were appreciated. She was instructed to apply bacitracin/polymyxin B ointment to the scabbing areas and open wounds. Forty-nine days after her tinting, both brows were noted to be completely healed with no alopecia.ResultsBurns following cosmetic procedures most commonly occur during hair lightening treatments where products frequently contain caustic chemicals such a hydrogen peroxide or persulphates leading to oxidation reactions lightening the hair. Thermal burns in hair salons have also been reported to heated hair-dressing instruments or external heat to hasten the highlighting process.The periorbital area is becoming an increasingly popular target for nonsurgical cosmetic procedures, including permanent eyelid tattooing, eyelash dying, and extensions, more recently, eyebrow tinting. Eyebrow tinting involves the application of semipermanent dyes to give the appearance of a fuller brow. There are no FDA-approved brow tinting formulations, and many contain para-phenylenediamine (PPD), a dying agent frequently associated with allergic dermatitis and less commonly chemical burns. This patient underwent brow tinting in a professional setting and still experienced a chemical burn. As the popularity of brow tinting increases, some patients will undoubtfully seek out readily available, unregulated products for self-application. The potential for dermatitis and chemical burns following eyebrow tinting will only increase.ConclusionsEyebrow tinting is not a benign cosmetic procedure, and even professional application of dyes may lead to chemical burns. We believe an increased awareness of brow tinting and its potential complications is warranted given its increasing popularity, the preponderance of unregulated products, and the potential for poor cosmetic outcomes.

DESIGN OF TEA TREE OIL-LOADED NANOSTRUCTURED LIPID CARRIERS: PREPARATION AND IN VITRO ANTIFUNGAL ACTIVITY

Tea tree oil (TTO) is a promising essential oil that has enormous potential for antifungal development. However, its pharmacological applications have several limitations, including volatility and an extensive range of partition coefficients. To overcome these, TTO can be loaded into a nanostructured lipid carrier (NLC). The combination of solid and liquid lipids and production conditions affect the characteristics of the NLC formed. This study aimed to design TTO-loaded NLCs with appropriate particle sizes to improve the therapeutic efficacy of TTO as an antifungal agent. The novelty of this research is the discovery of a stable and potential TTO loaded NLC formula as a topical antifungal agent. TTO-loaded NLCs were prepared using the high-shear homogenization method with formulas consisting of TTO, solid lipids, liquid lipids, surfactants, and distilled water. Then, they were characterized with particular attention to average particle size, polydispersity, zeta potential, pH, and viscosity. Further tests included physical stability for one month at room temperature (27±2 °C) and in vitro antifungal activity using the well diffusion method. TTO-loaded NLCs combining stearic acid, glyceryl monostearate, and cetyl alcohol (solid lipids) with Miglyol 812 and olive oil (liquid lipids) showed relatively small average particle sizes and low polydispersity index values. Also, the stirring speed did not affect the particle size. It was found that TTO exhibited in vitro antifungal activities as good as ketoconazole cream. This study has successfully combined various solid and liquid lipids to formulate TTO-loaded NLCs with favorable stability for one-month storage and great antifungal potential.

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?

Atopic dermatitis (AD) is one of the most prevalent chronic inflammatory diseases. Head and neck (H&N) involvement, also known as the picture-frame pattern, can be a diagnostic and even therapeutic challenge. Sensitization to the fungus Malassezia furfur seems to be implicated in this clinical presentation. To investigate the role of Malassezia furfur in H&N dermatitis, we performed an observational single-centre study. Serum-specific IgE levels for Malassezia furfur were determined in a total of 25 patients with AD (15 receiving dupilumab treatment, 10 not receiving dupilumab), 14 patients with seborrheic dermatitis, and 19 healthy controls. Reactivity to Malassezia furfur, in terms of serum-specific IgE levels (>0.35 Ku.arb./L), was found in 80% of patients with AD. Risk factors to consider include high total IgE levels, sensitization to multiple pneumoallergens, and elevated LDH and CRP levels. Prescription of topical antifungals, oral antifungals, or a combination of both showed good response in 100% of cases in the H&N AD group treated with dupilumab. The most appropriate treatment seems to be the use of oral itraconazole and/or ketoconazole cream. The median treatment time was 3 weeks. Localized dermatitis in H&N significantly affects the patient’s life. We present a study of sensitization to Malassezia furfur in patients with H&N AD. It is important to know the differential diagnosis and to approach the study correctly. Sensitization to Malassezia furfur may be one of the main reasons, especially in patients being treated with dupilumab. The use of antifungals allows for adequate control, avoiding treatment changes and improving the patient’s quality of life.

Ketoconazole 2% cream versus a combination of ketoconazole 2% cream and adapalene 0.1% gel in the treatment of pityriasis versicolor

Background and aim Pityriasis versicolor is a common chronic superficial fungal infection that manifests during or after puberty in hot humid temperatures. Topical treatments, which are the first line of treatment, are divided into nonspecific and specific antifungal agents; however, the therapeutic approaches for pityriasis versicolor depend mainly on synthetic antifungal drugs, in particular ketoconazole. However, due to the frequent recurrence of this disease, and the widespread application of azole drugs, resistant strains have emerged leading to increasingly failed treatment rates. Retinoic acid creams are also effective against pityriasis versicolor. Especially adapalene gel that has less irritation compared with other topical retinoid products and also has rapid onset of action. Therefore, we aimed to evaluate the efficacy and safety of a combination treatment of ketoconazole cream 2% and adapalene gel 0.01% in the treatment of pityriasis versicolor. Patients and methods In all, 100 patients were divided equally into two groups: group 1 patients were treated with topical application ketoconazole 2% cream and adapalene 0.1% gel once daily for a total duration of 2 weeks. Group 2 patients were treated with a topical application ketoconazole 2% cream for a total duration of 2 weeks. Results There was significant improvement rates in the combined group than ketoconazole-only group with P value=0.023. Adepalene+ketoconacole group had more irritation as a side effect than the ketoconazole group with significant P value=0.001. Conclusion The combination of adapalene 0.1% gel and ketoconazole 2% cream is safe, rapid, and effective in the treatment of pityriasis versicolor.

In Vivo Efficacy of Clove Essential Oil Ointment for Microsporum gallinae Avian Dermatophytosis-A Randomized Controlled Trial.

Avian favus (dermatophytosis) is a superficial mycosis caused by Microsporum gallinae in poultry. This disease is an important problem in poultry husbandry, but the standard antifungal treatment can leave drug residues in farm products. The aim of this study was to compare the efficacy of a clove essential oil ointment (3%, w/w) with commercially available ketoconazole cream (2%, w/w) for the treatment of M. gallinae infection in chickens. An in vitro time-kill assay showed that clove essential oil ointment reduced the number of viable M. gallinae ATCC 90749 by 99.99% within 1 hr. A randomized controlled trial showed that the therapeutic efficacy of clove essential oil ointment (3%, w/w) was noninferior to ketoconazole cream (2%, w/w) in M. gallinae-infected chickens. The percentage of completely recovered (culture-negative) animals in both treatment groups was 90% in day 35 after initial treatment. This study indicates that clove essential oil is suitable for preparation as an alternative topical treatment for avian dermatophytosis.

Allergic contact dermatitis from stearyl alcohol in ketoconazole cream.

Allergic contact dermatitis from stearyl alcohol in ketoconazole cream.

Profile of Tinea Corporis and Tinea Cruris in Dermatovenereology Clinic of Tertiery Hospital: A Retrospective Study

Background: Tinea corporis and cruris are dermatophytes that infect the skin, and they are caused by Trichophyton sp., Microsporum sp., and Epidermophyton sp. Dermatophyte fungal-infect keratin-containing skin classified by the body’s location, such as tinea corporis (skin besides haired area, body, hands, or feet) and tinea cruris (groin & perineal region). Purpose: To evaluate the clinical profiles and treatments of tinea corporis and cruris at Dermatology and Venereology (DV) outpatient clinic Dr. Soetomo General Academic Hospital in 2018. Methods: A retrospective-descriptive study based on medical records of DV outpatient clinic Dr. Soetomo General Academic Hospital, Surabaya. Data collected from August to December 2019. Tinea corporis and cruris profiles evaluation based on age, sex, occupation, precipitating factors, complaints, illness duration, family history, lesion’s location and description, and therapy. Result: A total of 164 patients (35 tinea corporis, 76 tinea cruris, and 53 tinea corporis and cruris), predominantly female, age 46–55 years, came treatment less-than-a-month cases, excessive sweating, itching, tinea corporis lesion’s location on the face and body, tinea cruris in groin, tinea corporis and cruris on body and groin, erythematous macules, firm borders, active margins, scales, central healing, positive KOH 10–20% examination, miconazole cream therapy 2%, griseofulvin therapy, griseofulvin oral and ketoconazole cream 2% combination therapy. Discussion: Tinea corporis and cruris are common in females as their history and symptoms supported by the characteristics of laboratory examination, the presence of hyphae in potassium hydroxide (KOH) 10–20%. Most patients were prescribed with oral griseofulvin, especially in large lesions cases.

Two Percentage of Ketoconazole Cream for the Treatment of Adult Female Acne: A Placebo-Controlled Trial.

IntroductionOur objective was to determine the efficacy of ketoconazole (KTZ) 2% cream for the treatment of mild adult female acne (AFA).Materials and methodsThis placebo-controlled trial was conducted in District Headquarters (DHQ) Teaching Hospital, Sahiwal, Pakistan. The study was completed in a period of January 2019-June 2020. A total of 60 females of age > 25 years having mild AFA were included. In Group I, the patients were advised to apply 2.0% KTZ cream covering the whole skin area twice daily for a period of eight weeks. In Group II (placebo group) patients, a topical cream containing propylene glycol was applied for similar period. After eight weeks, the cream was discontinued and participants were advised to use routine skincare products, and follow-up was done after two weeks. The main study outcome was reduction in the total count of acne lesions including both inflammatory and non-inflammatory lesions and overall success rate of treatment.ResultsMean age was 36.2 ± 6.3 years in KTZ group versus 35.4 ± 6.5 years in control group. Mean duration of acne was 14.3 ± 7.3 years in KTZ group versus 15.1 ± 6.9 years in control group. Improvement in facial adult female acne scoring tool (AFAST) scale (AFAST-F) was observed in 13 (43.3%) patients in KTZ group and in only 4 (13.3%) patients in control group (p value = 0.009). Improvement in submandibular AFAST (AFAST-S) was observed in 12 (40.0%) patients in KTZ group and in eight (26.7%) patients in control group. The overall success rate of treatment was 14 (46.7%) in KTZ group versus 4 (13.3%) in control group (p value = 0.012).ConclusionsIn our study, we found significant improvement in reduction of acne lesions as well as complete recovery using 2.0% ketoconazole for the treatment of mild AFA. So KTZ can be used as a preferred treatment option for these patients.

Kerion caused by Trichophyton tonsurans in an infant

A 6-month-old girl presented with 4 weeks history of rapid growing scalp erythema with multiple pustules, purulent secretions and alopecia (Figure 1a). Her father, mother, grandfather and grandmother suffered from tinea corporis in succession 2 months ago. Direct fungal microscopic examination revealed numerous endothrix spores (Figure 1b), and cultures grew Trichophyton tonsurans (Figure 1c). She was treated with oral fluconazole 50 mg/d (6 mg⁄kg⁄d) and 2% ketoconazole cream for 8 weeks with complete remission of the lesions (Figure 1d).