From the Guidelines
Antifungal treatments are not explicitly recommended in the provided guidelines for the management of atopic dermatitis, suggesting that their use may not be a primary consideration in the treatment of this condition. When considering the management of atopic dermatitis, the focus is primarily on emollients, prescription topical therapies, phototherapy, and systemic therapies such as immunosuppressants, corticosteroids, antimetabolites, Janus kinase (JAK) inhibitors, and biologics 1. However, in cases where fungal colonization or infection is suspected, particularly with Malassezia species, antifungal treatments may be beneficial.
For suspected fungal involvement in atopic dermatitis, topical antifungals like ketoconazole 2% cream applied twice daily for 2-4 weeks could be considered as first-line therapy, based on general principles of treating fungal infections in dermatology. Alternatives might include ciclopirox olamine 1% cream or econazole 1% cream with similar application schedules. For more widespread or severe cases, oral antifungals may be necessary, with fluconazole 150-300mg weekly for 2-4 weeks or itraconazole 200mg daily for 1-2 weeks being common regimens in other contexts. When treating the scalp or hairy areas, ketoconazole 2% shampoo used 2-3 times weekly can be effective.
It's crucial for patients to continue their regular atopic dermatitis treatments alongside antifungals, including moisturizers and topical anti-inflammatory medications. The decision to initiate any therapy should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1. Treatment success should be evaluated after 2-4 weeks, and maintenance therapy may be needed for recurrent cases. However, the primary guidelines provided do not specifically address the use of antifungals in atopic dermatitis management, emphasizing instead the role of other therapies 1.
From the Research
Antifungal Treatment in Atopic Dermatitis
- Atopic dermatitis (AD) is a chronic inflammatory skin disease that can be exacerbated by fungal colonization or infection, particularly the head and neck variant 2.
- The use of antifungals in selected AD patients may be beneficial, especially in those with positive Malassezia radioallergosorbent tests (RASTs) 2.
- Oral itraconazole treatment has been shown to reduce the need for topical corticosteroids, provide clinical improvement, and decrease cutaneous and intestinal fungal colonization in AD patients 2.
- Fluconazole is also effective in treating AD, although further research is needed to optimize antifungal management in AD patients 2.
Fungal Infections in Atopic Dermatitis
- Patients with AD are prone to recurrent infections, including fungal infections, due to impaired barrier function and altered immune response 3.
- Fungal infections, such as those caused by Malassezia, Candida, and dermatophytes, can affect the symptoms of AD and may be overlooked in some cases 4.
- The diagnosis and treatment of fungal infections in AD patients are crucial to prevent exacerbation of symptoms and improve treatment outcomes 4.
Treatment Options for Atopic Dermatitis
- Topical corticosteroids are the first-line treatment for AD flare-ups, while pimecrolimus and tacrolimus are topical calcineurin inhibitors that can be used in conjunction with topical corticosteroids 5.
- Ultraviolet phototherapy is a safe and effective treatment for moderate to severe AD, while antistaphylococcal antibiotics are effective in treating secondary skin infections 5.
- Systemic treatments, such as cyclosporine, azathioprine, and methotrexate, may be used in moderate to severe AD, but require careful consideration during the COVID-19 pandemic 6.