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Itraconazole is a broad spectrum triazole antifungal agent. It has favourable pharmacodynamic and pharmacokinetic profiles and is available as both oral and iv. formulations. Over the last two decades, clinical and animal infection studies have demonstrated the efficacy of itraconazole in a wide range of superficial fungal infections including difficult-to-treat dermatophytoses and onychomycoses. Furthermore, shortened treatment regimens have proven to be effective, ranging from 1-day treatment for vaginal candidosis to 1-week pulse therapy per month, for 2 - 4 months, in onychomycosis and follicular dermatophytosis. Clinical experience with itraconazole in the treatment of deep mycoses is less comprehensive. However, results in systemic candidosis, sporotrichosis, blastomycosis, paracoccidioiodomycosis, certain types of histoplasmosis and aspergillosis are extremely encouraging. Itraconazole is less effective in the treatment of chromomycosis and coccidioidomycosis. Nevertheless, considering the refractory nature of these diseases, itraconazole has proven to be a valuable addition to the antifungal drugs currently available for treatment. Itraconazole has been well-tolerated with doses of up to 400 mg/day being generally free of serious adverse effects. However, a potential for drug interactions exists, mediated through the cytochrome P450 enzyme 3A4 system, which should be considered when itraconazole is used as part of a multi-drug regimen.

The clinical efficacy of antidandruff shampoos containing antifungal agents is correlated with their anti-Malassezia activity. Other ingredients of the shampoos also affect the efficacy and tolerability of the treatments. This study was conducted to quantify the effect of eight proprietary antidandruff shampoos on the human stratum corneum. Corneosurfametry and squamometry were used to rate the interaction between the shampoos and the stratum corneum. Significant differences in mildness were disclosed between some test shampoos and SLES-7EO selected as a mild reference surfactant. The activity against corneocyte clumping also showed significant differences among the test products. It is concluded that the formulation of shampoos for dandruff should not be overlooked.

Androgenetic alopecia (AGA) is a common yet poorly understood condition. In particular, the significance of inflammatory cells close to the infrainfundibulum of transitional hairs remains obscure. This study was conducted in 20 men who used a lotion containing the antimicrobials, piroctone olamine and triclosan, regularly for 18 months. At entry, mild pruritus and abnormal hair loss were reported by the volunteers. During treatment, pruritus resolved rapidly. Comparison of clinical photographs and trichograms taken at 3-month intervals suggested signs of hair regrowth with moderate increase in density of transitional hairs. Biopsies taken at 6-month intervals were processed for immunohistochemistry. There was a decrease in the density of activated T cells in the region of the follicular infrainfundibulum and isthmus over time. IgG deposits found within the epithelial sheaths at entry to the study were absent in the subsequent biopsies. The volume of the sebaceous glands, as assessed by computerized morphometry, was not modified by the treatment. It was concluded that inflammation associated with AGA transitional hairs may be driven by the presence of microorganisms harboured in the infrainfundibulum. They may modulate the severity of AGA and may potentially be controllable. This offers a new possibility of prevention and partial reversal of hair loss in AGA.

New formulations of topical corticosteroids are developed to provide therapeutic and cosmetic benefits. The proper choice of the vehicle is important because the moisturizing effect of a topical formulation may increase the drug bioavailability and improve the skin barrier function. The effect was studied of eight proprietary corticosteroid formulations on the capacitance and water loss of skin with moderate xerosis. A transient hydration of the stratum corneum was perceptible for 2-4 h after application of some formulations, allowing a ranking of the vehicles according to the cumulative value of capacitance. It is concluded that the range in the changes in the physico-chemical properties of the stratum corneum induced by steroid vehicles is wide. Bioavailability of the drugs and clinical efficacy are likely to be influenced by these differences.

We studied the efficacy and tolerance of topical 0.5% podophyllotoxin in the treatment of molluscum contagiosum. In this open study, 24 patients applied the drug on a daily basis with temporary withdrawals of treatment when irritation occurred. All lesions cleared after less than 15 applications of podophyllotoxin over a period of less than 3 weeks. No systemic adverse effects occurred. This method of treatment of molluscum contagiosum was reliable and safe.