Efficacy of Topical Antifungals for Atopic Dermatitis Is Inconclusive

Existing data does not allow for the accurate assessment of the safety and efficacy of topical antifungal drugs for the treatment of patients with AD.

The safety and efficacy of topical antifungal drugs for treating patients with atopic dermatitis (AD) cannot be accurately assessed, as additional high-quality and large randomized controlled trials (RCTs) are needed, researchers reported in a study published in Dermatologic Therapy.

The meta-analysis sought to evaluate the safety and efficacy of topical antifungal drugs for AD and provide reliable evidence for clinical practice. The investigators conducted a search of multiple databases for relevant studies published in Chinese or English before May 27, 2021.

A total of 9 RCTs with 785 patients were included, 4 published in Chinese and 5 in English. The studies were categorized into 3 groups: topical antifungal drugs vs placebo, topical antifungal drugs vs topical glucocorticoids, and topical antifungal drugs plus topical glucocorticoids vs topical glucocorticoids.

For topical antifungal drugs vs placebo, 1 of 2 studies found that 2% sertaconazole was associated with a decrease in the SCORing Atopic Dermatitis (SCORAD) index of patients with mild to moderate AD more significantly compared with placebo, although the difference was not statistically significant (mean difference=-3.70; 95% CI, -9.65 to 2.25; P >.05). Another study cited by researchers found that the difference in the Investigator Global Assessment score between the topical antifungal drugs group and the placebo group was statistically significant after treatment with 1% ciclopirox cream (P =.04). Based on 1 study, no statistically significant differences were observed in adverse reactions between the 2 treatment groups.

The safety and efficacy of topical antifungal drugs for the treatment of patients with AD could not be accurately evaluated.

Regarding topical antifungal drugs compared with topical glucocorticoids, the 4 studies in this group demonstrated that the effective rate of topical antifungal drugs was significantly greater than that of topical glucocorticoids (relative risk [RR]=1.39; 95% CI, 1.12-1.72; Z=3.01; P =.003). Based on 1 study, the SCORAD index and Eczema Area and Severity Index scores after treatment were significantly different between the experimental and control groups (for SCORAD index: MD=-3.20; 95% CI, -4.33 to -2.07; P <.001; for EASI: MD=-1.60; 95% CI, -2.26 to -0.94; P <.001). In 2 studies that reported adverse reactions, no statistically significant differences were observed.

For topical antifungal drugs plus topical glucocorticoids vs topical glucocorticoids, 2 of 3 studies reported an effective rate. The combined effective rate of topical antifungal drugs plus topical glucocorticoids was higher than that of topical glucocorticoids, and the difference was statistically significant (RR=1.18; 95% CI, 1.07-1.30; Z=3.25; P =.001). In 1 study, participants were treated with 1% hydrocortisone cream plus miconazole cream plus ketoconazole shampoo or with 1% hydrocortisone cream. For the experimental and control groups, the SCORAD index score after treatment was lower compared with the score before treatment (P <.001), although the difference was not statistically significant between the 2 groups. The combined findings of the 3 studies showed that the difference in adverse reactions was not statistically significant (RR=2.04; 95% CI, 0.53 to 7.86; P >.05).

Among the limitations to the meta-analysis, only 9 studies were included and most had a small sample size. In addition, some treatment groups were included in only 1 study, and some studies did not report the clinical severity or location characteristics of patients with AD. Furthermore, a distinct heterogeneity in the clinical symptom scores was found.

“Because most of the RCTs included in this meta-analysis were of low quality, had incomplete data, and used intervention and control measures that were not verified via multiple studies, the safety and efficacy of topical antifungal drugs for the treatment of patients with AD could not be accurately evaluated,” the study authors stated.

References:

He D, Han Y, Wu H, Liu M, Li M, Lu M. Treatment of atopic dermatitis using topical antifungal drugs: a meta-analysis. Dermatol. Ther. Published online October 18, 2022. doi:10.1111/dth.15930