Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts

Background: IgE-mediated hypersensitivity to yeasts is often seen in atopic dermatitis (AD) patients, especially when dermatitis is located in the hea d, neck, and shoulder regions. Two studies have shown the efficacy of ketoc onazole in the treatment of this type of AD, in contrast to results of topi cal treatment. The objective was to assess the clinical efficacy of antifun gal treatment in AD in a randomized, double-blind, placebo-controlled study with oral ketoconazole and yeast-specific IgE levels and saprophytic yeast growth monitored simultaneously. Methods: Eighty patients with AD and positive P. ovale and/or C. albicans R AST/skin prick test results were randomized to receive ketoconazole or plac ebo for 30 days. The yeast growth of skin and pharynx; P. ovale, C. albican s, and S. cerevesiae RAST; serum total IgE; and the severity of the eczema (SCORAD) were assessed at day 0 and thereafter at 1 and 3 months. Results: A significant improvement was seen in the SCORAD scale in the keto conazole group at the second visit in comparison to the first visit (P < 0. 0005; n = 36), but not in the placebo group (n = 39). Of the individual det erminants of the SCORAD, itching (P < 0.005), the extent of dermatitis (are a percentage), excoriation, lichenification (P < 0.01), erythema, papulatio n, and dryness (P < 0.05) improved significantly in the ketoconazole group. In the placebo group, only the extent of dermatitis (area percentage) decr eased significantly (P < 0.05). In the ketoconazole group, the number of po sitive P. ovule cultures decreased from 60% to 32% (n = 35) compared to the placebo group (64% to 56%,; n = 39). The clinical response was most signif icant in female patients with positive yeast cultures. Conclusions: Saprophytic yeasts may be a source of allergens in AD. Thus, p atients with AD, yeast growth, and elevated IgE levels to yeasts should be offered antifungal treatment.