Efficacy of itraconazole pulse therapy with adjuvant isotretinoin in the treatment of recurrent and recalcitrant dermatophytosis

Abstract: There is a significant increase in the number of cases presented with atypical and unusual dermatophytosis. These patients have chronic and recurrent infection and seems to be more resistant to conventional topical and systemic treatments. This necessitate the use of other adjuvant treatment options such as isotretinoin along with itraconazole that would help to cure these challenging cases. Objective: To determine the efficacy of monthly pulse of oral itraconazole in combination with daily low dose of isotretinoin in the treatment of recurrent and recalcitrant dermatophytosis. Methods: This study was carried out in department of Dermatology, Shalamar Hospital, Lahore. Sixty patients attending the dermatology outpatient department at Shalamar Hospital Lahore, fulfilling the inclusion criteria were enrolled in the study. Patients were given oral itraconazole 200mg two times a day for 7 days/ month for 3 months with adjuvant 20 mg isotretinoin/day for the same duration. All the patients also received topical white soft paraffin and antihistamines. Patients were followed up monthly for first three months after starting the treatment and then once at the sixth week after stopping the treatment. During each follow up visit, clinical assessment score was recorded. All the information was collected in predesigned proforma. Results: Mean age of patients was 36.03±6.11 years, duration of disease 6.83±1.86 months, baseline and post treatment clinical assessment score (CAS) was 3.11±0.61 and 0.16±0.49 respectively. There were 55.0% (n=33) males and 45.0% (n=27) females. Among the co-morbidities studied, frequency of diabetes mellitus was 23.3% (n=14) and 15.0% (n=9) had family history of dermatophytosis. Ten percent (n=6) had history of contact with domestic or wild animal. Out of 60 patients, efficacy was achieved in 88.3 % (n=53). Conclusion: It is concluded that pulse therapy of Itraconazole with adjuvant daily Isotretinoin is an effective treatment regimen in treating recurrent & recalcitrant superficial dermatophytosis. Keywords Dermatophytosis, Isotretinoin, Itraconazole.