Possible applications of itraconazole ("Mikotroksa") in the treatment of scalp microsporia

Microsporia scalp and smooth the skin is still a common infection in Belarus. Given the fact that a major contingent of patients are children, the problem is the treatment of this disease is one of the most important in dermatology in this country.

It should be noted that the protocols for the treatment of this disease and the physician in identifying tactics microsporia virtually unchanged since the adoption of the order of MOH № 167 from 12.6 in 1995, "On strengthening measures to combat scabies mikrosporiya, trichophytosis and crusted ringworm." In accordance with this standard document treatment microsporia should be in the hospital. However, due to the duration of treatment, it annoys patients, and mindful of the frequent ineffectiveness of therapy - parental dissatisfaction and distrust of the doctor.

Standard therapy with microsporia defeat hard and baby hair for a long time regarded as griseofulvin, which to this day remains the 'gold standard' therapy in many countries. However, in Belarus, the drug is no longer used because of its potential hepatotoxicity of action. At present, he was replaced by terbinafine treatment duration which reaches an average of 30-35 days [3]. In some cases, however, the therapy is ineffective and can last up to 90 days. The causes of failure of individual patients are not clarified in detail. Perhaps the problem lies in the immune status of some patients, or in the peculiarities of the parasite.

In order to optimize therapy and apply various methods of local treatment, partly causing additional inconvenience in use. Thus, despite evidence of foreign colleagues, have long refused to shave the hair when microsporia scalp in dermatovenereological clinics in Belarus still apply this method, which, according to doctors, helps mechanically to remove pathogens. However, disputes can reach mikrosporuma base of the hair shaft, and thus, shaving hair causes only an additional trauma of the skin, without increasing the effectiveness of therapy.

In the absence of the effect of the most rational solution is to replace the drug [11]. To date, the most acceptable alternative to griseofulvin acts itraconazole. In-blind, randomized study conducted Lopez - Gomez S, et al. in 1996 showed that itraconazole and griseofulvin were equally effective in treating microsporia, but itraconazole is better tolerated by patients [12], and treatment with itraconazole significantly shorter [9]. With long-term monitoring of children receiving itraconazole, have been recorded relapse [15].

Ginter-Hanselmayer G. (2005) describes the treatment 55 children who had previously conducted treatment with griseofulvin was ineffective. The author assigned itraconazole at a dose of 5 mg / kg per day, which led to recovery after an average of 39 ╠ 12 days [8]. In studies where the drug was administered at once, without pre-treatment with griseofulvin or terbinafine, the average duration of therapy was 3.6 weeks [7].

Unfortunately, due to the fact that in many countries the drug is shown with 9-12 years of age, its use in children is limited. However, if necessary, itraconazole may be appointed at a younger age with a positive decision, a consultation [1]. To date, the youngest patients receiving itraconazole, a girl for 8 months. The drug has been appointed in the mode of pulse therapy with 50 mg / day for one week, then - 2 weeks break and repeat the same course, after which the fixed treatment. Side effects while taking the drug were observed [13].

The largest overseas research on the use of itraconazole in infants is the study of Gupta A. and Ginter G. (2001), which included 109 children (mean age 5,6 ╠ 0,2 years). Complete cure was achieved for all children in the 12th week. The duration of the drug depended on the degree of skin lesions. Thus, when more and more centers needed prolonged therapy [10].

MЖhrenschlager M. et al. (2000) conducted a study which was attended by 44 children with a mean age of 66 months (minimum age 12 months). British dermatologists have tried to optimize patient management and tactics. On the proposed scheme of itraconazole was used at a dosage of 50 mg per day for children weighing less than 20 kg, 100 mg per day - for children weighing 20 kg. The drug was administered for 4 weeks, which were followed by microscopic and cultural studies. In 34 of 42 patients healing occurred after a single 4-hnedelnogo course of itraconazole, 4 patients received a second two weeks of preparation, and the remaining 4 - the third [14].

Itraconazole is known as a drug that can accumulate in tissues rich in keratin (skin, nails, hair), which allowed the development of methods of pulse therapy, reducing the possible side effects of the drug. Itraconazole pulse therapy is widely used to treat fungal infections of nails. Some researchers have also used the method of pulse therapy with itraconazole in the treatment of microsporia scalp. At the same time itraconazole was administered at a dose of 5 mg / kg in one week, followed by a two-week break. This was followed by a one-week course followed by a three-week break. Need for the appointment of the second and third year was determined by examination of the child at the end of the third and seventh weeks of observation.

To date, known to us the data on the use of itraconazole in the treatment of scalp microsporia in Belarus is the data of VP Adaskevicha and IV Tikhon (2007), which examined the effectiveness of the drug in 59 children (mean age 7,3 ╠ 3,0 years). The drug is administered by the authors in a dose of 100 mg if body weight 20 kg, 150 mg in weight of 21-30 kg and 200 mg in weight over 31 kg. The first negative result obtained by microscopic examination of the authors at 25,4 ╠ 8,3 days of treatment. The authors observed no serious side effects while taking the drug [1].

Among the first drugs itraconazole, registered in Belarus, which the republic has gained practical experience, along with the original drug - "Orungal" (Janssen - Cilag), there is also the generic drug "Mikotroks" (company Farmakar). "Mikotroks" has already proved its efficacy and safety in the treatment of fungal infections of nails, smooth skin, candidiasis, rhinitis, caused by the fungal flora [2, 3, 4, 5, 6]. The quality of the drug and its conformity with the original proven by GMP Research. The cost of the drug is substantially lower than the original, which is especially important for long-term treatment of microspores.

In summary, it is worth noting that itraconazole is an effective drug for the treatment microsporia scalp. The optimal dose - 5 mg / kg per day. When a drug should evaluate the activity of alanine and aspartate aminotransferase, lactate dehydrogenase. "Mikotroks", being a drug whose effectiveness is confirmed clinically, may be appointed for initial therapy, as well as serve as the drug of choice with no effect in the treatment of other drugs.

References:

1. Adaskevich, VP The efficacy and safety of itraconazole in the treatment of children with mikrosporiya / VP Adaskevich, IV Tikhon / / Medical News. - 2007. - № 14. - S. 51 - 52.

2. Vetokhin, EL Using Mikotroksa (itraconazole) in the treatment of onychomycosis in diabetic patients / EL Vetokhin, NV Circle / / Medical Panorama. - 2006. - № 7. - S. 62 - 63.

3. Clinical protocols for diagnosis and treatment of patients with diseases of the skin and subcutaneous tissue, approved by the MOH Order № 142 dated 25.02.2008 / / recipe (special issue). - Minsk, 2008.

4. Levonchuk, E. Vulvovaginal candidiasis / / EA Levonchuk. - Medical News. - 2007. - № 1, p.77-78.

5. Levonchuk, E. Vulvovaginal candidiasis: current approaches to therapy of various forms of his / E. Levonchuk, IG Shimanskaya / / recipe. - 2007. - № 3,. 69-72.

6. Levonchuk, E. Pityriasis versicolor: clinical picture, diagnosis, modern therapy. - Medical News. - 2007. - № 13,. 59-60.

7. Ginter, G. Microsporum canis in children: results of a new oral antifungal therapy / G. Ginter / / Mycoses. - 1996. - Vol. 39. - P. 265 - 269.

8. Ginter-Hanselmayer, G. Itraconazole in the treatment of tinea capitis caused by Microsporum canis: experience in a large cohort / G. Ginter-Hanselmayer, J. Smolle, A. Gupta / / Pediatr. Dermatol. - 2005. - Vol. 22. - P. 372.

9. Gupta, A. Efficacy and safety of itraconazole in children / AK Gupta, EA Cooper, G. Ginter / / Dermatol. Clin. - 2003. - Vol. 21. - P. 521-535.

10. Gupta, A. Itraconazole is effective in treatment of tinea capitis caused by Microsporum canis / AK Gupta, G. Ginter / / Pediatr. Dermatol. - 2001. - Vol. 18. - P. 519-522.

11. Is itraconazole the treatment of choice in Microsporum canis tinea capitis? / E. Koumantaki-Mathioudaki et al. / / Drugs Exp. Clin. Res. - 2005. - Vol. 31. - P. 11 - 15.

12. Itraconazole versus griseofulvin in the treatment of tinea capitis: a double - blind randomized study in children / S. Lopez - Gomez / / Int. J. Dermatol. - 1996 - Vol. 33. - P. 743 - 747.

13. Microsporim canis tinea capitis in an 8 month old infant successfully treated with 2 weekly pulses of itraconazole / E. Koumantaki et al. / / Pediatr. Dermatol. - 2001. - Vol. 18. - P. 60-62.

14. Optimizing the therapeutic approach in tinea capitis of childhood with Itraconazole / M. MЖhrenschlager et al. / / Br. J. Dermatol. - 2000. - Vol. 143. - P. 1011-1015.

15. Schauder, S. Itraconazole in the treatment of tinea capitis in children. Case reports with long-term follow-up evaluation. Review of the literature. / S. Schauder / / Mycoses. - 2002. - Vol. 45. - P. 1-9.