Role of antifungal therapy in the treatment of atopic dermatitis in children

Background. Atopic dermatitis is a multifactorial di­sease in which the microbial products of Malassezia yeast may play a certain role in triggering the disease. Topical application of zinc pyrithione has an antifungal effect and can improve the course of disease. The aim of this study was to evaluate the effectiveness of zinc pyrithione in the treatment of atopic dermatitis in children by conducting a randomized clinical trial using zinc pyrithione as an adjunct therapy. Materials and methods. Sixty-two patients with atopic dermatitis were included in the study and randomly divided into two groups: 31 people received only traditional therapy, 31 — additional topical zinc pyrithione in the form of 0.2% cream. Disease severity was evaluated using the dynamics of SCORAD (SCORing Atopic Dermatitis) indicators. Specific IgE to Malassezia was analyzed in 31 patients of the main group. Results. The improvement on the SCORAD was 45 % (T-W=496.0, p < 0.001) in the group of children who received zinc pyrithione in addition to traditional therapy, in the control group — 35.2 % (T-W = 496.0, p < 0.001). Children receiving zinc pyrithione locally had statistically significantly better dynamics on the SCORAD than controls: the average value of ΔSCORAD in the main group was 17.9, in the control group — 12.6 (W = 782.5, p = 0.006). Specific IgE to Ma­lassezia mixture (m227) was evaluated in 31 children of the main group, among them 38.7 % had a positive result: 3 patients had class 1 sensitization; 1 — class 2; 4 — class 3; 4 children — class 5 of sensitization. Sensitization to Malassezia had not any impact on the effectiveness of treatment (W = 179.0, p = 0.597). Conclusions. This study demonstrated the effectiveness of a 3-week course of using zinc pyrithione in the treatment of atopic dermatitis as an adjunct therapy. Since the pathogenetic mechanism and interaction between Malassezia spp. and atopic dermatitis remain partially unclear, there is still a need for further research to understand the exact role of these organisms in the disease course and the role of antifungal drugs in the treatment of atopic dermatitis.