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 head, neck, and shoulder regions. Two studies have shown the efficacy of ketoconazole in the treatment of this type of AD, in contrast to results of topical treatment. The objective was to assess the clinical efficacy of antifungal 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 RAST/skin prick test results were randomized to receive ketoconazole or placebo for 30 days. The yeast growth of skin and pharynx; P. ovale, C. albicans, 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 ketoconazole 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 determinants of the SCORAD, itching (P < 0.005), the extent of dermatitis (area percentage), excoriation, lichenification (P < 0.01), erythema, papulation, and dryness (P < 0.05) improved significantly in the ketoconazole group. In the placebo group, only the extent of dermatitis (area percentage) decreased significantly (P < 0.05). In the ketoconazole group, the number of positive 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 significant in female patients with positive yeast cultures. Conclusions: Saprophytic yeasts may be a source of allergens in AD. Thus, patients with AD, yeast growth, and elevated IgE levels to yeasts should be offered antifungal treatment.