A retrospective descriptive study of oral azole antifungal agents in patients with patch test–negative head and neck predominant atopic dermatitis

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II

“…may contribute to the pathogenesis of AE are not fully understood and remain to be elucidated . Several randomized, placebo‐controlled trials investigated the benefit of topical or systemic antifungal treatment for AE patients . The ambiguous results of these clinical trials might be attributed to a selection bias.…”

“…36 Several randomized, placebo-controlled trials investigated the benefit of topical or systemic antifungal treatment for AE patients. 37,38 The ambiguous results of these clinical trials might be attributed to a selection bias. It can be speculated that antifungal therapies are more effective in certain subgroups of AE.…”

Malassezia Infections in Humans and Animals: Pathophysiology, Detection, and Treatment

“…One should always bear in mind that Malassezia yeasts are integral components of the skin microbiota and therefore the therapeutic target should be controlling the Malassezia population with subsequent long-term antifungal treatment, rather than eradicating it. Likewise, the need for extended (>2 months) azole treatment is required for suppression of symptoms in the Malassezia -triggered head and neck variant of atopic dermatitis [55] . Although the in vitro susceptibility testing is not yet standardized for Malassezia spp., the Clinical and Laboratory Standards Institute (CLSI) broth microdilution protocol was adapted by modifying media, time of incubation, and inocula, showing that itraconazole, ketoconazole, and posaconazole are the most effective drugs [50] , [56] .…”

The Role of Fungi in Atopic Dermatitis

“…It can be speculated that antifungal therapies are more effective in a particular subgroup of AD, for example in patients with a head-neck type of eczema. More recently published studies were of less quality, for example they comprised retrospective observations and lacked a standardized scoring system to assess the severity of AD 64 . More randomized, placebo controlled studies on large patient populations are needed to reliably assess the benefit of an antifungal therapy in AD.…”