Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review
ABSTRACT Background Atopic dermatitis (AD) is characterised by immune dysregulation and skin‐barrier dysfunction, which can predispose to microbial dysbiosis and skin infections. Fungi, particularly Malassezia, are common skin colonisers in AD patients and may exacerbate the condition. Previous stud...
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Wiley
2025-06-01
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| Series: | JEADV Clinical Practice |
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| Online Access: | https://doi.org/10.1002/jvc2.604 |
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| author | Luis F. Andrade Teresa Ju Parsa Abdi Michael R. Anderson Elise Edwards Nicole Khalil Olivia Burke Daniella Jaguan Jonathan I. Silverberg |
| author_facet | Luis F. Andrade Teresa Ju Parsa Abdi Michael R. Anderson Elise Edwards Nicole Khalil Olivia Burke Daniella Jaguan Jonathan I. Silverberg |
| author_sort | Luis F. Andrade |
| collection | DOAJ |
| description | ABSTRACT Background Atopic dermatitis (AD) is characterised by immune dysregulation and skin‐barrier dysfunction, which can predispose to microbial dysbiosis and skin infections. Fungi, particularly Malassezia, are common skin colonisers in AD patients and may exacerbate the condition. Previous studies on the efficacy of antifungal treatments for AD have shown inconsistent results. Objectives This systematic review aims to evaluate the effectiveness of topical and oral antifungal therapies in treating AD. Methods A systematic review was conducted following the PRISMA guidelines (PROSPERO ID: CRD42022338791). Databases searched included PubMed, MEDLINE, Embase, Scopus, LILACS, Cochrane, CINAHL, GREAT, and ClinicalTrials.gov. Inclusion criteria encompassed interventional studies using antifungal agents for AD, with outcomes such as SCORing Atopic Dermatitis (SCORAD). Results Of 35,591 studies obtained from the initial search, seven met the inclusion criteria. Topical antifungal treatments, such as sertaconazole, miconazole, and ciclopirox olamine, showed minimal efficacy in reducing AD severity when compared to placebo or hydrocortisone treatments. Oral antifungal treatments, including itraconazole and ketoconazole, demonstrated mixed results, with some studies showing modest improvements in SCORAD scores but overall lacking significant clinical benefit. Conclusions The systematic review found weak evidence supporting the efficacy of both topical and oral antifungal therapies for treating AD. Topical antifungals showed limited improvement and fewer adverse effects, while oral antifungals posed a higher risk of systemic adverse events without consistent efficacy. Based on these findings, antifungal treatments are not recommended for AD severity management alone other than for treatment of comorbid fungal and yeast infections. Future research should focus on larger sample sizes, standardised severity assessments, and comprehensive adverse event reporting to better evaluate antifungal treatments in AD. |
| format | Article |
| id | doaj-art-2629b0ef632f4887a6445e009fba104a |
| institution | DOAJ |
| issn | 2768-6566 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | JEADV Clinical Practice |
| spelling | doaj-art-2629b0ef632f4887a6445e009fba104a2025-08-20T03:06:53ZengWileyJEADV Clinical Practice2768-65662025-06-014240040610.1002/jvc2.604Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic ReviewLuis F. Andrade0Teresa Ju1Parsa Abdi2Michael R. Anderson3Elise Edwards4Nicole Khalil5Olivia Burke6Daniella Jaguan7Jonathan I. Silverberg8Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USADr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USAFaculty of Medicine Memorial University St. Johns Newfoundland CanadaMarnix E. Heersink School of Medicine University of Alabama Birmingham Birmingham Alabama USADr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USADr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USADr. Phillip Frost Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami Florida USASchool of Medicine Georgetown University Washington, DC USASchool of Medicine and Health Sciences George Washington University Washington, DC USAABSTRACT Background Atopic dermatitis (AD) is characterised by immune dysregulation and skin‐barrier dysfunction, which can predispose to microbial dysbiosis and skin infections. Fungi, particularly Malassezia, are common skin colonisers in AD patients and may exacerbate the condition. Previous studies on the efficacy of antifungal treatments for AD have shown inconsistent results. Objectives This systematic review aims to evaluate the effectiveness of topical and oral antifungal therapies in treating AD. Methods A systematic review was conducted following the PRISMA guidelines (PROSPERO ID: CRD42022338791). Databases searched included PubMed, MEDLINE, Embase, Scopus, LILACS, Cochrane, CINAHL, GREAT, and ClinicalTrials.gov. Inclusion criteria encompassed interventional studies using antifungal agents for AD, with outcomes such as SCORing Atopic Dermatitis (SCORAD). Results Of 35,591 studies obtained from the initial search, seven met the inclusion criteria. Topical antifungal treatments, such as sertaconazole, miconazole, and ciclopirox olamine, showed minimal efficacy in reducing AD severity when compared to placebo or hydrocortisone treatments. Oral antifungal treatments, including itraconazole and ketoconazole, demonstrated mixed results, with some studies showing modest improvements in SCORAD scores but overall lacking significant clinical benefit. Conclusions The systematic review found weak evidence supporting the efficacy of both topical and oral antifungal therapies for treating AD. Topical antifungals showed limited improvement and fewer adverse effects, while oral antifungals posed a higher risk of systemic adverse events without consistent efficacy. Based on these findings, antifungal treatments are not recommended for AD severity management alone other than for treatment of comorbid fungal and yeast infections. Future research should focus on larger sample sizes, standardised severity assessments, and comprehensive adverse event reporting to better evaluate antifungal treatments in AD.https://doi.org/10.1002/jvc2.604antifungal treatmentsatopic dermatitisdermatitiseczema |
| spellingShingle | Luis F. Andrade Teresa Ju Parsa Abdi Michael R. Anderson Elise Edwards Nicole Khalil Olivia Burke Daniella Jaguan Jonathan I. Silverberg Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review JEADV Clinical Practice antifungal treatments atopic dermatitis dermatitis eczema |
| title | Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review |
| title_full | Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review |
| title_fullStr | Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review |
| title_full_unstemmed | Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review |
| title_short | Lack of Evidence for the Efficacy of Antifungal Medications to Treat Atopic Dermatitis: A Systematic Review |
| title_sort | lack of evidence for the efficacy of antifungal medications to treat atopic dermatitis a systematic review |
| topic | antifungal treatments atopic dermatitis dermatitis eczema |
| url | https://doi.org/10.1002/jvc2.604 |
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