Treatment of pityriasis versicolor using 1% diclofenac gel and clotrimazole cream (comparative therapeutic study)

Background

Pityriasis versicolor is a superficial fungal infection of the skin. Multiple modalities of therapy have been used including both topical and systemic agents, such as imidazoles, triazoles and allylamines.

Objective

To evaluate the effectiveness of topical 1% diclofenac gel in the treatment of pityriasis versicolor in comparison with topical clotrimazole cream and aqua rosa cream as a placebo control.

Patients and methods

This is a single-blinded, comparative therapeutic trial of topical 1% diclofenac gel in the treatment of pityriasis versicolor in comparison with topical 1% clotrimazole cream and aqua rosa cream as a placebo control group was conducted at the Department of Dermatology – Baghdad Teaching Hospital during November 2006–November 2008.

This study included 75 patients (39 males and 36 females). They were divided randomly into three groups, each containing 25 patients. Group A patients treated with diclofenac gel: include 15 (60%) males and 10 (40%) females. Their ages ranged from 15 to 44 (23.72 ± 6.52) years, while the duration of the disease ranged from 1 to 24 (4.28 ± 5.79) months. Group B patients treated with clotrimazole cream: composed of 13 (52%) males and 12 (48%) females, their ages ranged from 15 to 38 (22.56 ± 5.09) years, and the duration of the disease ranged from 1 to 18 (3.76 ± 3.98) months. Group C patients treated with aqua rosa cream: contain 11 (44%) males and 14 (56%) females, their ages ranged from 16 to 33 (23.68 ± 4.98) years and the duration of the disease ranged from 1 to 18 (3.26 ± 3.53) months. Detailed history, close clinical examination, skin scraping test and Wood’s light examination were done for all patients. Patients with immune suppression conditions or who received treatment during the last 2 months before the beginning of the study were excluded. Every patient was instructed to apply the drug twice daily for 1-month and to be seen every 2 weeks during the treatment and the follow up which is another 1-month. All patients were assessed clinically; skin scraping test and Wood’s light examination were done at each visit.

Results

The result of this study revealed that at the end of 4 weeks: in Group A 14 (56%) patients had complete improvement (P value = 0.00004), while in Group B 23 (92%) patients had complete improvement (P value <0.00000001) and no one achieved complete improvement in Group C. Mild side effects were recorded as itching in few patients, which do not need to discontinue the therapy.

Conclusion

Diclofenac gel proved to be an effective, new topical treatment for pityriasis versicolor infections, and it is safe with no important side effects and well tolerated by the patients, but in the present concentration (1%) it cannot compete with other much superior topical drugs.