■花色糠疹是一种常见的由毛马拉色菌引起的浅表皮肤层真菌感染,皮肤中的正常共生.角质层分离剂很受欢迎,便宜,和现成的非处方药治疗杂色糠疹。传统的抗真菌剂更昂贵,需要处方,并可能诱导耐药菌株。然而,目前仍缺乏其相对安全性和有效性的证据.
■通过系统评价,评估合成抗真菌药与角质层分离剂在花斑癣局部治疗中的疗效和安全性。
■我们搜索了以下数据库:MEDLINE(从1966年开始)通过PubMed,CENTRAL(2021年9月12日第9期),EMBASE(自1974年起),LILACS(从1987年开始);Herdin(从1970年开始),www.clinicaltrials.gov,www.isrctn.com,www.trialregister.nl.我们联系了该领域的研究人员,手工搜索相关会议摘要,和菲律宾皮肤病学会杂志1992-2019。我们纳入了所有随机对照试验,这些试验涉及诊断为活动性花色糠疹的患者,其中将局部抗真菌药物与局部角质层疗法进行了比较。两名评论作者独立应用资格标准,使用Cochrane协作工具评估偏差风险,并从纳入的研究中提取数据。我们使用RevMan5.3汇集使用风险比(RR)的二分结果和使用平均差异(MD)的连续结果,使用随机效应荟萃分析。我们使用Chi²检验和I²检验测试了统计异质性。我们使用森林地块提供了95%置信区间的结果。我们计划创建一个漏斗图来确定发表偏倚,但由于研究很少,我们无法做到。使用GRADE配置文件软件为主要结果创建结果总结表。
■我们纳入了8项RCT,共有617名参与者比较了唑类药物制剂(酮康唑,联苯苄唑和益康唑)与角质溶解剂(硫化硒,阿达帕林,水杨酸-苯甲酸)。汇总数据显示,唑类药物与角质层分离剂在临床治疗中没有显着差异(RR0.99、0.88、1.12;4项随机对照试验,N=274,I2=55%;非常低质量的证据),和不良事件(0.59[0.17,2.06];非常低质量的证据)基于6项随机对照试验(N=536)。有两名患者服用角质层分离剂(硫化硒洗发水),患有急性皮炎并停止治疗。
■在杂色糠疹患者的临床清除和不良事件发生方面,局部用唑类药物是否与角质层分离剂一样有效,尚不确定。有必要对灰色文献和本地研究进行更广泛的搜索。建议使用偏倚风险较低的较大RCT。
UNASSIGNED: Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking.
UNASSIGNED: To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review.
UNASSIGNED: We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www.isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes.
UNASSIGNED: We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment.
UNASSIGNED: It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.