Efficacy of topical vs combined oral and topical antifungals
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Topical antifungals are the most commonly used therapy in white piedra of the scalp. However, persistence and relapse of infection still pose a significant challenge. Systemic antifungals have been recommended to enhance the therapeutic response. To compare the efficacy of topical antifungal alone versus combined topical and oral antifungals in the treatment of white piedra of the scalp a study was conducted.

Sixty patients with white piedra of the scalp were divided into 3 groups, each containing 20 patients.
- Group A received: topical clotrimazole,
- Group B received: Combined topical clotrimazole and oral itraconazole
- Group C received: combined topical clotrimazole and oral terbinafine.

The treatment was continued until clearance of infection was confirmed by dermoscopic and mycological examination. Positive responders were followed up for 3 months after treatment.

All the patients achieved complete clearance of infection. The median treatment time in group B was significantly shorter than group A and group C respectively. In addition, the median treatment time in group C was significantly shorter than group A. No recurrence of infection was noted during follow-up period. The three modalities were effective in the treatment of white piedra of the scalp. While the most rapid response was observed with the combined use of topical and oral azoles.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.13769?af=R
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