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Meta-Analysis
. 2015 May 2:(5):CD008138.
doi: 10.1002/14651858.CD008138.pub3.

Topical antifungals for seborrhoeic dermatitis

Enembe O Okokon  1 , Jos H Verbeek, Jani H Ruotsalainen, Olumuyiwa A Ojo, Victor Nyange Bakhoya
Affiliations
Meta-Analysis

Topical antifungals for seborrhoeic dermatitis

Enembe O Okokon et al. Cochrane Database Syst Rev. .

Abstract

Background: Seborrhoeic dermatitis is a chronic inflammatory skin condition that is distributed worldwide. It commonly affects the scalp, face and flexures of the body. Treatment options include antifungal drugs, steroids, calcineurin inhibitors, keratolytic agents and phototherapy.

Objectives: To assess the effects of antifungal agents for seborrhoeic dermatitis of the face and scalp in adolescents and adults.A secondary objective is to assess whether the same interventions are effective in the management of seborrhoeic dermatitis in patients with HIV/AIDS.

Search methods: We searched the following databases up to December 2014: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 11), MEDLINE (from 1946), EMBASE (from 1974) and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982). We also searched trials registries and checked the bibliographies of published studies for further trials.

Selection criteria: Randomised controlled trials of topical antifungals used for treatment of seborrhoeic dermatitis in adolescents and adults, with primary outcome measures of complete clearance of symptoms and improved quality of life.

Data collection and analysis: Review author pairs independently assessed eligibility for inclusion, extracted study data and assessed risk of bias of included studies. We performed fixed-effect meta-analysis for studies with low statistical heterogeneity and used a random-effects model when heterogeneity was high.

Main results: We included 51 studies with 9052 participants. Of these, 45 trials assessed treatment outcomes at five weeks or less after commencement of treatment, and six trials assessed outcomes over a longer time frame. We believe that 24 trials had some form of conflict of interest, such as funding by pharmaceutical companies.Among the included studies were 12 ketoconazole trials (N = 3253), 11 ciclopirox trials (N = 3029), two lithium trials (N = 141), two bifonazole trials (N = 136) and one clotrimazole trial (N = 126) that compared the effectiveness of these treatments versus placebo or vehicle. Nine ketoconazole trials (N = 632) and one miconazole trial (N = 47) compared these treatments versus steroids. Fourteen studies (N = 1541) compared one antifungal versus another or compared different doses or schedules of administration of the same agent versus one another. KetoconazoleTopical ketoconazole 2% treatment showed a 31% lower risk of failed clearance of rashes compared with placebo (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.59 to 0.81, eight studies, low-quality evidence) at four weeks of follow-up, but the effect on side effects was uncertain because evidence was of very low quality (RR 0.97, 95% CI 0.58 to 1.64, six studies); heterogeneity between studies was substantial (I² = 74%). The median proportion of those who did not have clearance in the placebo groups was 69%.Ketoconazole treatment resulted in a remission rate similar to that of steroids (RR 1.17, 95% CI 0.95 to 1.44, six studies, low-quality evidence), but occurrence of side effects was 44% lower in the ketoconazole group than in the steroid group (RR 0.56, 95% CI 0.32 to 0.96, eight studies, moderate-quality evidence).Ketoconozale yielded a similar remission failure rate as ciclopirox (RR 1.09, 95% CI 0.95 to 1.26, three studies, low-quality evidence). Most comparisons between ketoconazole and other antifungals were based on single studies that showed comparability of treatment effects. CiclopiroxCiclopirox 1% led to a lower failed remission rate than placebo at four weeks of follow-up (RR 0.79, 95% CI 0.67 to 0.94, eight studies, moderate-quality evidence) with similar rates of side effects (RR 0.9, 95% CI 0.72 to 1.11, four studies, moderate-quality evidence). Other antifungalsClotrimazole and miconazole efficacies were comparable with those of steroids on short-term assessment in single studies.Treatment effects on individual symptoms were less clear and were inconsistent, possibly because of difficulties encountered in measuring these symptoms.Evidence was insufficient to conclude that dose or mode of delivery influenced treatment outcome. Only one study reported on treatment compliance. No study assessed quality of life. One study assessed the maximum rash-free period but provided insufficient data for analysis. One small study in patients with HIV compared the effect of lithium versus placebo on seborrhoeic dermatitis of the face, but treatment outcomes were similar.

Authors' conclusions: Ketoconazole and ciclopirox are more effective than placebo, but limited evidence suggests that either of these agents is more effective than any other agent within the same class. Very few studies have assessed symptom clearance for longer periods than four weeks. Ketoconazole produced findings similar to those of steroids, but side effects were fewer. Treatment effect on overall quality of life remains unknown. Better outcome measures, studies of better quality and better reporting are all needed to improve the evidence base for antifungals for seborrhoeic dermatitis.

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Figures

figure 1.
figure 1.
Flow diagram for study inclusion.
figure 2.
figure 2.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
figure 3.
figure 3.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
figure 4.
figure 4.
Funnel plot of comparison: 1 Ketoconazole vs placebo, outcome: 1.1 Failure to achieve complete resolution.
Analysis 1.1.
Analysis 1.1.
Comparison 1 Ketoconazole vs placebo, Outcome 1 Failure to achieve complete resolution.
Analysis 1.2.
Analysis 1.2.
Comparison 1 Ketoconazole vs placebo, Outcome 2 Decrease in erythema score.
Analysis 1.3.
Analysis 1.3.
Comparison 1 Ketoconazole vs placebo, Outcome 3 Decrease in erythema score (long term).
Analysis 1.4.
Analysis 1.4.
Comparison 1 Ketoconazole vs placebo, Outcome 4 Erythema - Failure to achieve complete resolution.
Analysis 1.5.
Analysis 1.5.
Comparison 1 Ketoconazole vs placebo, Outcome 5 Decrease in pruritus score.
Analysis 1.6.
Analysis 1.6.
Comparison 1 Ketoconazole vs placebo, Outcome 6 Decrease in pruritus (long term).
Analysis 1.7.
Analysis 1.7.
Comparison 1 Ketoconazole vs placebo, Outcome 7 Pruritus - Failure to achieve complete resolution.
Analysis 1.8.
Analysis 1.8.
Comparison 1 Ketoconazole vs placebo, Outcome 8 Decrease in scaling score.
Analysis 1.9.
Analysis 1.9.
Comparison 1 Ketoconazole vs placebo, Outcome 9 Decrease in scaling (long term).
Analysis 1.10.
Analysis 1.10.
Comparison 1 Ketoconazole vs placebo, Outcome 10 Scaling - Failure to achieve complete resolution.
Analysis 1.11.
Analysis 1.11.
Comparison 1 Ketoconazole vs placebo, Outcome 11 Side effects.
Analysis 2.1.
Analysis 2.1.
Comparison 2 Ketoconazole vs steroids, Outcome 1 Failure to achieve complete resolution.
Analysis 2.2.
Analysis 2.2.
Comparison 2 Ketoconazole vs steroids, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 2.3.
Analysis 2.3.
Comparison 2 Ketoconazole vs steroids, Outcome 3 Decrease in erythema score.
Analysis 2.4.
Analysis 2.4.
Comparison 2 Ketoconazole vs steroids, Outcome 4 Decrease in erythema score (long term).
Analysis 2.5.
Analysis 2.5.
Comparison 2 Ketoconazole vs steroids, Outcome 5 Erythema - Failure to achieve complete resolution.
Analysis 2.6.
Analysis 2.6.
Comparison 2 Ketoconazole vs steroids, Outcome 6 Decrease in pruritus score.
Analysis 2.7.
Analysis 2.7.
Comparison 2 Ketoconazole vs steroids, Outcome 7 Decrease in pruritus (long term).
Analysis 2.8.
Analysis 2.8.
Comparison 2 Ketoconazole vs steroids, Outcome 8 Pruritus - Failure to achieve complete resolution.
Analysis 2.9.
Analysis 2.9.
Comparison 2 Ketoconazole vs steroids, Outcome 9 Decrease in scaling score.
Analysis 2.10.
Analysis 2.10.
Comparison 2 Ketoconazole vs steroids, Outcome 10 Decrease in scaling score (long term).
Analysis 2.11.
Analysis 2.11.
Comparison 2 Ketoconazole vs steroids, Outcome 11 Scaling - Failure to achieve complete resolution.
Analysis 2.11.
Analysis 2.11.
Comparison 2 Ketoconazole vs steroids, Outcome 12 Side effects.
Analysis 3.1.
Analysis 3.1.
Comparison 3 Ketoconazole vs zinc pyrithione, Outcome 1 Failure to achieve complete resolution.
Analysis 3.2.
Analysis 3.2.
Comparison 3 Ketoconazole vs zinc pyrithione, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 3.3.
Analysis 3.3.
Comparison 3 Ketoconazole vs zinc pyrithione, Outcome 3 Decrease in scaling score.
Analysis 3.4.
Analysis 3.4.
Comparison 3 Ketoconazole vs zinc pyrithione, Outcome 4 Decrease in scaling score (long term).
Analysis 3.5.
Analysis 3.5.
Comparison 3 Ketoconazole vs zinc pyrithione, Outcome 5 Side effects.
Analysis 4.1.
Analysis 4.1.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 1 Failure to achieve complete resolution.
Analysis 4.2.
Analysis 4.2.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 4.3.
Analysis 4.3.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 3 Decrease in erythema score.
Analysis 4.4.
Analysis 4.4.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 4 Decrease in erythema score (long term).
Analysis 4.5.
Analysis 4.5.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 5 Erythema - Failure to achieve complete resolution.
Analysis 4.6.
Analysis 4.6.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 6 Decrease in pruritus score.
Analysis 4.7.
Analysis 4.7.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 7 Decrease in pruritus score (long term).
Analysis 4.8.
Analysis 4.8.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 8 Decrease in scaling score.
Analysis 4.9.
Analysis 4.9.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 9 Decrease in scaling score (long term).
Analysis 4.10.
Analysis 4.10.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 10 Scaling - Failure to achieve complete resolution.
Analysis 4.11.
Analysis 4.11.
Comparison 4 Ketoconazole vs ciclopirox, Outcome 11 Side effects.
Analysis 5.1.
Analysis 5.1.
Comparison 5 Ketoconazole vs metronidazole, Outcome 1 Failure to achieve complete resolution.
Analysis 5.2.
Analysis 5.2.
Comparison 5 Ketoconazole vs metronidazole, Outcome 2 Decrease in pruritus score.
Analysis 5.3.
Analysis 5.3.
Comparison 5 Ketoconazole vs metronidazole, Outcome 3 Side effects.
Analysis 6.1.
Analysis 6.1.
Comparison 6 Ketoconazole vs climbazole, Outcome 1 Failure to achieve complete resolution (long term).
Analysis 6.2.
Analysis 6.2.
Comparison 6 Ketoconazole vs climbazole, Outcome 2 Erythema - Failure to achieve complete resolution.
Analysis 6.3.
Analysis 6.3.
Comparison 6 Ketoconazole vs climbazole, Outcome 3 Erythema - Failure to achieve complete resolution (long term).
Analysis 6.4.
Analysis 6.4.
Comparison 6 Ketoconazole vs climbazole, Outcome 4 Scaling - Erythema - Failure to achieve complete resolution.
Analysis 6.5.
Analysis 6.5.
Comparison 6 Ketoconazole vs climbazole, Outcome 5 Scaling - Erythema - Failure to achieve complete resolution (long term).
Analysis 7.1.
Analysis 7.1.
Comparison 7 Ketoconazole vs S. chrysotrichum, Outcome 1 Failure to achieve complete resolution.
Analysis 8.1.
Analysis 8.1.
Comparison 8 Ketoconazole vs pimecrolimus, Outcome 1 Decrease in erythema score (long term).
Analysis 8.2.
Analysis 8.2.
Comparison 8 Ketoconazole vs pimecrolimus, Outcome 2 Decrease in scaling score (long term).
Analysis 8.3.
Analysis 8.3.
Comparison 8 Ketoconazole vs pimecrolimus, Outcome 3 Side effects.
Analysis 9.1.
Analysis 9.1.
Comparison 9 Ketoconazole vs lithium, Outcome 1 Failure to achieve complete resolution.
Analysis 9.2.
Analysis 9.2.
Comparison 9 Ketoconazole vs lithium, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 9.3.
Analysis 9.3.
Comparison 9 Ketoconazole vs lithium, Outcome 3 Erythema - Failure to achieve complete resolution.
Analysis 9.4.
Analysis 9.4.
Comparison 9 Ketoconazole vs lithium, Outcome 4 Erythema - Failure to achieve complete resolution (long term).
Analysis 9.5.
Analysis 9.5.
Comparison 9 Ketoconazole vs lithium, Outcome 5 Pruritus - Failure to achieve complete resolution.
Analysis 9.6.
Analysis 9.6.
Comparison 9 Ketoconazole vs lithium, Outcome 6 Pruritus - Failure to achieve complete resolution (long term).
Analysis 9.7.
Analysis 9.7.
Comparison 9 Ketoconazole vs lithium, Outcome 7 Scaling - Failure to achieve complete resolution.
Analysis 9.8.
Analysis 9.8.
Comparison 9 Ketoconazole vs lithium, Outcome 8 Scaling - Failure to achieve complete resolution (long term).
Analysis 9.9.
Analysis 9.9.
Comparison 9 Ketoconazole vs lithium, Outcome 9 Side effects.
Analysis 10.1.
Analysis 10.1.
Comparison 10 Ketoconazole vs selenium, Outcome 1 Decrease in scaling score.
Analysis 11.1.
Analysis 11.1.
Comparison 11 Ketoconazole vs Quassia amara, Outcome 1 Failure to achieve complete resolution.
Analysis 11.2.
Analysis 11.2.
Comparison 11 Ketoconazole vs Quassia amara, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 12.1.
Analysis 12.1.
Analysis 12.1. Comparison 12 Ketoconazole foam vs ketoconazole cream, Outcome 1 Failure to achieve complete resolution.
Analysis 12.2.
Analysis 12.2.
Comparison 12 Ketoconazole foam vs ketoconazole cream, Outcome 2 Erythema - Failure to achieve complete resolution.
Analysis 12.3.
Analysis 12.3.
Comparison 12 Ketoconazole foam vs ketoconazole cream, Outcome 3 Pruritus - Failure to achieve complete resolution.
Analysis 12.4.
Analysis 12.4.
Comparison 12 Ketoconazole foam vs ketoconazole cream, Outcome 4 Scaling - Failure to achieve complete resolution.
Analysis 13.1.
Analysis 13.1.
Comparison 13 Ketoconazole 2% vs ketoconazole 1%, Outcome 1 Failure to achieve complete resolution.
Analysis 13.2.
Analysis 13.2.
Comparison 13 Ketoconazole 2% vs ketoconazole 1%, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 14.1.
Analysis 14.1.
Comparison 14 Bifonazole vs placebo, Outcome 1 Failure to achieve complete resolution.
Analysis 14.2.
Analysis 14.2.
Comparison 14 Bifonazole vs placebo, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 14.3.
Analysis 14.3.
Comparison 14 Bifonazole vs placebo, Outcome 3 Decrease in erythema score.
Analysis 14.4.
Analysis 14.4.
Comparison 14 Bifonazole vs placebo, Outcome 4 Decrease in erythema score (long term).
Analysis 14.5.
Analysis 14.5.
Comparison 14 Bifonazole vs placebo, Outcome 5 Decrease in pruritus score.
Analysis 14.6.
Analysis 14.6.
Comparison 14 Bifonazole vs placebo, Outcome 6 Decrease in pruritus score (long term).
Analysis 14.7.
Analysis 14.7.
Comparison 14 Bifonazole vs placebo, Outcome 7 Decrease in scaling score.
Analysis 14.8.
Analysis 14.8.
Comparison 14 Bifonazole vs placebo, Outcome 8 Decrease in scaling score (long term).
Analysis 14.9.
Analysis 14.9.
Comparison 14 Bifonazole vs placebo, Outcome 9 Side effects.
Analysis 15.1.
Analysis 15.1.
Comparison 15 Clotrimazole vs steroid, Outcome 1 Decrease in erythema score.
Analysis 15.2.
Analysis 15.2.
Comparison 15 Clotrimazole vs steroid, Outcome 2 Decrease in pruritus score.
Analysis 15.3.
Analysis 15.3.
Comparison 15 Clotrimazole vs steroid, Outcome 3 Decrease in scaling score.
Analysis 16.1.
Analysis 16.1.
Comparison 16 Clotrimazole vs Emu oil, Outcome 1 Decrease in erythema score.
Analysis 16.2.
Analysis 16.2.
Comparison 16 Clotrimazole vs Emu oil, Outcome 2 Decrease in pruritus score.
Analysis 16.3.
Analysis 16.3.
Comparison 16 Clotrimazole vs Emu oil, Outcome 3 Decrease in scaling score.
Analysis 17.1.
Analysis 17.1.
Comparison 17 Miconazole vs steroids, Outcome 1 Failure to achieve complete resolution.
Analysis 17.2.
Analysis 17.2.
Comparison 17 Miconazole vs steroids, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 18.1.
Analysis 18.1.
Comparison 18 Miconazole rinse plus shampoo vs shampoo, Outcome 1 Itching - Failure to achieve complete resolution.
Analysis 18.2.
Analysis 18.2.
Comparison 18 Miconazole rinse plus shampoo vs shampoo, Outcome 2 Scaling - Failure to achieve complete resolution.
Analysis 19.1.
Analysis 19.1.
Comparison 19 Ciclopirox vs placebo, Outcome 1 Failure to achieve complete resolution.
Analysis 19.2.
Analysis 19.2.
Comparison 19 Ciclopirox vs placebo, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 19.3.
Analysis 19.3.
Comparison 19 Ciclopirox vs placebo, Outcome 3 Decrease in erythema score.
Analysis 19.4.
Analysis 19.4.
Comparison 19 Ciclopirox vs placebo, Outcome 4 Decrease in erythema score (long term).
Analysis 19.5.
Analysis 19.5.
Comparison 19 Ciclopirox vs placebo, Outcome 5 Erythema - Failure to achieve complete resolution.
Analysis 19.6.
Analysis 19.6.
Comparison 19 Ciclopirox vs placebo, Outcome 6 Decrease in pruritus score.
Analysis 19.7.
Analysis 19.7.
Comparison 19 Ciclopirox vs placebo, Outcome 7 Decrease in pruritus score (long term).
Analysis 19.8.
Analysis 19.8.
Comparison 19 Ciclopirox vs placebo, Outcome 8 Pruritus - Failure to achieve complete resolution.
Analysis 19.9.
Analysis 19.9.
Comparison 19 Ciclopirox vs placebo, Outcome 9 Decrease in scaling score.
Analysis 19.10.
Analysis 19.10.
Comparison 19 Ciclopirox vs placebo, Outcome 10 Decrease in scaling score (long term).
Analysis 19.11.
Analysis 19.11.
Comparison 19 Ciclopirox vs placebo, Outcome 11 Scaling - Failure to achieve complete resolution.
Analysis 19.12.
Analysis 19.12.
Comparison 19 Ciclopirox vs placebo, Outcome 12 Side effects.
Analysis 20.1.
Analysis 20.1.
Comparison 20 Ciclopirox (higher dose) vs ciclopirox (lower dose), Outcome 1 Failure to achieve complete resolution.
Analysis 21.1.
Analysis 21.1.
Comparison 21 Ciclopirox vs Quassia amara, Outcome 1 Failure to achieve complete resolution.
Analysis 21.2.
Analysis 21.2.
Comparison 21 Ciclopirox vs Quassia amara, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 22.1.
Analysis 22.1.
Comparison 22 Lithium vs placebo, Outcome 1 Failure to achieve complete resolution.
Analysis 22.2.
Analysis 22.2.
Comparison 22 Lithium vs placebo, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 22.3.
Analysis 22.3.
Comparison 22 Lithium vs placebo, Outcome 3 Decrease in erythema score.
Analysis 22.4.
Analysis 22.4.
Comparison 22 Lithium vs placebo, Outcome 4 Decrease in erythema score (long term).
Analysis 22.5.
Analysis 22.5.
Comparison 22 Lithium vs placebo, Outcome 5 Erythema - Failure to achieve complete resolution.
Analysis 22.6.
Analysis 22.6.
Comparison 22 Lithium vs placebo, Outcome 6 Decrease in scaling score.
Analysis 22.7.
Analysis 22.7.
Comparison 22 Lithium vs placebo, Outcome 7 Decrease in scaling score (long term).
Analysis 22.8.
Analysis 22.8.
Comparison 22 Lithium vs placebo, Outcome 8 Scaling - Failure to achieve complete resolution.
Analysis 22.9.
Analysis 22.9.
Comparison 22 Lithium vs placebo, Outcome 9 Side effects.
Analysis 23.1.
Analysis 23.1.
Comparison 23 Ketoconazole vs placebo - Subgroup analysis by COI, Outcome 1 Failure to achieve complete resolution.
Analysis 23.2.
Analysis 23.2.
Comparison 23 Ketoconazole vs placebo - Subgroup analysis by COI, Outcome 2 Decrease in erythema score.
Analysis 23.3.
Analysis 23.3.
Comparison 23 Ketoconazole vs placebo - Subgroup analysis by COI, Outcome 3 Decrease in pruritus score.
Analysis 23.4.
Analysis 23.4.
Comparison 23 Ketoconazole vs placebo - Subgroup analysis by COI, Outcome 4 Side effects.
Analysis 24.1.
Analysis 24.1.
Comparison 24 Ketoconazole vs steroids - Subgroup analysis by COI, Outcome 1 Failure to achieve complete resolution.
Analysis 24.2.
Analysis 24.2.
Comparison 24 Ketoconazole vs steroids - Subgroup analysis by COI, Outcome 2 Failure to achieve complete resolution.
Analysis 24.3.
Analysis 24.3.
Comparison 24 Ketoconazole vs steroids - Subgroup analysis by COI, Outcome 3 Decrease in scaling score.
Analysis 25.1.
Analysis 25.1.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 1 Failure to achieve complete resolution.
Analysis 25.2.
Analysis 25.2.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 2 Decrease in erythema score.
Analysis 25.3.
Analysis 25.3.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 3 Erythema - Failure to achieve complete resolution.
Analysis 25.4.
Analysis 25.4.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 4 Decrease in pruritus score.
Analysis 25.5.
Analysis 25.5.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 5 Pruritus - Failure to achieve complete resolution.
Analysis 25.6.
Analysis 25.6.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 6 Decrease in scaling score.
Analysis 25.7.
Analysis 25.7.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 7 Decrease in scaling (long term).
Analysis 25.8.
Analysis 25.8.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 8 Scaling - Failure to achieve complete resolution.
Analysis 25.9.
Analysis 25.9.
Comparison 25 Ketoconazole vs placebo - Subgroup analysis by dose, Outcome 9 Side effects.
Analysis 26.1.
Analysis 26.1.
Comparison 26 Ketoconazole vs steroids - Subgroup analysis by dose, Outcome 1 Failure to achieve complete resolution.
Analysis 26.2.
Analysis 26.2.
Comparison 26 Ketoconazole vs steroids - Subgroup analysis by dose, Outcome 2 Failure to achieve complete resolution (long term).
Analysis 26.3.
Analysis 26.3.
Comparison 26 Ketoconazole vs steroids - Subgroup analysis by dose, Outcome 3 Erythema - Failure to achieve complete resolution.
Analysis 26.4.
Analysis 26.4.
Comparison 26 Ketoconazole vs steroids - Subgroup analysis by dose, Outcome 4 Decrease in scaling score.
Analysis 27.1.
Analysis 27.1.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 1 Failure to achieve complete resolution.
Analysis 27.2.
Analysis 27.2.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 2 Decrease in erythema score.
Analysis 27.3.
Analysis 27.3.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 3 Erythema - Failure to achieve complete resolution.
Analysis 27.4.
Analysis 27.4.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 4 Decrease in pruritus score.
Analysis 27.5.
Analysis 27.5.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 5 Decrease in scaling score.
Analysis 27.6.
Analysis 27.6.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 6 Decrease in scaling score (long term).
Analysis 27.7.
Analysis 27.7.
Comparison 27 Ketoconazole vs placebo - Subgroup analysis by mode of delivery, Outcome 7 Side effects.
Analysis 28.1.
Analysis 28.1.
Comparison 28 Ketoconazole vs steroids - Subgroup analysis by mode of delivery, Outcome 1 Failure to achieve complete resolution.
Analysis 28.2.
Analysis 28.2.
Comparison 28 Ketoconazole vs steroids - Subgroup analysis by mode of delivery, Outcome 2 Decrease in scaling score.
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