A Meta-Analysis on the Effectiveness of Sertaconazole 2% Cream Compared with Other Topical Therapies for Seborrheic Dermatitis

Abstract

Seborrheic dermatitis (SD) is a relapsing inflammatory skin disorder that affects the seborrheic areas of the body. Its etiology is not completely elucidated; however, the link between disease exacerbations and the proliferation of Malassezia spp., along with the good response to antifungal agents, indicate the role of fungi in its pathophysiology. Sertaconazole nitrate is a relatively new imidazole antifungal agent with a particular structure, consisting in a benzothiophene ring similar to the indole ring of tryptophan, and it acts mainly through the inhibition of ergosterol synthesis and the formation of pores in the fungal cell membrane. The aim of our study was to evaluate the efficiency of sertaconazole 2% cream compared with other topical treatments in patients with SD. We performed an extensive literature search by browsing the PubMed database with the keyword combination "sertaconazole AND seborrheic dermatitis AND clinical trial", which retrieved eight controlled clinical trials evaluating the effects of sertaconazole in SD. All of the clinical trials included a standard scoring index (SI). At 28 days since the beginning of the treatment, the sertaconazole regimen was associated with a significantly higher percentage of patients with mild SI and a lower percentage of patients with moderate or severe SI (odds ratio 0.51) than the other investigated treatments-hydrocortisone, ketoconazole, clotrimazole, metronidazole, pimecrolimus, and tacrolimus (odds ratio 1.95). In conclusion, treatment with sertaconazole 2% cream may represent an efficient alternative therapy for patients with SD.

Keywords: Malassezia; seborrheic dermatitis; sertaconazole; therapy.

Figure 1

Retrieval and selection of publications to be included in the meta-analysis according to the PRISMA guidelines.

Figure 2

Dynamics of percentages of patients featuring mild SI at different times (0, 14, and 28 days of treatment) in the sertaconazole vs. control groups in the eight studies included in the meta-analysis.

Figure 3

Forrest plot illustrating the effect of sertaconazole vs. other treatments in the eight selected studies for the mild SI at 28 days of treatment (OR with 95% confidence interval, heterogeneity, and overall effect).

Figure 4

Forrest plot illustrating the effect of sertaconazole vs. other treatments in the eight selected studies for the moderate and severe SI at 28 days of treatment (OR with 95% confidence interval, heterogeneity, and overall effect).

Figure 5

Forrest plot illustrating the effect of sertaconazole vs. other treatments in the eight selected studies for the “good” ranking in the self-assessment and patient satisfaction questionnaire at 28 days of treatment (OR with 95% confidence interval, heterogeneity, and overall effect).