Comparison between fluconazole and ketoconazole effectivity in the treatment of pityriasis versicolor

Topical drugs are often effective in limited lesions of pityriasis versicolor; but in extensive cases, systemic drugs are more suitable. Previous studies have shown that ketoconazole and fluconazole are effective in 42-97% and 74-100% of lesions respectively. Our purpose was to compare the effectiveness of a single dose of 400 mg ketoconazole with two doses of 300 mg of fluconazole with 2 weeks interval. Ninety patients with extensive pityriasis versicolor (body involved area > or =25%) were randomly assigned to treatment with either a single dose of 400 mg of ketoconazole or with two doses of 300 mg of fluconazole with 2 weeks interval. One month after the treatment, the improvement rate and side effects were evaluated by clinical examination and questionnaire. Sixty cases (66.7%) completed the study. They were 51 males and nine females, with a mean age of 30 years. At the follow-up visit (1 month after the end of treatment), the improvement rate for ketoconazole (87.9%) was not significantly different from fluconazole (81.5%), (Fisher test: P = 0.37). Due to the hepatotoxicity of ketoconazole, fluconazole appears to be more suitable in the treatment of extensive pityriasis versicolor.