Efficacy of Itraconazole in Prevention of Recurrence of Pyriasis Versicolor

Abstract

Pityriasis versicolor is a chronic, recurrent superficial fungal infection caused by Malassezia species, with recurrence rates reported to be as high as 80% after standard treatment. Effective prophylactic strategies are particularly needed in tropical climates where relapse is common. Objective: To evaluate the efficacy of a short-term pulsed itraconazole regimen versus placebo in preventing recurrence of pityriasis versicolor after successful initial treatment. Methods: This study was conducted at a tertiary care hospital in Quetta, Pakistan, from 22 January 2025 to 22 June 2025. A total of 144 patients aged 13 to 50 years with clinically diagnosed or Wood’s lamp-confirmed pityriasis versicolor were enrolled. All participants received induction therapy with itraconazole 100 mg twice daily for one week. Of these, 134 patients who achieved clinical clearance were randomized to receive either prophylactic itraconazole 200 mg twice daily for 1 day each month for 3 consecutive months (n = 67) or a matched placebo (n = 67). Recurrence was assessed at 3 and 5 months. Data were analyzed using appropriate statistical tests, and p < 0.05 was considered statistically significant. Results: Recurrence at 3 months occurred in 6.0% of patients in the itraconazole group compared with 35.8% in the placebo group (p < 0.001). At 5 months, recurrence was observed in 9.0% and 43.3% of patients, respectively (p < 0.001). Adherence was 100% in both groups, and no adverse events were recorded. Conclusion: Monthly pulsed itraconazole significantly reduced the recurrence of pityriasis versicolor at both 3 and 5 months compared with placebo. The regimen was well tolerated and may represent an effective prophylactic strategy in patients at high risk of relapse.