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Clotrimazole cream for malassezia, it was reported that use of 2% topical cream was associated with improved clinical signs over 24 weeks (3). The use of this cream is not recommended due to its poor therapeutic effect (3). A single report for the use of 2% topical product in malasseZia patients and their skin type (4) revealed that there was no clinically significant effect of 2% application in malasseZia group compared to placebo group. Therefore, 2%, if used for Malassezia patients, should be considered as a no treatment solution. Soybean based preparations containing 0.1%-0.5% isoflavonoid extracts showed no significant efficacy in alleviating skin conditions patients with mild malassezia (5, 6, 7). This observation is based on 2 small prospective randomized controlled studies, each one comparing isoflavonoids, soybean products of 2% in 0.1% and 1% concentrations, with placebo. An overall efficacy in reducing itching, irritation and discomfort was observed in the 2 studies where efficacy was determined with a grading system based on the mean change from baseline using the visual analog scale (VAS) and was not different from placebo (5, 6). The efficacy of isoflavonoid product in mild to moderate malasseZia may vary and needs to be compared with a standardized standard product. One study reported that topical application of soy isoflavonoids significantly reduced lesion count (7). However, the results were analyzed with sub group analysis and are not statistically significant in this regard. However, study had several limitations, including the fact that there were multiple variables (including sun exposure and patient age) for improvement no significant effect was found with topical application. In addition to these studies, one study demonstrated that topical isoflavonoids may improve the appearance of skin lesions in severe malasseZia (8). However, the efficacy was reported to be not statistically significant. The overall conclusion is not favorable, since isoflavonoids have been used in the treatment of malasseZia, but current lack efficacy is likely due to the small sample size and relatively number of malasseZia patients used in the studies tested. Therefore, as these are from the early phase in development of this agent, more extensive evaluation of the efficacy is required in course of future studies. As topical treatments and systemic medication are not sufficient by themselves in treating severe malasseZia, alternative approaches need to be employed on an ongoing basis. The alternative options include topical antibiotics that may be more specific for Malassezia and also use biologic agents that have the potential to act on underlying biological process of MalasseZia, specifically the inflammation that occurs in MalasseZia. The recent development of novel agents that specifically target malasseZia involves the research and development of antiangiogenic drugs. The following sections will address current evidence available for the efficacy of agents that have been shown to be effective against malasseZia, and will also summarize the safety, tolerability and cost issues of using such agents. Doxycycline is a broad-spectrum bactericidal antibiotic that is widely used. Doxycycline an orally available antibiotic with a broad-spectrum ability that is well tolerated in most medical settings. The recommended duration of therapy for doxycycline is 2 to 4 weeks. Because of the broad-spectrum antibiotic effect, doxycycline is not commonly used as a treatment for Malassezia. In the United States, FDA and ACOG recommend only treatment of Malassezia with antibiotics when the physician recommends that treatment be undertaken to treat other infection and that there is no alternative. The risk for Malassezia-related complications in the United States and European Community with use of antibiotics for Malassezia is low. In the United States, a case of fulminant uveitis involving severe systemic infection is reported annually to the Vaccine Adverse Event Reporting System from the end of 1997 through November 2006. the 765 patients aged 1 month or older, the cases involved less than 10% of the cases from whole group. resulted in 1.6 million outpatient visits and approximately 12,000 hospitalizations (9). Doxycycline should only be used during pregnancy with caution, especially following an exposure to a known or suspected drug-resistant organism parasites (10). Ascorbic acid is the most prevalent dietary supplement in the United States. This food based preparation, commonly found in the American diet, contains hydroperoxide derivative of vitamin C, known as ascorbic Acular eye drops buy acid. There are no FDA-approved indications for use of the ascorbic acid in treatment of malassezia. The clinical effectiveness ascorbic acid is very limited, Zaditen 40mg $120.24 - $1 Per pill although, it has been shown to reduce malasseZia symptoms associated with infection (11,)Zaditen 50 Capsules 100mg $99 - $1.98 Per pill
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