Which treatment is best for Malassezia dermatitis?

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In a recent study in Veterinary Dermatology, researchers sifted through online article citation databases, books, proceeding papers, and more looking for studies that discussed Malassezia dermatitis treatment and examining which ones had good evidence-based results. A total of 14 trials met the authors' criteria for inclusion: they involved in vivo trials, at least five dogs were studied, and the dogs had clinical lesions. The trials examined a variety of drugs used to treat Malassezia dermatitis, including enilconazole, itraconazole, ketoconazole, miconazole, terbinafine, chlorhexidine, selenium sulfide, piroctone olamine, and benzalkonium chloride, as well as combinations of several of the drugs and treatment modalities. Although there was not a consistent study design or level of dosing among the trials, the authors were able to reach some conclusions.

The treatment the authors recommended with good evidence was topical treatment with a shampoo containing a combination of 2% miconazole nitrate and 2% chlorhexidine gluconate applied twice a week for three weeks. Systemically, two oral treatments were recommended with fair support: ketoconazole and itraconazole. Although a dosage range of 5 to 10 mg/kg ketoconazole given once a day for three weeks is effective, the authors recommended the lower dose of 5 mg/kg because it appeared to be as effective as the higher dose yet would lessen the chances of adverse effects. The recommended dose for itraconazole is 5 mg/kg given once a day two consecutive days a week for three weeks. Administration with food is recommended to enhance absorption. The authors did not find strong enough evidence to support other therapies. In those animals that experience chronic relapses, regular topical treatments or pulse therapy with itraconazole is recommended. Topical therapies are preferred because of the lower risk for toxicity. The authors recommend single-agent studies to further evaluate each drug's individual efficacy and optimal frequency of administration.

Negre A, Bensignor E, Guillot J. Evidence-based veterinary dermatology: a systematic review of interventions for Malassezia dermatitis in dogs. Vet Dermatol 2009;20(1):1-12.

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