Eczema: Can ciclopirox olamine combat this dermatosis?

The eczema is a chronic inflammatory skin disease marked by redness, skin dryness, and sometimes intense itching. While it is classically associated with a compromised skin barrier, immune hyperreactivity, and environmental factors, several recent studies underscore the central role of the skin microbiota in its pathophysiology. The proliferation of certain microorganisms, such as Staphylococcus aureus, which secretes antigens capable of activating T lymphocytes, could indeed exacerbate or sustain skin inflammation. Other lipophilic microorganisms, like yeasts of the genus Malassezia, naturally present in seborrheic areas, are also suspected of inducing IgE-mediated and T-cell immune responses.

Eczema does not result solely from disruption of the skin barrier: an imbalance of the skin microbiota can also contribute, which justifies interest in certain antifungal and antibacterial molecules, such as ciclopirox olamine.

Often found in anti-dandruff shampoos or antifungal creams, the ciclopirox olamine is an active ingredient featuring antifungal, antibacterial, and anti-inflammatory properties. Its mechanism of action is based on the chelation of metal cations, notably iron and aluminum, metals essential for the enzymatic activity of microorganisms. Furthermore, studies have shown that ciclopirox olamine can inhibit the activation of certain pro-inflammatory enzymes, such as cyclooxygenase and 5-lipoxygenase, thereby preventing the release of pro-inflammatory cytokines like IL-1β, IL-6, and TNF-α.

The ciclopirox olamine could therefore be particularly relevant for eczema. A double‐blind study involving 50 eczema patients evaluated the efficacy of a 1% ciclopirox olamine cream against the same formulation without the active ingredient. Participants applied one treatment or the other daily for 28 days. Efficacy was assessed using the Eczema Area and Severity Index (EASI) to measure the extent of eczema, and a pruritus score was recorded. The results showed a more pronounced improvement in the ciclopirox olamine group, especially between days 21 and 28, with a statistically significant difference compared to the placebo group. However, this improvement appears to be transient : after discontinuation of the treatment, IGA scores deteriorated, suggesting a possible rebound of inflammation upon stopping the antifungal application. Furthermore, no significant change was observed in pruritus.