miconazole
Sources réglementaires consultées
Indications approuvées
- En Espagne, la solution pour pulvérisation cutanée est indiquée dans la teigne du pied chez l’adulte.
- Aux États-Unis, la poudre topique est indiquée pour les teignes du pied, corporelle ou inguinale.
Contre-indications
Absolues
- Hypersensibilité au miconazole, aux autres imidazolés ou à tout excipient.
- Dysfonction hépatique pour la solution espagnole pour pulvérisation cutanée.
- Asthme allergique susceptible d’être aggravé par l’utilisation d’un pulvérisateur.
Mises en garde cliniques
- Arrêter en cas d’hypersensibilité ou d’irritation. Ne pas pulvériser dans les yeux, sur les muqueuses, les plaies ou de grandes surfaces ; ne pas ingérer ni associer à d’autres préparations cutanées sur la même zone. — CIMA registro 52875
- Mise en garde majeure · Des cas d’anaphylaxie et d’angio-œdème ont été rapportés avec le miconazole topique ; arrêter et consulter immédiatement en cas de signes de réaction sévère. — CIMA registro 52875
- Une inflammation, une hypopigmentation, un érythème, une urticaire, une dermatite de contact, une éruption, un prurit, une sensation de brûlure et une irritation localisée ont été rapportés très rarement avec la solution cutanée. — CIMA registro 52875
- La solution contient 737,8214 mg d’éthanol par ml ; elle peut provoquer une sensation de brûlure sur une peau lésée et, lors d’applications fréquentes, une irritation et une sécheresse cutanées. — CIMA registro 52875
Interactions médicamenteuses
- SévèreWarfarine ou autres antagonistes de la vitamine K
Mécanisme: Bien que l’absorption topique soit limitée, le miconazole peut inhiber le CYP3A4/2C9 et renforcer ou prolonger l’effet anticoagulant.
Recommandation: Utiliser avec prudence, surveiller étroitement l’effet anticoagulant et avertir des signes de saignement.
https://cima.aemps.es/cima/dochtml/ft/52875/FT_52875.html
- ModéréeAntidiabétiques oraux ou phénytoïne
Mécanisme: Le miconazole peut renforcer l’action et les effets indésirables de ces médicaments, bien que les interactions topiques cliniquement pertinentes soient rares.
Recommandation: Utiliser avec prudence et surveiller les effets cliniques.
https://cima.aemps.es/cima/dochtml/ft/52875/FT_52875.html
Effets indésirables
Rares mais graves
Anaphylaxie ou angio-œdème · Hypersensibilité sévère
Grossesse et allaitement
Pendant la grossesse, n’utiliser la solution cutanée que si le bénéfice l’emporte sur le risque fœtal. Pendant l’allaitement, décider d’interrompre l’allaitement ou le traitement en tenant compte du bénéfice pour l’enfant et la mère.
Bibliographie récente (PubMed)
Seborrheic dermatitis (SD) is a common chronic inflammatory skin disorder that mostly affects young adults in areas rich in sebaceous glands (scalp, face, and trunk). In adolescents and adults, SD clinical presentation may range from mild patches to diffuse scalp scaling. In infants, it mainly occurs on the scalp as yellowish, scaly patches ("cradle cap"). In adults, several environmental triggers are likely to promote SD development, along with fungal colonization by Malassezia spp., sebaceous gland activity, as well as immunosuppression, endocrine, neurogenic and iatrogenic factors. In children, early occurrence in the first trimester suggests the role of excessive sebaceous gland activity from maternal hormones, along with cutaneous microbiome alterations. The diagnosis of SD is usually clinical, and specific laboratory and/or instrumental investigations are seldom required. Treatment is aimed at modulating sebum production, reducing skin colonization by Malassezia spp., and controlling inflammation. In adults, mild-to-moderate scalp SD forms can be managed with topical antifungals (ketoconazole, ciclopirox, miconazole) or antiinflammatory (mild-to-moderate potency corticosteroids) or keratolytic/humectant (propylene glycol) agents. Recommended topical therapeutic options for mild-to-moderate facial or body areas SD include topical ketoconazole, ciclopirox, clotrimazole, mild-to-moderate potency corticosteroids, lithium succinate/gluconate, and topical calcineurin inihibitors (off-label use). In severe and/or resistant cases, the use of systemic antifungal drugs (terbinafine, itraconazole), as well as UVB phototherapy, may be considered. In children, scant scientific evidence supports the effectiveness and safety of topical drugs, and "cradle cap" is usually successfully managed with baby shampoos enriched with emollient agents and vegetable oils. Alternatively, similarly to adult scalp SD, medical device shampoos with antiinflammatory and antifungal properties,
Dandruff is a scalp disorder affecting the male populace predominantly. Topical agents and synthetic drugs used for dandruff treatment have specific side effects including burning at the application site, depression, dizziness, headache, itching or skin rash, nausea, stomach pain, vision change, vomiting, discoloration of hair, dryness or oiliness of the scalp and increased loss of hair. Thus, essential oils and extracts from plants could be valuable in the treatment and prevention of dandruff. This review aims to highlight current findings in dandruff occurrence, its etiology, promising plant essential oils/extracts, and novel treatment strategies. The main emphasis has been given on the anti-dandruff effect of essential oils and plant extracts to disrupt microbial growth. The proposed mechanism(s) of action, novel approaches used to perk up its biopharmaceutical properties, and topical application have been discussed. The literature survey was done, and bibliographic sources and research papers were retrieved from different search engines and databases, including SciFinder, PubMed, NCBI, Scopus, and Google Scholar. The selection of papers was accomplished based on exclusion and inclusion criteria. The scalp of diverse populations revealed an association of dandruff with microbial symbiosis, including Staphylococcus, Propionibacterium, Malassezia, and Candida as the pathogens responsible for the cause of dandruff. Topical antifungals are considered the first line of treatment for dandruff including azoles, with clotrimazole (1%), ketoconazole (2%), and miconazole (2%). Other commonly used therapies integrate benzoyl peroxide, coal tar, glycerin, zinc pyrithione, lithium succinate/gluconate, salicylic acid, selenium disulfide/sulfide, sodium sulfacetamide, etc. However, these medicaments and chemicals are known to cause specific side effects. Alternative therapies, including tea tree oil, thyme, Aloe vera, Mentha have been reported to demonstrate anti-dandruff activ