3. Discussion
SD, reduction of cutaneous inflammation
DISEASE, ATOPIC DERMATITIS, PATHOPHYSIOLOGY
The use of topical AMPs holds promise for the treatment of SD since both antifungal and antibacterial involvement has been previously established in this disease. In this randomized, comparator- and placebo-controlled clinical trial, the efficacy of 1.75% omiganan gel was compared to its vehicle and standard-of-care 2% ketoconazole cream in a cohort of 36 patients with facial SD. Twice daily administration of omiganan did not result in significantly decreased clinical scores compared to the placebo. In contrast, a significant decrease in disease activity compared to the placebo was observed in the ketoconazole-treated group, which was paralleled by an improved barrier function and a reduced abundance of Multiple physician-reported scores were used to establish a treatment effect that yielded conclusive evidence of disease improvement in the ketoconazole-treated group versus the placebo. Clinical photography and OCT were performed to objectively reinforce these outcomes, but no differences were observed, even though these methods could detect a reduction of cutaneous inflammation over time in previous studies [The absence of significant clinical effects in the omiganan-treated group was unexpected considering the clear microbiome-modulating effects found in vitro and in vivo [While bacterial involvement might not be integral to SD pathophysiology, the involvement of In contrast to omiganan, ketoconazole demonstrated potent fungicidal effects. It remains debated whether ketoconazole’s therapeutic effect can be contributed solely to its ability to impair mycobial cell wall synthesis [Interestingly, the analysis of skin permeability and underlying molecular ceramide markers of barrier integrity yielded significant differences for ketoconazole compared to the placebo. Barrier impairment is a hallmark of atopic dermatitis, and barrier recovery is associated with clinical improvement [In conclusion, this randomized controlled study showed that topical administration of the AMP omiganan was safe and well tolerated but did not lead to clinical improvement in patients with facial SD. Microbial abundances and skin barrier parameters were not significantly altered compared to the placebo, either. In contrast, clinical scores significantly decreased in the ketoconazole group along with a potent fungicidal effect and an improved skin barrier function. This study underlines the efficacy of ketoconazole for the treatment of SD. Additionally, our comprehensive overview of the treatment response of ketoconazole as a comparative treatment supports the idea that 