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Kumar Behera J, Kumar S, Sharma R, Jain A, Kumar Garg N, Khopade A, Sawant KK, Singh R, Nirbhavane P. Novel Discoveries and Clinical Advancements for Treating Onychomycosis: A Mechanistic Insight. Adv Drug Deliv Rev 2024; 205:115174. [PMID: 38161056 DOI: 10.1016/j.addr.2023.115174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
Onychomycosis continues to be the most challenging disease condition for pharmaceutical scientists to develop an effective drug delivery system. Treatment challenges lie in incomplete cure and high relapse rate. Present compilation provides cumulative information on pathophysiology, diagnostic techniques, and conventional treatment strategies to manage onychomycosis. Novel technologies developed for successful delivery of antifungal molecules are also discussed in brief. Multidirectional information offered by this article also unlocks the panoramic view of leading patented technologies and clinical trials. The obtained clinical landscape recommends the use of advanced technology driven approaches, as a promising way-out for treatment of onychomycosis. Collectively, present review warrants the application of novel technologies for the successful management of onychomycosis. This review will assist readers to envision a better understanding about the technologies available for combating onychomycosis. We also trust that these contributions address and certainly will encourage the design and development of nanocarriers-based delivery vehicles for effective management of onychomycosis.
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Affiliation(s)
- Jitesh Kumar Behera
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Saharanpur, 247341, Uttar Pradesh, India
| | - Samarth Kumar
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India; Department of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, Gujarat, India
| | - Rajeev Sharma
- Amity Institute of Pharmacy, Amity University Madhya Pradesh, Gwalior, 474005, M.P., India
| | - Ashay Jain
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India.
| | - Neeraj Kumar Garg
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India
| | - Ajay Khopade
- Formulation Research & Development-Non-Orals Sun Pharmaceutical Industries Ltd, Vadodara, 390020, Gujarat, India
| | - Krutika K Sawant
- Department of Pharmacy, The Maharaja Sayajirao University of Baroda, Vadodara, 390002, Gujarat, India
| | - Ranjit Singh
- Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Saharanpur, 247341, Uttar Pradesh, India
| | - Pradip Nirbhavane
- Amity Institute of Pharmacy, Amity University of Haryana, Gurgaon, 122413, India.
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Kishishita J, de Almeida Perez Pimenta C, Cerqueira Macedo DP, Delgado-Charro MB, Bastos Leal L. New Formulation-Microporation Combination Approaches to Delivering Ciclopirox across Human Nails. Pharmaceutics 2024; 16:72. [PMID: 38258083 PMCID: PMC10819317 DOI: 10.3390/pharmaceutics16010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Topical treatments for onychomycosis are of interest to those seeking to avoid systemic drug interactions and to improve systemic safety. This work aimed to develop aqueous-based, simple, and cost-effective vehicles that provide high solubility for ciclopirox and enable the delivery of an active through channels created by nail microporation. Following solubility tests, aqueous gels and thermogels based on hydroxypropylmethylcellulose and poloxamer 407, respectively, were loaded with 8% and 16% ciclopirox. Their performance was then compared to the marketed lacquer Micolamina® in in vitro release tests with artificial membranes and in in vitro permeation tests with human nail clippings with and without poration. Finally, a microbiological assay compared the best gel formulations and the reference product. Little correlation was observed between the in vitro release and the permeation data, and the drug release was highly membrane-dependent. Ciclopirox nail retention in single-dose, porated nails tests was larger than in daily-dosing, non-porated nail conditions. The series of new gel and thermogel vehicles delivered ciclopirox more effectively than Micolamina® in single-dose, porated nail experiments. The inhibition of Trichophyton rubrum activity was significantly increased with microporated nails when the gel formulations were applied but not with Micolamina®. Overall, the results suggest that the new vehicles could be successfully combined with nail microporation to improve the drug delivery and efficacy of topical antifungal medication while reducing the dosing frequency, facilitating patients' adherence.
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Affiliation(s)
- Juliana Kishishita
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
| | - Camila de Almeida Perez Pimenta
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
| | - Danielle Patricia Cerqueira Macedo
- Departamento de Ciências Farmacêuticas, Laboratório de Análises Microbiológicas (LAM), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil;
| | | | - Leila Bastos Leal
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
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Chakraborty S, Sanshita, Singh I. Therapeutic treatment strategies for the management of onychomycosis: a patent perspective. Expert Opin Ther Pat 2023; 33:613-630. [PMID: 37800854 DOI: 10.1080/13543776.2023.2268278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Onychomycosis, a multifactorial fungal infection of the nails, shows a global prevalence of about 5.5% and is responsible for 50% of all nail infections. To develop effective management strategies, it is necessary to understand the etiology, pathophysiology, and risk factors of onychomycosis. Oral route of drug delivery is one of the routes utilized to deliver anti-fungal agents, but, has its own limitations like longer duration of treatment, increased adverse effects, and potential for drug interaction. The ungual route has received greater attention due to its localized, non- invasive action and improved patient compliance. AREAS COVERED This review comprehensively discusses conventional onychomycosis therapies and patented novel drug delivery systems for the management of onychomycosis including chemical permeation enhancers, non-particulate drug delivery systems, penetration enhancing devices etc., Databases such as PubMed, ResearchGate, and Google Patents were searched by using the keywords onychomycosis and trans-ungual drug delivery. EXPERT OPINION Enormous research has been conducted and is still ongoing to find the best possible novel drug delivery system for onychomycosis management. Approaches like incorporation of herbal constituents in nano-formulations, inkjet printing, laser devices, iontophoretic techniques, etc. can be employed to make safe and effective drug delivery systems which are regulatory compliant.
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Affiliation(s)
| | - Sanshita
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
| | - Inderbir Singh
- Chitkara College of Pharmacy, Chitkara University, Punjab, India
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Gupta I, Adin SN, Rashid MA, Alhamhoom Y, Aqil M, Mujeeb M. Linalool-Incorporated Synergistically Engineered Modified Liposomal Nanocarriers for Enhanced Transungual Delivery of Terbinafine against Onychomycosis. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4424. [PMID: 37374607 DOI: 10.3390/ma16124424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023]
Abstract
This work investigates the synthesis of linalool-containing invasomes for terbinafine (TBF-IN) in order to increase the solubility, bioavailability, and nail permeability of terbinafine (TBF) for transungual administration. TBF-IN was created utilising the thin-film hydration technique, and with the Box-Behnken design (BBD), optimisation was carried out. TBF-INopt were investigated for vesicle size, zeta potential, PDI (Polydispersity index), entrapment efficiency (EE) and in vitro TBF release. In addition, nail permeation analysis, TEM (transmission electron microscopy), and CLSM (confocal scanning laser microscopy) were performed for further evaluation. The TBF-INopt exhibited spherical as well as sealed vesicles with a considerably small size of 146.3 nm, an EE of 74.23 per cent, a PDI of 0.1612, and an in vitro release of 85.32 per cent. The CLSM investigation revealed that the new formulation had better TBF nail penetration than the TBF suspension gel. The antifungal investigation demonstrated that the TBF-IN gel has superior antifungal activity against Trichophyton rubrum and Candida albicans compared to the commercially available terbinafine gel. In addition, an investigation of skin irritation using Wistar albino rats indicates that the TBF-IN formulation is safe for topical treatment. This study confirmed that the invasomal vesicle formulation is an effective vehicle for the transungual delivery of TBF for the treatment of onychomycosis.
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Affiliation(s)
- Isha Gupta
- Phytomedicine Laboratory, Department of Pharmacognosy & Phytochemistry, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi 110062, India
| | - Syeda Nashvia Adin
- Phytomedicine Laboratory, Department of Pharmacognosy & Phytochemistry, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi 110062, India
| | - Md Abdur Rashid
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Al Faraa, Abha 62223, Saudi Arabia
| | - Yahya Alhamhoom
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Al Faraa, Abha 62223, Saudi Arabia
| | - Mohd Aqil
- Department of Pharmaceutics, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi 110062, India
| | - Mohd Mujeeb
- Phytomedicine Laboratory, Department of Pharmacognosy & Phytochemistry, School of Pharmaceutical Education & Research, Jamia Hamdard, New Delhi 110062, India
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Adin SN, Gupta I, Ali A, Aqil M, Mujeeb M, Sultana Y. Investigation on utility of some novel terpenes on transungual delivery of fluconazole for the management of onychomycosis. J Cosmet Dermatol 2022; 21:5103-5110. [PMID: 35390220 DOI: 10.1111/jocd.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/08/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Onychomycosis, the most prevailing affliction of the nail, accounts for approximately 90% of the toenail infection worldwide. Owing to this infection, the affected patients experience reduced quality of their life as its awful appearance undermines their daily activities and social interactions. Onychomycosis is notoriously strenuous to cure. Systemic therapy, though effective, possess severe complication of toxicities, contra-indication, and drug-drug interaction. Albeit topical therapy is favorable to its localized effect, its potency relates to the effective concentration of the antifungal drugs achieved at the infection site. An approach to accomplish this goal would be acquiring benefits from the terpenes as penetration enhancers from natural sources. This investigation aimed to study the effectiveness of six terpenes, namely safranal, lavandulol, rose oxide, 3-methyl-2-butene-1-ol, linalool, and limonene, as potential penetration enhancers for improved nail permeation of fluconazole through the human nail. METHODS Ex vivo permeation experiments were carried out by soaking the nail clippings of human volunteers in control and working solutions containing fluconazole (5 mg/ml) per se and fluconazole (5 mg/ml) with 6% of each terpene, including safranal, lavandulol, rose oxide, 3-methyl-2-butene-1-ol, linalool, and limonene, respectively, for 48 hours. The amount of fluconazole in nail clippings was quantified using an HPLC method. RESULTS Statistical analysis showed that fluconazole transungual permeation was influenced by the studied terpenes in the following order: safranal > lavandulol acetate > limonene > rose oxide (P-value > 0.05) while the other terpenes showed no significant difference with the control group and safranal represents as the most effective permeation enhancer for the transungual delivery of fluconazole. CONCLUSION It is concluded that the safranal can be successfully used as a safe and potential permeation enhancer to enhance the transungual delivery of fluconazole for the treatment of onychomycosis.
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Affiliation(s)
- Syeda Nashvia Adin
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
| | - Isha Gupta
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
| | - Asad Ali
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
| | - Mohd Aqil
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
| | - Mohd Mujeeb
- Department of Pharmacognosy and Phytochemistry, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
| | - Yasmin Sultana
- Department of Pharmaceutics, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi-110062
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A Clinical Study for the Treatment of Onychomycosis Patients Using a Novel ROS Producing Onychomycosis Treatment When Compared Against 5% Amorolfine Topical Lacquer to Reduce the Visible Size of Infected Toenails. J Mycol Med 2022; 32:101256. [DOI: 10.1016/j.mycmed.2022.101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/19/2022]
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Gupta AK, Quinlan EM. Fungal Lung. J Am Podiatr Med Assoc 2021; 111. [PMID: 34121121 DOI: 10.7547/20-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Foot and nail care specialists spend a great portion of their day using nail drills to reduce nail thickness and smooth foot calluses. This process generates a large amount of dust, some of which is small enough to breathe in and deposit into the deepest regions of the respiratory tract, potentially causing health problems. Foot and nail dust often contains fungi, from both fungus-infected and healthy-appearing nails. Although the majority of healthy individuals can tolerate inhaled fungi, the immune systems of older, immunocompromised, and allergy-prone individuals often react using the inflammatory T helper cell type 2 pathway, leading to mucus overproduction, bronchoconstriction, and, in severe cases, lung tissue damage. To protect vulnerable podiatry professionals, wearing a surgical mask, using a water spray suppression system on nail drills, installing air filtration systems, and considering drilling technique can help reduce exposure to nail dust.
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Aslam R, Hussain T, Yousaf AM, Ghori MU, Khan IU, Rizvi SAA, Shahzad Y. Onychomycosis: Current Understanding and Strategies for Enhancing Drug Delivery into Human Nail Tissue. Curr Drug Res Rev 2021; 13:25-35. [PMID: 32735534 DOI: 10.2174/2589977512666200731171505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Onychomycosis is by far the most common finger or toe nail fungal infectious disease caused by dermatophytes, non-dermatophytic molds or yeast. It accounts for 50% of the total nail disorders, and affects patients physically, socially, and psychologically and can seriously influence their quality of life. OBJECTIVES Oral antifungals are routinely used to treat the nail fungal disease; however oral therapy is associated with severe side effects and longer treatment times. In recent years, drug delivery directly into the nail or nail bed has gained attention and various topical products have been tested that can cure the disease when applied topically or transungually. Nevertheless, drug penetration into and through the nail is not straightforward and requires chemicals to improve its permeability or by applying physical stress to promote drug penetration into and through the nail. This lucid review presents an overview of various causes of onychomycosis, current therapeutic approaches, and efforts aimed at increasing the permeability of nails through various strategies such as chemical, physical and mechanical methods for permeation enhancement. CONCLUSION Various strategies have been proposed for the treatment of onychomycosis, however, much research into a more precise and effective therapy is still required.
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Affiliation(s)
- Rabia Aslam
- Faculty of Pharmacy, University of Central Punjab, Lahore, Pakistan
| | - Talib Hussain
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Abid Mehmood Yousaf
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
| | - Muhammad U Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | - Ikram U Khan
- Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Syed A A Rizvi
- Department of Pharmaceutical Sciences, Hampton University School of Pharmacy, Hampton University, VA, United States
| | - Yasser Shahzad
- Department of Pharmacy, COMSATS University Islamabad, Lahore Campus, Lahore, Pakistan
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Bonetti M, Bracchi M, Musitelli G, Perugini P. Production and characterization of bovine hoof membranes as standardized in vitro model for nail studies. Int J Pharm 2021; 600:120409. [PMID: 33639225 DOI: 10.1016/j.ijpharm.2021.120409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/18/2022]
Abstract
Several studies can be found using bovine hoof membranes as a nail in vitro model. Most of them are actually permeability studies, while it is very hard to find reference in literature related to the use of those membranes to evaluate safety and efficacy of products. In facts, some effects, both desirable or not, are not strongly related to the penetration of the products thru all of the nail plate keratin layers. There are morphological characteristics and properties such as mechanical ones which could be affected even by a product acting on the surface of the nail. Moreover, hoof membranes production is not a standardized procedure, as well as membranes characterization which is a critical step to deal with when we are looking for a specific in vitro model. In this work, hoof membranes production is described in detail, along with the characterization techniques and parameters chosen for studying the model, such as contact angle measurement and mechanical properties assessment. The production method developed in this work has shown to be effective, making it possible to obtain membranes with desirable thickness, homogenous morphology and suitable mechanical properties. Mechanical properties were the most challenging to be assessed, also for the poor coverage of the topic by scientific literature. In particular the mechanical assessment has never been used before with this specific aim thus this research could be considered as a feasibility protocol in order to obtain a suitable nail model for further studies concerning drug permeability or safety and efficacy of final products .
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Affiliation(s)
- Margherita Bonetti
- Department of Drug Sciences, University of Pavia, Via Taramelli 12, 27100 Pavia, Italy
| | - Marcello Bracchi
- Department of Drug Sciences, University of Pavia, Via Taramelli 12, 27100 Pavia, Italy
| | - Giorgio Musitelli
- Department of Drug Sciences, University of Pavia, Via Taramelli 12, 27100 Pavia, Italy
| | - Paola Perugini
- Department of Drug Sciences, University of Pavia, Via Taramelli 12, 27100 Pavia, Italy; Etichub s.rl., academic spin-off, University of Pavia, Via Taramelli 12, 27100 Pavia, Italy.
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Aggarwal R, Targhotra M, Kumar B, Sahoo PK, Chauhan MK. Treatment and management strategies of onychomycosis. J Mycol Med 2020; 30:100949. [PMID: 32234349 DOI: 10.1016/j.mycmed.2020.100949] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/15/2020] [Accepted: 03/05/2020] [Indexed: 12/12/2022]
Abstract
Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-β-cyclodextrin (HP-β-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.
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Affiliation(s)
- R Aggarwal
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India.
| | - M Targhotra
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - B Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
| | - M K Chauhan
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Mehrauli - Badarpur Rd, Sector 3, Pushp Vihar, New Delhi 110017, India
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Vanstone S, Stone JM, Gordeev SN, Guy RH. Mechanism of human nail poration by high-repetition-rate, femtosecond laser ablation. Drug Deliv Transl Res 2020; 9:956-967. [PMID: 31016477 PMCID: PMC6731198 DOI: 10.1007/s13346-019-00638-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Optical poration, or drilling, of the human nail has the potential to drastically improve transungual drug delivery. However, this approach is accompanied by thermal damage to the nail tissue surrounding the laser radiation-created pore. In this paper, fluorescence microscopy has been employed to quantitatively evaluate thermal damage to the nail induced by laser ablation with 80 MHz, nanojoule, femtosecond pulses delivered via a hollow-core fibre. An empirical relation has been established between the intensity of the resulting fluorescence signal and temperature to which the nail was exposed. Using this relationship, detailed temperature maps have been created of the areas surrounding the pores, enabling the mechanism of poration to be better understood. It was deduced that plasma-mediated ablation is primarily responsible for nail tissue ablation at the centre of the pore, while cumulative photothermal processes dominate at the pore edges. It is concluded, furthermore, that temperature mapping represents a useful new tool with which to optimise the process of nail poration. The method is potentially generic and may be applicable to other biological materials.
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Affiliation(s)
- Simon Vanstone
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - James M Stone
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Sergey N Gordeev
- Department of Physics, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Centre for Nanoscience & Nanotechnology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Richard H Guy
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK. .,Centre for Nanoscience & Nanotechnology, University of Bath, Claverton Down, Bath, BA2 7AY, UK. .,Centre for Therapeutic Innovation and Centre for Biosensors, Bioelectronics & Biodevices, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
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Davies-Strickleton H, Cook J, Hannam S, Bennett R, Gibbs A, Edwards D, Ridden C, Ridden J, Cook D. Assessment of the nail penetration of antifungal agents, with different physico-chemical properties. PLoS One 2020; 15:e0229414. [PMID: 32107486 PMCID: PMC7046211 DOI: 10.1371/journal.pone.0229414] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 02/05/2020] [Indexed: 12/25/2022] Open
Abstract
Onychomycosis, or fungal nail infection, is a common fungal infection largely caused by dermatophyte fungi, such as Trichophyton rubrum or Trichophyton mentagrophytes, which affects a significant number of people. Treatment is either through oral antifungal medicines, which are efficacious but have significant safety concerns, or with topical antifungal treatments that require long treatment regimens and have only limited efficacy. Thus, an efficacious topical therapy remains an unmet medical need. Among the barriers to topical delivery through the nail are the physico-chemical properties of the antifungal drugs. Here, we explore the ability of a range of antifungal compounds with different hydrophilicities to penetrate the nail. Human nail discs were clamped within static diffusion (Franz) cells and dosed with equimolar concentrations of antifungal drugs. Using LC-MS/MS we quantified the amount of drug that passed through the nail disc and that which remained associated with the nail. Our data identified increased drug flux through the nail for the more hydrophilic compounds (caffeine as a hydrophilic control and fluconazole, with LogP -0.07 and 0.5, respectively), while less hydrophilic efinaconazole, amorolfine and terbinafine (LogP 2.7, 5.6 and 5.9 respectively) had much lower flux through the nail. On the other hand, hydrophilicity alone did not account for the amount of drug associated with/bound to the nail itself. While there are other factors that are likely to combine to dictate nail penetration, this work supports earlier studies that implicate compound hydrophilicity as a critical factor for nail penetration.
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Affiliation(s)
| | - Julie Cook
- Blueberry Therapeutics Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - Sally Hannam
- Alderley Analytical Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - Rhys Bennett
- Alderley Analytical Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - Alan Gibbs
- Alderley Analytical Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - David Edwards
- Blueberry Therapeutics Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - Christine Ridden
- Blueberry Therapeutics Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - John Ridden
- Blueberry Therapeutics Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
| | - David Cook
- Blueberry Therapeutics Limited, Alderley Park, Alderley Edge, Cheshire, United Kingdom
- * E-mail:
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Belikov AV, Tavalinskaya AD, Smirnov SN, Sergeev AN. Active Er-laser drug delivery using drug-impregnated gel for treatment of nail diseases. BIOMEDICAL OPTICS EXPRESS 2019; 10:3232-3240. [PMID: 31467776 PMCID: PMC6706032 DOI: 10.1364/boe.10.003232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 06/10/2023]
Abstract
Active Er-laser drug delivery under the nail plate using a drug-impregnated gel containing liquid methylene blue clusters is demonstrated for the first time. The effect of the agar-agar concentration in the gel and the gel plate thickness on the number of Er:YLF-laser pulses required for formation of a through microhole in the gel and in the nail plate with subsequent active drug delivery is discussed. The influence of the laser pulse energy, the gel plate thickness, and the external pressure applied to the gel on the rate of delivery of methylene blue under the nail plate through a single microhole in it is investigated. It is shown that with a laser pulse energy of 4.0 ± 0.1 mJ, the delivery rate can reach 0.024 ± 0.004 mg/pulse.
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Amra K, Momin M. Formulation evaluation of ketoconazole microemulsion-loaded hydrogel with nigella oil as a penetration enhancer. J Cosmet Dermatol 2019; 18:1742-1750. [PMID: 30980617 DOI: 10.1111/jocd.12945] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Onychomycosis is an opportunistic fungal infection often infecting people with compromised immune system. Currently available treatment interventions such as physical, surgical, and chemical-based approaches are successful in treating the condition, however, are painful and nonpatient complaint. Moreover, dermal creams with antifungal agents do not penetrate nail plate as required; hence, there is a necessity of developing a novel formulation with enhanced penetration. AIMS The aim of the present research work was to develop ketoconazole microemulsion-loaded hydrogel formulation containing nigella oil as permeation enhancer for the treatment of onychomycosis. METHODS Screening of oils, surfactants, and cosurfactants were done based on solubility studies followed by the construction of pseudo-ternary phase diagrams with 2% ketoconazole. The microemulsion was characterized for globule size, zeta potential, viscosity, and thermodynamic stability. Ex-vivo studies were carried out using Franz diffusion cells using porcine skin membrane. The antifungal activity of microemulsion-loaded hydrogel was evaluated using cup plate method using Candida albicans and Aspergillus niger. RESULTS The optimized microemulsion had a composition of 54.97% Capryol:Nigella (2:1), 36.07% Transcutol:Propylene glycol (2:1), and 7.13% water and was later incorporated into polymeric gel base. The microemulsion-loaded hydrogel exhibited a 10 hours sustained release profile as compared to the marketed cream and an enhanced activity against marketed ketoconazole cream and compared with marketed ketoconazole formulation. CONCLUSION The thermodynamic stability, sustained drug release with greater permeation, and enhanced activity due to the presence of nigella oil in microemulsion-loaded hydrogel warrant its application as an excellent vehicle for treating fungal infections.
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Affiliation(s)
| | - Munira Momin
- Department of Pharmaceutics, Dr Bhanuben Nanavati College of Pharmacy, Mumbai, India
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Potential of Chemical and Physical Enhancers for Transungual Delivery of Amorolfine Hydrochloride. MATERIALS 2019; 12:ma12071028. [PMID: 30925734 PMCID: PMC6480142 DOI: 10.3390/ma12071028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 02/06/2023]
Abstract
Topical monotherapy of nail infection is limited by poor drug permeability into the human nail plate. Numerous substances and methods are applied to improve the antifungal agent delivery across the nail plate. This work aimed to evaluate the effect of chemical and physical enhancers on the accumulation and permeation of amorolfine hydrochloride through human nail clippings. Polymeric nail lacquers with Eudragit E100 were developed as a potentially suitable delivery system for amorolfine hydrochloride. Incorporating thioglycolic acid and urea into formulations provided increased accumulation of antifungal agent in nail layers of up to 100% and 57%, respectively. Structural changes of nail barrier, induced by fractional CO2 laser, were visualized by microscopy. The permeation of amorolfine hydrochloride through the nail increased twofold when thioglycolic acid-containing formulation was applied and the nail was pretreated with a fractional CO2 laser. The results suggest that this novel combination of enhancers has the potential to be an effective option for topical drug delivery through the nail, and increased the efficacy of treatment.
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Kreutz T, de Matos SP, Koester LS. Recent Patents on Permeation Enhancers for Drug Delivery Through Nails. RECENT PATENTS ON DRUG DELIVERY & FORMULATION 2019; 13:203-218. [PMID: 31663846 PMCID: PMC7011684 DOI: 10.2174/1872211313666191030155837] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/21/2019] [Accepted: 10/24/2019] [Indexed: 12/29/2022]
Abstract
The human nail is a unique barrier with a keratinized constitution that favors protection and fine touch. However, many disorders can affect the nail, among them, are the onychomycosis and psoriasis. Systemic oral therapy has been applied to treat these diseases, even presenting disadvantages, including side effects, drug interactions, contraindications, toxicity, high cost and low patient compliance. A great option to succeed in dealing with the problems associated with oral therapy is the topical administration of drugs. However, nail composition, low diffusion through ungual route and reduced tissue bioavailability for topical treatments are limiting factors. These drawbacks can be overcome by promoting penetration through the nails by employing penetration enhancers. The review focuses on patents that highlight permeation enhancers applied to nail drug delivery for the treatment of onychomycosis and psoriasis. Literature and patent searches were conduced regarding the topic of interest. The substantial literature and patent search revealed that permeation enhancers, especially chemicals, are great strategies for promoting the ungual delivery of drugs. Nail topical therapy containing permeation enhancers is an attractive option for delivering localized treatments.
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Affiliation(s)
- Tainá Kreutz
- Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Av. Ipiranga, Santana, 2752, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sheila Porto de Matos
- Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Av. Ipiranga, Santana, 2752, Porto Alegre, Rio Grande do Sul, Brazil
| | - Letícia Scherer Koester
- Graduate Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Rio Grande do Sul, Av. Ipiranga, Santana, 2752, Porto Alegre, Rio Grande do Sul, Brazil
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Angelo T, Borgheti-Cardoso LN, Gelfuso GM, Taveira SF, Gratieri T. Chemical and physical strategies in onychomycosis topical treatment: A review. Med Mycol 2018; 55:461-475. [PMID: 27703019 DOI: 10.1093/mmy/myw084] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/30/2016] [Indexed: 12/13/2022] Open
Abstract
Onychomycosis is a fungal infection of the fingernails or toenails caused by dermatophytes, nondermatophytes, moulds, and yeasts. This condition affects around 10-30% people worldwide, negatively influencing patients' quality of life, with severe outcomes in some cases. Since the nail unit acts as a barrier to exogenous substances, its physiological features hampers drug penetration, turning the onychomycosis treatment a challenge. Currently, there are several oral and topical therapies available; nevertheless, cure rates are still low and relapse rates achieves 10-53%. Also, serious side effects may be developed due to long-term treatment. In light of these facts, researchers have focused on improving topical treatments, either by modifying the vehicle or by using some physical technique to improve drug delivery trough the nail plate, hence increasing therapy effectiveness. Therefore, the aim of this paper is to explain these novel alternative approaches. First, the challenges for drug ungual penetration are presented. Then, the chemical and physical strategies developed for overcoming the barriers for drug penetration are discussed. We hope that the information gathered may be useful for the development of safer and more effective treatments for onychomycosis.
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Affiliation(s)
- Tamara Angelo
- Laboratory of Food, Drugs and Cosmetics (LTMAC). School of Health Sciences, University of Brasília. Campus Universitário Darcy Ribeiro, s/n, 70910-900, Brasília, DF, Brazil
| | - Lívia Neves Borgheti-Cardoso
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo. Avenida do Café, s/n, 14040903, Ribeirão Preto, SP, Brazil
| | - Guilherme Martins Gelfuso
- Laboratory of Food, Drugs and Cosmetics (LTMAC). School of Health Sciences, University of Brasília. Campus Universitário Darcy Ribeiro, s/n, 70910-900, Brasília, DF, Brazil
| | - Stephânia Fleury Taveira
- School of Pharmacy, Federal University of Goiás. Rua 240 c/5ª. Avenida, s/n, Setor Leste Universitário, 74.605-170, Goiânia, GO, Brazil
| | - Tais Gratieri
- Laboratory of Food, Drugs and Cosmetics (LTMAC). School of Health Sciences, University of Brasília. Campus Universitário Darcy Ribeiro, s/n, 70910-900, Brasília, DF, Brazil
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Monti D, Egiziano E, Burgalassi S, Tampucci S, Terreni E, Tivegna S, Chetoni P. Influence of a Combination of Chemical Enhancers and Iontophoresis on In Vitro Transungual Permeation of Nystatin. AAPS PharmSciTech 2018; 19:1574-1581. [PMID: 29484614 DOI: 10.1208/s12249-018-0977-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/11/2018] [Indexed: 12/28/2022] Open
Abstract
To promote transungual permeation of nystatin (NYST), molecule with high molecular weight, no water-soluble, amphoteric by iontophoresis. The synergic effect of the combination of cetylpyridinium chloride, CPC, or polyoxyethylene (20) sorbitan monooleate, TW80, and iontophoresis was investigated. In vitro permeation experiments were carried out through bovine hoof slices using vertical diffusion cells. A low current density (0.2 mA/cm2) was applied by introducing Ag/AgCl electrodes in the donor (anode) and receptor (cathode) chambers. The donor phase consisted of a solution, a suspension, or gel-type vehicles containing NYST and surfactants in pH 5.6 HEPES buffer. The addition of CPC to NYST suspension (SOSP) produced a fivefold increase on the permeability of the bovine hoof membrane to the drug. The application of anodal iontophoresis further improved NYST flux. Conversely, NYST transungual permeation was not influenced by TW80 either in the passive diffusion or iontophoretic flux. Furthermore, the iontophoretic treatment does not appear to induce irreversible alterations to the hoof bovine membranes. The present work demonstrated the efficacy of iontophoresis as a treatment for different nail pathologies with large molecules very slightly soluble in water without irreversibly affecting the nail structure. A synergistic effect between CPC and iontophoresis was observed.
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Evaluation of the promoting effect of soluble cyclodextrins in drug nail penetration. Eur J Pharm Sci 2018; 117:270-278. [DOI: 10.1016/j.ejps.2018.02.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 02/26/2018] [Indexed: 12/17/2022]
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Khattab A, Shalaby S. Optimized Ciclopirox-Based Eudragit RLPO Nail Lacquer: Effect of Endopeptidase Enzyme as Permeation Enhancer on Transungual Drug Delivery and Efficiency Against Onychomycosis. AAPS PharmSciTech 2018; 19:1048-1060. [PMID: 29138987 DOI: 10.1208/s12249-017-0917-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022] Open
Abstract
The aims of our investigation were to develop and optimize ciclopirox (CPX) nail lacquer using nonbiodegradable Eudragit RLPO (E-RLPO) as a film former and to assess its penetration efficiency across the human nail plate. Preliminary trials such as hydration enhancement factor (HEF), a retained drug in the nail plate, and SEM were studied to select the optimized permeation enhancer to be incorporated in the optimized lacquer formulation. A 33 full factorial design was built up to study the effect of three different factors, concentration of E-RLPO (10, 20, and 30%), Tween 80 (0.25, 0.5, and 1%), and triacetin (0, 10, and 30% of polymer weight). The studied responses were the drying time, water resistance, viscosity, and drug release up to 4 h. An ex vivo permeation study for the optimized formulations was carried out. The preliminary study aided the selection of 5% papain (endopeptidase enzyme) as a penetration enhancer; it showed the highest HEF of 15.27%, the highest amount of drug retained in the nail plate (886.2 μg/g). An ex vivo permeation study guided the selection of F4B (flux value of 3.79 μg/cm2/h) as optimized formulation. The optimized lacquer formula showed threefold increases in the permeation than the marketed CPX lacquer (Batrafen®). Confocal laser scanning microscopy revealed the higher intensity of the Rhodamine B dye across the nail plate in the case of the formula containing papain than the marketed formula without papain. Conclusively, an efficient and stable nail lacquer was developed for potential transungual delivery of CPX to target the drug to the nail bed and ensure efficiency against onychomycosis.
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21
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Voriconazole-loaded nanostructured lipid carriers (NLC) for drug delivery in deeper regions of the nail plate. Int J Pharm 2017; 531:292-298. [PMID: 28859937 DOI: 10.1016/j.ijpharm.2017.08.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 12/31/2022]
Abstract
Voriconazole-loaded nanostructured lipid carriers (VOR-NLC) were developed and drug penetration evaluated in porcine hooves in vitro. Synergistic effect of urea (Ur), selected among other known chemical enhancers according to hoof hydration potential, was also evaluated. VOR-NLC presented a high encapsulation efficiency (74.52±2.13%), approximate mean diameter of 230nm and were positively charged (+27.32±2.74mV). Stability studies indicated they were stable under refrigeration (4±2°C) for up to 150days. SEM images revealed hooves treated with VOR-NLC and VOR-NLC-Ur suffered a disturbance on the surface depicting high roughness and porosity. Permeation data showed a substantial VOR amount retained in superficial hooves sections independent of the formulation used (2.42±0.26; 2.52±0.36 and 2.41±0.60μg/cm2 for unloaded VOR, VOR-NLC and VOR-NLC-Ur, respectively, p>0.05). Still, successive extractions, revealed the amount of VOR retained in deeper regions was significantly higher when VOR-NLC or VOR-NLC-Ur was used (0.17±0.04, 0.47±0.14 and 0.36±0.07μg/cm2 for unloaded VOR, VOR-NLC and VOR-NLC-Ur, respectively, p<0.05). Such results indicate NLC are promising formulations for the management of onychomycosis. Further studies in diseased nail plates are necessary.
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22
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Tsai MT, Tsai TY, Shen SC, Ng CY, Lee YJ, Lee JD, Yang CH. Evaluation of Laser-Assisted Trans-Nail Drug Delivery with Optical Coherence Tomography. SENSORS (BASEL, SWITZERLAND) 2016; 16:E2111. [PMID: 27973451 PMCID: PMC5191091 DOI: 10.3390/s16122111] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023]
Abstract
The nail provides a functional protection to the fingertips and surrounding tissue from external injuries. The nail plate consists of three layers including dorsal, intermediate, and ventral layers. The dorsal layer consists of compact, hard keratins, limiting topical drug delivery through the nail. In this study, we investigate the application of fractional CO₂ laser that produces arrays of microthermal ablation zones (MAZs) to facilitate drug delivery in the nails. We utilized optical coherence tomography (OCT) for real-time monitoring of the laser-skin tissue interaction, sparing the patient from an invasive surgical sampling procedure. The time-dependent OCT intensity variance was used to observe drug diffusion through an induced MAZ array. Subsequently, nails were treated with cream and liquid topical drugs to investigate the feasibility and diffusion efficacy of laser-assisted drug delivery. Our results show that fractional CO₂ laser improves the effectiveness of topical drug delivery in the nail plate and that OCT could potentially be used for in vivo monitoring of the depth of laser penetration as well as real-time observations of drug delivery.
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Affiliation(s)
- Meng-Tsan Tsai
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan.
- Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan.
| | - Ting-Yen Tsai
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Su-Chin Shen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Chau Yee Ng
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
| | - Ya-Ju Lee
- Institute of Electro-Optical Science and Technology, National Taiwan Normal University, Taipei 11677, Taiwan.
| | - Jiann-Der Lee
- Department of Electrical Engineering, Chang Gung University, Taoyuan 33302, Taiwan.
- Department of Neurosurgery, Chang Gung Memorial Hospital, LinKou 33305, Taiwan.
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
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Coopman R, Van de Vyver T, Kishabongo AS, Katchunga P, Van Aken EH, Cikomola J, Monteyne T, Speeckaert MM, Delanghe JR. Glycation in human fingernail clippings using ATR-FTIR spectrometry, a new marker for the diagnosis and monitoring of diabetes mellitus. Clin Biochem 2016; 50:62-67. [PMID: 27598437 DOI: 10.1016/j.clinbiochem.2016.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Although HbA1c is a good diagnostic tool for diabetes, the precarity of the health system and the costs limit the use of this biomarker in developing countries. Fingernail clippings contain ±85% of keratins, which are prone to glycation. Nail keratin glycation may reflect the average glycemia over the last months. We explored if attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) can be used as a non-invasive tool for assessing glycation in diabetes. DESIGN AND METHODS Using ATR-FTIR spectroscopy, glycation and deglycation experiments with fructosamine 3-kinase allowed to identify the spectrum that corresponds with keratin glycation in fingernail clippings. Clippings of 105 healthy subjects and 127 diabetics were subjected to the standardized ATR-FTIR spectroscopy method. RESULTS In vitro glycation resulted in an increased absorption at 1047cm-1. Following enzymatic deglycation, this peak diminished significantly, proving that the AUC between 970 and 1140cm-1 corresponded with glycated proteins. Within-run CV of the assay was 3%. Storage of nail clippings at 37°C for 2weeks did not significantly change results. In diabetics, glycated nail protein concentrations (median: 1.51μmol/g protein, IQR: 1.37-1.85μmol/g protein) were significantly higher than in the controls (median: 1.19μmol/g protein, IQR: 1.09-1.26μmol/g protein) (p<0.0001). ROC analysis yielded an AUC of 0.92 at a cut-off point of 1.28μmol/g nail (specificity: 82%; sensitivity: 90%). No correlation was observed between the glycated nail protein concentrations and HbA1c. CONCLUSIONS Protein glycation analysis in fingernails with ATR-FTIR spectroscopy could be an alternative affordable technique for diagnosing and monitoring diabetes. As the test does not consume reagents, and the preanalytical phase is extremely robust, the test could be particularly useful in developing countries.
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Affiliation(s)
- Renaat Coopman
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | - Thijs Van de Vyver
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | - Antoine Sadiki Kishabongo
- Department of Laboratory Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Philippe Katchunga
- Department of Internal Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | | | - Justin Cikomola
- Department of Internal Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo
| | - Tinne Monteyne
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | | | - Joris R Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium.
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Thapa RK, Choi JY, Go TG, Kang MH, Han SD, Jun JH, Son MW, Yong CS, Kim JO. Development of ciclopirox nail lacquer with enhanced permeation and retention. Arch Pharm Res 2016; 39:953-9. [PMID: 27306785 DOI: 10.1007/s12272-016-0774-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
Onychomycosis is a prevailing disease caused by fungal infection of nails that mostly affects athletes and the elderly. Ciclopirox is approved by the US Food and Drug Administration for the topical treatment of onychomycosis. However, the desired penetration of ciclopirox into the nail bed has not been achieved via topical application for efficient treatment. Therefore, the main aim of this study was to enhance ciclopirox permeation and retention in nail by the development of a new nail lacquer formulation. We screened the effects of different solvents, alkalizing agents, and permeation enhancers on the permeation of bovine hooves by ciclopirox and its retention in human nail clippings. The results suggest that isopropyl alcohol, potassium hydroxide, and urea as the solvent, alkalizing agent, and permeation enhancer, respectively, improved the permeation of the ciclopirox nail lacquer formulation the most with high flux rates. Comparison of the final formulation and marketed product revealed enhanced retention of ciclopirox from our developed formulation in human nail clippings. Therefore, our newly developed nail lacquer may be a potentially effective formulation for the treatment of onychomycosis in humans.
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Affiliation(s)
- Raj Kumar Thapa
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Ju Yeon Choi
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Toe Gyung Go
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Min Hyung Kang
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Sang Duk Han
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Joon-Ho Jun
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Mi Won Son
- Dong-A ST Research Institute, Pharmaceutical Product Research Laboratories, Yongin, 449-905, South Korea
| | - Chul Soon Yong
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea
| | - Jong Oh Kim
- College of Pharmacy, Yeungnam University, 214-1 Dae-dong, Gyeongsan, 712-749, South Korea.
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Kataria P, Sharma G, Thakur K, Bansal V, Dogra S, Katare OP. Emergence of nail lacquers as potential transungual delivery system in the management of onchomycosis. Expert Opin Drug Deliv 2016; 13:937-52. [DOI: 10.1080/17425247.2016.1174691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Gajanand Sharma
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Kanika Thakur
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
| | - Vikas Bansal
- Chandigarh College of Pharmacy, Mohali, Punjab, India
| | - Sunil Dogra
- Department of Dermatology Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Om Prakash Katare
- Division of Pharmaceutics, University Institute of Pharmaceutical Sciences, UGC Centre of Advanced Studies, Panjab University, Chandigarh, India
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Joshi M, Sharma V, Pathak K. Nail psoriasis: An updated review of clinical reports on therapy and formulation aspects for topical delivery. J Drug Deliv Sci Technol 2015. [DOI: 10.1016/j.jddst.2015.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Nail disorders are beyond cosmetic concern; besides discomfort in the performance of daily chores, they disturb patients psychologically and affect their quality of life. Fungal nail infection (onychomycosis) is the most prevalent nail-related disorder affecting a major population worldwide. Overcoming the impenetrable nail barrier is the toughest challenge for the development of efficacious topical ungual formulation. Sophisticated techniques such as iontophoresis and photodynamic therapy have been proven to improve transungual permeation. This article provides an updated and concise discussion regarding the conventional approach and upcoming novel approaches focused to alter the nail barrier. A comprehensive description regarding preformulation screening techniques for the identification of potential ungual enhancers is also described in this review while highlighting the current pitfalls for the development of ungual delivery.
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Joshi M, Sharma V, Pathak K. Matrix based system of isotretinoin as nail lacquer to enhance transungal delivery across human nail plate. Int J Pharm 2014; 478:268-277. [PMID: 25445993 DOI: 10.1016/j.ijpharm.2014.11.050] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/21/2014] [Accepted: 11/23/2014] [Indexed: 02/07/2023]
Abstract
The project was aimed at development of isotretinoin nail lacquer and assessment of its penetration efficiency across human nail plate. Preliminary studies (hydration enhancement factor and SEM) aided the selection of thioglycolic acid as permeation and eugenol was selected as local anesthetic in the formulation. The nail lacquer was optimized by 3(2) factorial design and a total of nine formulations were prepared and screened. In vitro adhesion and ex vivo permeation (cumulative drug permeation per unit area (CDP/A) = 6.61 ± 0.57 mg/cm(2)) across bovine hoof guided the selection of F3 as optimized formulation that was improvised. Viscosity adjustments to improve handling characteristics were affected by incorporation of ethyl cellulose (6%; F3M1) that scaled the viscosity to 312.681 cp and insignificantly (p > 0.05) affected CDP/A (6.32 ± 0.45 mg/cm(2)). In comparison to marketed preparation (Retino-A cream) F3M1 afforded two fold increase in CDP/A. The permeation characteristics were defined by Higuchi model (r(2) = 0.964) and flux value of 176 μg/cm(2)/h. Confocal laser scanning microscopy, after 72 h of nail lacquer application, revealed extensive distribution of the fluorescent tracer across the human nail plate in comparison to control that was confined to the top layer. Conclusively, an efficacious and stable nail lacquer of isotretinoin was developed for potential clinical topical use to target the drug to nail bed in treatment of nail psoriasis.
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Affiliation(s)
- Monika Joshi
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India
| | - Vijay Sharma
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India
| | - Kamla Pathak
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, N.H.# 2, Delhi Mathura Road, P.O. Chhatikkara, Mathura 281001, India.
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Gupta S, Bansal R, Gupta S, Jindal N, Jindal A. Nanocarriers and nanoparticles for skin care and dermatological treatments. Indian Dermatol Online J 2014; 4:267-72. [PMID: 24350003 PMCID: PMC3853888 DOI: 10.4103/2229-5178.120635] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Nanotechnology (nano: One billionth) is a novel arena with promising applications in the field of medicine, especially pharmaceuticals for safe and targeted drug delivery. The skin is a phenomenal tool for investigation of nanocarriers for drug delivery for topical and dermatological application. The physicochemical characteristics of the nanoparticles, such as rigidity, hydrophobicity, size and charge are crucial to the skin permeation mechanism. Many nanocarriers such as polymeric, inorganic and lipid nanoparticles and nanoemulsions have been developed and some like carbon nanotubes and fullerenes still need further exploration for future use in skin care and dermatological treatments. Risks of nanopollution and cytotoxicity also need to be kept in mind while exploring various nanoparticles for medical use.
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Affiliation(s)
- Sanjeev Gupta
- Department of Dermatology, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Radhika Bansal
- Department of Dermatology, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Sunita Gupta
- Department of Medicine, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Nidhi Jindal
- Department of Dermatology, Pt. BDS PGIMS, Rohtak, Haryana, India
| | - Abhinav Jindal
- Department of Dermatology, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Naumann S, Meyer JP, Kiesow A, Mrestani Y, Wohlrab J, Neubert RH. Controlled nail delivery of a novel lipophilic antifungal agent using various modern drug carrier systems as well as in vitro and ex vivo model systems. J Control Release 2014; 180:60-70. [DOI: 10.1016/j.jconrel.2014.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 12/28/2022]
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Kishabongo AS, Katchunga P, Van Aken EH, Speeckaert MM, Lagniau S, Husein D, Taes YE, Delanghe JR. Glycated nail proteins: a new approach for detecting diabetes in developing countries. Trop Med Int Health 2013; 19:58-64. [DOI: 10.1111/tmi.12218] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Antoine Sadiki Kishabongo
- Department of Laboratory Medicine; Catholic University of Bukavu; Bukavu Democratic Republic of the Congo
| | - Philippe Katchunga
- Department of Internal Medicine; Catholic University of Bukavu; Bukavu Democratic Republic of the Congo
| | | | | | - Sabrina Lagniau
- Department of Clinical Chemistry; Ghent University Hospital; Gent Belgium
| | - Dashty Husein
- Department of Endocrinology; Ghent University Hospital; Gent Belgium
| | - Youri E. Taes
- Department of Endocrinology; Ghent University Hospital; Gent Belgium
| | - Joris R. Delanghe
- Department of Clinical Chemistry; Ghent University Hospital; Gent Belgium
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Transungual delivery of ketoconazole using novel lacquer formulation. Int J Pharm 2013; 456:357-61. [PMID: 24029171 DOI: 10.1016/j.ijpharm.2013.08.082] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/29/2013] [Accepted: 08/27/2013] [Indexed: 11/23/2022]
Abstract
Onychomycosis, a common fungal infection of the nail, can have a substantial impact on quality of life. The success of topical therapy for onychomycosis depends on effective penetration, which can be enhanced using an appropriate delivery method. This study evaluated the effectiveness of a novel topical lacquer on enhancing [(14)C]-ketoconazole penetration by comparing nail absorption, nail distribution, and nail penetration of [(14)C]-ketoconazole dissolved in the novel lacquer versus a commercial ketoconazole cream. Using the in vitro finite dose model, the formulations were applied daily to human nail plates for 7 days. Drug absorption was measured by monitoring rate of appearance in each nail layer and the supporting bed. After the multiple day treatment, cumulative concentrations of ketoconazole formulated in novel lacquer in the deep nail layer and the nail bed were significantly greater than cumulative concentrations of commercial ketoconazole (p<0.05), as well as several orders of magnitude greater than the minimal inhibitory concentration (MIC) deemed necessary to inhibit the growth of causative dermatophytic and yeast species. These results suggest that this novel ketoconazole lacquer has the potential to be an effective topical treatment for onychomycosis.
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Hafeez F, Hui X, Selner M, Rosenthal B, Maibach H. Ciclopirox delivery into the human nail plate using novel lipid diffusion enhancers. Drug Dev Ind Pharm 2013; 40:838-44. [PMID: 23600655 DOI: 10.3109/03639045.2013.788016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Onychomycosis is a common fungal infection of the nail plate and bed that affects up to 14% of the population and can have a substantial impact on the quality of life of those affected. OBJECTIVE This study compared the onychopharmacokinetics, nail absorption, nail distribution, and nail penetration of [(14)C]-ciclopirox dissolved in novel lipid diffusion enhancers with that of a commercial ciclopirox nail lacquer using the in vitro finite dose model. MATERIALS AND METHODS The penetration rate of ciclopirox was determined by applying doses of topical formulation twice daily to human nail plates for 11 d. Drug absorption was then measured by monitoring its rate of appearance in each nail layer and in the cotton pad/nail supporting bed. RESULTS After a multiple day treatment, cumulative concentrations of ciclopirox formulated with lipid enhancers in the deep nail layer and the nail bed were significantly greater than cumulative concentrations of the commercial ciclopirox lacquer (p < 0.001) as well as several orders of magnitude greater than the minimal inhibitory concentration (MIC) deemed necessary to inhibit the growth of the causative dermatophyte species. CONCLUSION When formulated with lipid enhancers, the amount of ciclopirox in the ventral/intermediate layer and supporting bed dramatically exceed the inhibitory concentration of ciclopirox for the most common onychomycosis organisms. These results suggest that topical ciclopirox with lipid enhancers has the potential to be an effective topical treatment for onychomycosis, and the lipidic pathway of the nail can be utilized as a means of effective transungual delivery.
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Affiliation(s)
- Farhaan Hafeez
- Dermatology Department, University of California , San Francisco, CA , USA and
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Thermogelling hydrogels of cyclodextrin/poloxamer polypseudorotaxanes as aqueous-based nail lacquers: Application to the delivery of triamcinolone acetonide and ciclopirox olamine. Eur J Pharm Biopharm 2013. [DOI: 10.1016/j.ejpb.2012.11.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Pereiro Ferreirós M, García-Martínez F, Alonso-González J. Update on the Treatment of Superficial Mycoses. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pereiro Ferreirós M, García-Martínez F, Alonso-González J. Actualización en el tratamiento de las micosis cutáneas. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:778-83. [DOI: 10.1016/j.ad.2012.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 01/11/2012] [Accepted: 01/15/2012] [Indexed: 10/28/2022] Open
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Nair AB, Singh K, Shinu P, Harsha S, Al-Dhubiab BE. A comprehensive study to evaluate the effect of constant low voltage iontophoresis on transungual delivery. Drug Dev Ind Pharm 2012; 39:807-15. [PMID: 23057692 DOI: 10.3109/03639045.2012.722106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Treatment of nail diseases by topical drug delivery continues to draw much attention in the recent days. This study aims to systematically investigate the effect of constant voltage iontophoresis in the transungual drug delivery, using ciclopirox as a model drug. Preliminary permeation studies were carried out by applying constant voltage (6 V for 24 h) using a gel formulation across the human nail plate in a Franz diffusion cell. Different protocols have been studied to authenticate the potential of the proposed technique. Antifungal studies were carried out to assess the pharmacodynamic effect of drug depot formed in the nail plate. Initial studies revealed that application of constant voltage iontophoresis enhanced the permeation by an order of magnitude (p = 0.019) and delivered significant amount of drug into the deeper nail layers. Noticeably higher permeation was observed during the active phase in on-off studies. Excellent correlation was observed in permeation (r(2) = 0.98) and drug load (r(2) = 0.97) with the increase in applied voltage (3-12 V), indicating that the current technique is predictable. The data observed suggest that any further increase in voltage could eventually lead to increase in the permeation and drug load, as the saturation level is very distant. Furthermore, the enhancement in permeation with the applied voltage (3-12 V) was found to be 6-20 folds, compared to the passive process. Results of step up and step down studies substantiated the viability of the current technique. Zone of inhibition measured during the antifungal studies demonstrated that the drug molecules loaded into the nail plate by low voltage iontophoresis is active and releases over an extended period of time (~32 days). Given the excellent results, the current technique could be used as an effective approach for the delivery of antimycotics, which would localize the drug at the infection site and potentially offer higher patient compliance.
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Affiliation(s)
- Anroop B Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, KSA.
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Hui X, Lindahl Å, Lamel S, Maibach HI. Onychopharmacokinetics of terbinafine hydrochloride penetration from a novel topical formulation into the human nail in vitro. Drug Dev Ind Pharm 2012; 39:1401-7. [DOI: 10.3109/03639045.2012.704041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Assessment of Iontophoretic and Passive Ungual Penetration by Laser Scanning Confocal Microscopy. Pharm Res 2012; 29:3464-74. [DOI: 10.1007/s11095-012-0841-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 07/13/2012] [Indexed: 12/28/2022]
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Cordoba Diaz D, Losa Iglesias ME, Cordoba Diaz M, Becerro de Bengoa Vallejo R. Enhanced removal of phenol with saline solution over alcohol: an in vitro study. Dermatol Surg 2012; 38:1296-301. [PMID: 22861059 DOI: 10.1111/j.1524-4725.2012.02459.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phenol cauterization is a chemical equivalent often chosen for treatment of ingrown toenails. Many reports describe intraoperative irrigation, or lavage, of the wound with various types of alcohol to neutralize any remaining phenol. There are conflicting reports in the literature as to whether true neutralization or merely effective removal of excess phenol is needed. OBJECTIVE The aim of our study was to analyze the suitability and effectiveness of ethyl alcohol versus sterile saline when used in a lavage step after phenol application in the treatment of ingrown toenails. METHODS We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol recovered after lavage with ethyl alcohol or sterile saline. RESULTS When the wound was irrigated with ethyl alcohol, the total phenol recovered after two irrigation washes was 55.7% of the original amount initially used in treatment, compared with 80.4% when sterile saline solution was used for irrigation. CONCLUSION Alcohol and sterile saline solution do not neutralize phenol but dilute it and aid in its removal. We found that saline solution recovered more phenol than when washing with alcohol and recommend its use instead of alcohol for irrigation purposes after chemical matrixectomy.
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Affiliation(s)
- Damian Cordoba Diaz
- Department of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, Universidad Complutense de Madrid, Madrid, Spain
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De Simone C, Maiorino A, Tassone F, D’Agostino M, Caldarola G. Tacrolimus 0.1% ointment in nail psoriasis: a randomized controlled open-label study. J Eur Acad Dermatol Venereol 2012; 27:1003-6. [DOI: 10.1111/j.1468-3083.2012.04642.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
INTRODUCTION Topical drug delivery to treat nail diseases such as onychomycosis and psoriasis is receiving increasing attention. Topical nail delivery is challenged by the complicated structure of the nail and the low permeability of most drugs across the nail plate. Considerable effort has been directed at developing methods to promote drug permeation across the nail plate. Iontophoresis efficiently enhances molecular transport across the skin and the eye and is now being tested for its potential in ungual delivery. AREAS COVERED This review covers the basic mechanisms of transport (electro-osmosis and -migration) and their relative contribution to nail iontophoresis as well as the key factors governing nail permselectivity and ionic transport numbers. Methodological issues concerning research in this area are summarized. The data available in vivo on nail iontophoresis of terbinafine specifically are reviewed in separate sections. EXPERT OPINION Our understanding of nail iontophoresis has improved considerably since 2007; most decisively, the feasibility of nail iontophoresis in vivo has been clearly demonstrated. Future work is required to establish the adequate implementation of the technique so that its clinical efficacy to treat onychomycosis and nail psoriasis can be unequivocally determined.
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Nogueiras-Nieto L, Gómez-Amoza J, Delgado-Charro M, Otero-Espinar F. Hydration and N-acetyl-l-cysteine alter the microstructure of human nail and bovine hoof: Implications for drug delivery. J Control Release 2011; 156:337-44. [DOI: 10.1016/j.jconrel.2011.08.021] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 08/08/2011] [Accepted: 08/14/2011] [Indexed: 11/17/2022]
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Lusiana, Reichl S, Müller-Goymann CC. Keratin film made of human hair as a nail plate model for studying drug permeation. Eur J Pharm Biopharm 2011; 78:432-40. [DOI: 10.1016/j.ejpb.2011.01.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 01/19/2011] [Accepted: 01/31/2011] [Indexed: 10/18/2022]
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Monti D, Saccomani L, Chetoni P, Burgalassi S, Tampucci S, Mailland F. Validation of bovine hoof slices as a model for infected human toenails: in vitro ciclopirox transungual permeation. Br J Dermatol 2011; 165:99-105. [DOI: 10.1111/j.1365-2133.2011.10303.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Permeation studies of novel terbinafine formulations containing hydrophobins through human nails in vitro. Int J Pharm 2010; 397:67-76. [PMID: 20620203 DOI: 10.1016/j.ijpharm.2010.06.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/26/2010] [Accepted: 06/30/2010] [Indexed: 11/21/2022]
Abstract
Existing treatments of onychomycosis are not satisfactory. Oral therapies have many side effects and topical formulations are not able to penetrate into the human nail plate and deliver therapeutical concentrations of active agent in situ. The purpose of the present study was to determine the amount of terbinafine, which permeates through the human nail plate, from liquid formulations containing enhancers, namely hydrophobins A-C in the concentration of 0.1% (w/v). The used reference solution contained 10% (w/v) of terbinafine in 60% (v/v) ethanol/water without enhancer. Permeability studies have been performed on cadaver nails using Franz diffusion cells modified to mount nail plates and filled with 60% (v/v) ethanol/water in the acceptor chamber. Terbinafine was quantitatively determined by HPLC. The amount of terbinafine remaining in the nail was extracted by 96% ethanol from pulverized nail material after permeation experiment and presented as percentage of the dry nail weight before the milling test. Permeability coefficient (PC) of terbinafine from reference solution was determined to be 1.52E-10 cm/s. Addition of hydrophobins improved PC in the range of 3E-10 to 2E-9 cm/s. Remaining terbinafine reservoir in the nail from reference solution was 0.83% (n=2). An increase of remaining terbinafine reservoir in the nail was observed in two out of three tested formulations containing hydrophobins compared to the reference. In all cases, known minimum inhibitory concentration of terbinafine for dermatophytes (0.003 microg/ml) has been exceeded in the acceptor chamber of the diffusion cells. All tested proteins (hydrophobins) facilitated terbinafine permeation after 10 days of permeation experiment, however one of them achieved an outstanding enhancement factor of 13.05 compared to the reference. Therefore, hydrophobins can be included in the list of potential enhancers for treatment of onychomycosis.
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Dutet J, Delgado-Charro MB. Electroosmotic transport of mannitol across human nail during constant current iontophoresis. J Pharm Pharmacol 2010; 62:721-9. [DOI: 10.1211/jpp.62.06.0008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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