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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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2
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Malallah OS, Coleman L, Nasereddin SM, Lockhat M, Chen T, Jones SA. Systematic review and QSPR analysis of chemical penetration through the nail to inform onychomycosis candidate selection. Drug Discov Today 2024; 29:103844. [PMID: 38000719 DOI: 10.1016/j.drudis.2023.103844] [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: 10/06/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023]
Abstract
Recalcitrant nail plate infections can be life-long problems because localizing antifungal agents into infected tissues is problematic. In this systematic review, guided by the SPIDER method, we extracted chemical nail permeation data for 38 compounds from 16 articles, and analyzed the data using quantitative structure-property relationships (QSPRs). Our analysis demonstrated that low-molecular weight was essential for effective nail penetration, with <120 g/mol being preferred. Interestingly, chemical polarity had little effect on nail penetration; therefore, small polar molecules, which effectively penetrate the nail, but not the skin, should be set as the most desirable target chemical property in new post-screen onychomycosis candidate selections.
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Affiliation(s)
- Osamah S Malallah
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Lucy Coleman
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Sara M Nasereddin
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; College of Pharmacy, Amman Arab University, Mubis, Amman 11953, Jordan
| | - Mohammad Lockhat
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK
| | - Tao Chen
- School of Chemistry and Chemical Engineering, University of Surrey, Guildford GU2 7XH, UK
| | - Stuart A Jones
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, Franklin-Wilkins Building, King's College London, 150 Stamford Street, London SE1 9NH, UK; Centre for Pharmaceutical Medicine Research, Institute of Pharmaceutical Science, King's College, SE1 9NH, UK.
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3
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Wu S, Guo W, Li B, Zhou H, Meng H, Sun J, Li R, Guo D, Zhang X, Li R, Qu W. Progress of polymer-based strategies in fungal disease management: Designed for different roles. Front Cell Infect Microbiol 2023; 13:1142029. [PMID: 37033476 PMCID: PMC10073610 DOI: 10.3389/fcimb.2023.1142029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/22/2023] [Indexed: 04/11/2023] Open
Abstract
Fungal diseases have posed a great challenge to global health, but have fewer solutions compared to bacterial and viral infections. Development and application of new treatment modalities for fungi are limited by their inherent essential properties as eukaryotes. The microorganism identification and drug sensitivity analyze are limited by their proliferation rates. Moreover, there are currently no vaccines for prevention. Polymer science and related interdisciplinary technologies have revolutionized the field of fungal disease management. To date, numerous advanced polymer-based systems have been developed for management of fungal diseases, including prevention, diagnosis, treatment and monitoring. In this review, we provide an overview of current needs and advances in polymer-based strategies against fungal diseases. We high light various treatment modalities. Delivery systems of antifungal drugs, systems based on polymers' innate antifungal activities, and photodynamic therapies each follow their own mechanisms and unique design clues. We also discuss various prevention strategies including immunization and antifungal medical devices, and further describe point-of-care testing platforms as futuristic diagnostic and monitoring tools. The broad application of polymer-based strategies for both public and personal health management is prospected and integrated systems have become a promising direction. However, there is a gap between experimental studies and clinical translation. In future, well-designed in vivo trials should be conducted to reveal the underlying mechanisms and explore the efficacy as well as biosafety of polymer-based products.
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Affiliation(s)
- Siyu Wu
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Wenlai Guo
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Bo Li
- Department of Cardiovascular Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Huidong Zhou
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Hongqi Meng
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Junyi Sun
- Changchun American International School, Changchun, China
| | - Ruiyan Li
- Orthpoeadic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, China
| | - Deming Guo
- Orthpoeadic Medical Center, The Second Hospital of Jilin University, Changchun, China
- Jilin Provincial Key Laboratory of Orhtopeadics, Changchun, China
| | - Xi Zhang
- Department of Burn Surgery, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
| | - Rui Li
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
| | - Wenrui Qu
- Department of Hand Surgery, The Second Hospital of Jilin University, Changchun, China
- *Correspondence: Xi Zhang, ; Rui Li, ; Wenrui Qu,
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Shahid M, Hussain A, Khan AA, Ramzan M, Alaofi AL, Alanazi AM, Alanazi MM, Rauf MA. Ketoconazole-Loaded Cationic Nanoemulsion: In Vitro- Ex Vivo- In Vivo Evaluations to Control Cutaneous Fungal Infections. ACS OMEGA 2022; 7:20267-20279. [PMID: 35721949 PMCID: PMC9201893 DOI: 10.1021/acsomega.2c02219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
An attempt has been made to optimize ketoconazole (KTZ)-loaded cationic nanoemulsion for topical delivery followed by in vitro, ex vivo, and in vivo evaluations. Central composite design suggested a total of 13 outcomes at 3 factors and 2 levels against 6 responses. Formulations were characterized for globular size, polydispersity index, pH, ζ potential, % entrapment efficiency (% EE), and drug content. Moreover, the optimized KTZ-CNM13 was compared against drug suspension (KTZ-SUS), commercial cream, and anionic nanoemulsion for in vitro drug release, ex vivo permeation, in vitro hemolysis, antifungal assay, in vivo dermal irritancy, and long-term stability. KTZ-CNM13 was found to have a low size (239 nm), an optimal ζ potential (+22.7 mV), a high % EE (89.1%), a spherical shape, a high drug content (98.9%), and a high numerical desirability value (1.0). In vitro drug release behavior of KTZ from KTZ-CNM13 was 7.54- and 1.71-folds higher than those of KTZ-ANM13 and KTZ-SUS, respectively, at 24 h. The permeation rate values were ordered as KTZ-CNM13 > KTZ-ANM13 > KTZ-MKT > KTZ-SUP due to various studied factors. High values of zone of inhibition for KTZ-CNM13 were observed against Candida albicans, Candida glabrata, Candida tropicalis, and Candida krusei as compared to KTZ-SUS. In vitro hemolysis and in vivo irritation studied confirmed the safety concern of the nanoemulsion at the explored composition. Long-term stability result revealed a stable product at the explored temperature for a year. Conclusively, cationic nanoemulsion is a promising approach to deliver KTZ for high permeation and therapeutic efficacy.
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Affiliation(s)
- Mudassar Shahid
- Department
of Pharmaceutics, College of Pharmacy, King
Saud University, Riyadh 11451, Saudi Arabia
| | - Afzal Hussain
- Department
of Pharmaceutics, College of Pharmacy, King
Saud University, Riyadh 11451, Saudi Arabia
| | - Azmat Ali Khan
- Pharmaceutical
Biotechnology Laboratory, Department of Pharmaceutical Chemistry,
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohhammad Ramzan
- School
of Pharmaceutical Sciences, Lovely Professional
University, Phagwara, Jalandhar, Punjab 144411, India
| | - Ahmed L. Alaofi
- Department
of Pharmaceutics, College of Pharmacy, King
Saud University, Riyadh 11451, Saudi Arabia
| | - Amer M. Alanazi
- Pharmaceutical
Biotechnology Laboratory, Department of Pharmaceutical Chemistry,
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad M. Alanazi
- Pharmaceutical
Biotechnology Laboratory, Department of Pharmaceutical Chemistry,
College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mohd Ahmar Rauf
- Department
of Pharmacy, Eugene Applebaum, College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan 48201, United States
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5
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Alqahtani A, Raut B, Khan S, Mohamed JMM, Fatease AA, Alqahtani T, Alamri A, Ahmad F, Krishnaraju V. The Unique Carboxymethyl Fenugreek Gum Gel Loaded Itraconazole Self-Emulsifying Nanovesicles for Topical Onychomycosis Treatment. Polymers (Basel) 2022; 14:polym14020325. [PMID: 35054731 PMCID: PMC8779379 DOI: 10.3390/polym14020325] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 12/12/2022] Open
Abstract
The novel itraconazole (ITZ) nail penetration enhancing self-emulsifying nanovesicles (ITZ-nPEVs) loaded in carboxymethyl fenugreek gum (CMFG) gel circumvent the systemic onychomycosis treatment. The ITZ-nPEVs were prepared by the thin film hydration technique, and the particle size (PS), zeta potential (ZP), drug content (DC), entrapment efficiency (% EE), deformity index (DI), viscosity, morphology, and physical stability of the ITZ-nPEVs were measured. In terms of nail hydration, transungual drug absorption, and antifungal efficacy against Candida albicans, the chosen ITZ-nPEVs, nPEV-loaded CMFG (CMFG-ITZ-nPEVs) gel, and the commercialized Itrostred gel were compared. The ITZ-nPEVs showed spherical structure with high DC, % EE, low PS and PDI and positive ZP of ITZ ranging from 95.36 to 93.89 mg/5 mL and 95.36–96.94%, 196.55–252.5 nm, 0.092–0.49, and +11.1 to +22.5 mV, respectively. Compared to the Itrostred gel, the novel ITZ-nPEVs exhibited hydration enhancement factor for 24 h (HE24) of 1.53 and 1.39 drug uptake enhancement factor into nail clippings. Moreover, zone of inhibitions for ITZ-nPEVs (27.0 ± 0.25 mm) and CMFG-ITZ-nPEVs (33.2 ± 0.09 mm) against Candida albicans were significantly greater than that of Itrostred gel (22.9 ± 0.44 mm). For clinical investigation on onychomycotic patients, a nail penetration enhancer containing ITZ-nPEV-loaded CMFG gel presents a highly promising approach.
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Affiliation(s)
- Ali Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
| | - Bhavana Raut
- Institute of Pharmaceutical Education and Research, Borgaon (Meghe) Wardha, Wardha 442001, India;
| | - Shagufta Khan
- Institute of Pharmaceutical Education and Research, Borgaon (Meghe) Wardha, Wardha 442001, India;
- Correspondence: ; Tel.: +91-75591-78862
| | | | - Adel Al Fatease
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.F.); (A.A.)
| | - Taha Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
| | - Ali Alamri
- Department of Pharmaceutics, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.F.); (A.A.)
| | - Fazil Ahmad
- Department of Anesthesia Technology, College of Applied Medical Sciences in Jubail, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Venkatesan Krishnaraju
- Department of Pharmacology, College of Pharmacy, King Khalid University, Guraiger, Abha 62529, Saudi Arabia; (A.A.); (T.A.); (V.K.)
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Mercer DK, Robertson JC, Miller L, Stewart CS, O'Neil DA. NP213 (Novexatin®): A unique therapy candidate for onychomycosis with a differentiated safety and efficacy profile. Med Mycol 2020; 58:1064-1072. [PMID: 32232410 PMCID: PMC7657096 DOI: 10.1093/mmy/myaa015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/17/2022] Open
Abstract
NP213 (Novexatin®) is a novel antifungal peptide specifically designed for the topical treatment of onychomycosis. NP213 was designed using host defense peptides (HDP), essential components of the innate immune response to infection, as a template. NP213 is a water-soluble cyclic fungicidal peptide that effectively penetrates human nail. NP213 demonstrated a promising preclinical and clinical safety profile, with no evidence of systemic exposure following topical application to the skin and nails. NP213 was efficacious in two phase IIa human trials with 43.3% of patients having no fungi detectable by culture of fragments from NP213-treated nails after 180 days in the first study and likewise 56.5% of patients were culture negative for dermatophytes after 360 days in the second phase IIa study. In both trials, NP213 was applied daily for only 28 days in marked contrast to other topical onychomycosis treatments that require application for up to 52 weeks. Patient reported outcomes from the phase IIa studies were positive with participants recording an improved appearance of their nails after only 14 days of application. All fungi identified in these studies were Trichophyton spp. NP213 (Novexatin®) is a promising, highly differentiated peptide-based candidate for the topical treatment of onychomycosis, addressing the infectious cause and cosmetic issues of this very common condition.
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Affiliation(s)
- Derry K Mercer
- NovaBiotics Ltd, Bridge of Don, Aberdeen, United Kingdom
| | | | - Lorna Miller
- NovaBiotics Ltd, Bridge of Don, Aberdeen, United Kingdom
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Vikas A, Rashmin P, Mrunali P, Chavan RB, Kaushik T. Mechanistic Insights of Formulation Approaches for the Treatment of Nail Infection: Conventional and Novel Drug Delivery Approaches. AAPS PharmSciTech 2020; 21:67. [PMID: 31938980 DOI: 10.1208/s12249-019-1591-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/25/2019] [Indexed: 02/07/2023] Open
Abstract
Onychomycosis is a chronic disorder that is difficult to manage and hard to eradicate with perilous trends to relapse. Due to increased prevalence of HIV, use of immunosuppressant drugs and lifestyle-related factors, population affected with fungal infection of nail (Onychomycosis) happens to increase extensively in last two decades. Modalities available for the treatment of onychomycosis include systemically administered antifungals, mechanical procedures, and topical drug therapy. But the efficacy of the most of approaches to deliver drug at targeted site, i.e., deep-seated infected nail bed is limited due to compact and highly keratinized nail structure. A series of advanced formulation approaches, such as transfersomes, liposomes, nano/micro emulsion, nail lacquers etc., have been attempted to improve the drug penetration into nail plate more efficiently. The manuscript reviews these formulation approaches with their possible mechanisms by which they improve the drug penetration.Comparative analysis of available treatment modalities for onychomycosis has been provided with pros and cons of each alternatives. Additionally, ongoing research about the application of biological materials such as modified cationic antimicrobial peptides (AMPs), plant-derived proteins, and synthetic antimicrobial peptidomimetics have also been explored.
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Dhamoon RK, Goyal RK, Popli H, Gupta M. Luliconazole-Loaded Thermosensitive Hydrogel as Aqueous based Nail Lacquer for the Treatment of Onychomycosis. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/2210303109666190520081552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Onychomycosis is a nail fungal infection which accounts for 50% of the nail
diseases and is characterized by disfigurement and discoloration of nails. The current therapy includes
oral and topical formulations both of which come with their own drawbacks. This has left a room for
developing patient- compliant novel strategies which can facilitate drug delivery deeper into the nails
effectively.
Objective:
The main objective of the present work was to develop and evaluate in situ gelling thermosensitive
hydrogel as an aqueous nail lacquer for the treatment of onychomycosis. The idea was to
enhance permeation of Luliconazole into the nail while simultaneously solubilizing it in a hydrophilic
formulation.
Methods:
The sample of Luliconazole was authenticated using modern analytical techniques. The hydrogel-
nail lacquer was prepared using poloxamer Pluronic F127. The formulation was evaluated in
terms of drying time, viscosity, non- volatile content, pH, transition temperature, etc. In vitro study was
done to check the drug release while determining release kinetics. In vitro transungual permeation study
was done to check drug permeation through porcine hoof membrane. Stability studies were conducted
to ensure formulation stability.
Results:
The results confirmed a stable formulation with enhanced permeation through porcine hoof
membrane.
Conclusion:
The results support the potential use of in situ gelling thermo-sensitive hydrogels as a
novel transungual formulation in the treatment of onychomycosis with a slight improvement in water
resistance.
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Affiliation(s)
- Rupinder K. Dhamoon
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Ramesh K. Goyal
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Harvinder Popli
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp vihar, Sector-3, M.B Road, New Delhi -110017, India
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Choi FD, Juhasz MLW, Atanaskova Mesinkovska N. Topical ketoconazole: a systematic review of current dermatological applications and future developments. J DERMATOL TREAT 2019; 30:760-771. [PMID: 30668185 DOI: 10.1080/09546634.2019.1573309] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Although labeling changes and market withdrawal have been implemented for oral ketoconazole (KTZ) due to serious adverse effects (AEs), topical KTZ is generally thought to be effective and safe for the treatment of superficial fungal infections. New dermatologic indications for the use of topical KTZ have arisen such as onychomycosis, blepharitis, and hair loss. This article aims to review the literature on topical KTZ's efficacy and AEs, as well as provide an overview on current insights regarding its mechanism of action and upcoming developments. Methods: A PubMed search was done to include randomized controlled trials (RCTs) focusing on the use of topical KTZ in human subjects. Results: Forty studies with 4566 patients were included in this review. Topical KTZ is clinically effective for the treatment of Malassezia-related conditions such as seborrheic dermatitis (SD) and pityriasis versicolor (PV) with a reported efficacy of 63-90% and 71-89%, respectively. Conclusions: Topical KTZ demonstrates high clinical efficacy for Malassezia-related conditions. More efficacious alternatives are now available for Tinea and Candida. Although topical KTZ is safe, clinicians should be aware that allergic contact dermatitis may occur. Further studies should be completed to investigate the use of topical KTZ for hair loss and inflammatory dermatoses.
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Affiliation(s)
- Franchesca D Choi
- Department of Dermatology, University of California , Irvine , CA, USA.,College of Medicine, Kaohsiung Medical University , Kaohsiung , Taiwan
| | - Margit L W Juhasz
- Department of Dermatology, University of California , Irvine , CA, USA
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Dhamoon RK, Popli H, Gupta M. Novel Drug Delivery Strategies for the Treatment of Onychomycosis. Pharm Nanotechnol 2019; 7:24-38. [PMID: 31092174 PMCID: PMC6691844 DOI: 10.2174/2211738507666190228104031] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. It was primarily considered a cosmetic problem but has been garnering attention lately due to its persistent nature and difficult treatment with relapses. With prolonged treatment duration and high cost involved in treating onychomycosis, several attempts have been made in overcoming the rigid nail barrier. The conventional treatment of onychomycosis involves oral and topical therapy. The oral antifungal agents though quite effective, are hepato-toxic and cause drug-drug interactions. Topical therapy is more patient compliant being devoid of such adverse effects but it suffers from another setback of improper nail penetration. Amorolfine and ciclopirox nail lacquers are popular market products. Since decades, efforts have been made to enhance topical delivery for efficiently treating onychomycosis. Mechanical, physical and chemical methods have been employed. Despite all the attempts made, the nail delivery issues are far from being solved. Recently, the focus has shifted to novel drug delivery systems like nanoparticles, microemulsions, polymeric films and nail lacquers for enhanced drug permeation and localized therapy. The research around the world is exploring their potential as effective treatment options. This review intends to further explore the novel delivery strategies to treat a persistent fungal infection like onychomycosis.
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Affiliation(s)
- Rupinder K. Dhamoon
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Harvinder Popli
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, Pushp Vihar, Sector-3, M.B Road, New Delhi -110017, India
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11
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12
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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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13
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El-sherif NI, Shamma RN, Abdelbary G. In-situ gels and nail lacquers as potential delivery systems for treatment of onychomycosis. A comparative study. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2017.10.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Recent advances in delivery of antifungal agents for therapeutic management of candidiasis. Biomed Pharmacother 2017; 96:1478-1490. [PMID: 29223551 DOI: 10.1016/j.biopha.2017.11.127] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 01/08/2023] Open
Abstract
Candidiasis is a fungal infection caused by yeasts that belong to the genus Candida. There are over twenty species of Candida yeasts that can cause infection in humans, the most common of which is Candida albicans. Candida yeasts normally reside in the intestinal tract and can be found on mucous membranes and skin without causing infection; however, overgrowth of these organisms can cause symptoms to develop. Presence of other diseases that compromises the patient's immunity makes it more difficult to treat. Candidiasis is majorly divided into superficial infections (oral or vaginal) and systemic infections, also known as invasive candidiasis. The conventional therapeutic modalities used to treat candidiasis are associated with several side effects that limits the dose and dosing frequency. Development of novel drug delivery systems for reduction in dose and alleviation of side effects is an important strategy to improve the clinical efficacy and patient acceptability. This review gives a bird's eye view of the classification and current therapeutic regime of candidiasis. It presents the varied types of drug delivery systems that have been exploited for delivery of antifungal agents with measurable benefits. It also touches upon echinocandins a relatively new class of drugs that are amenable for translation into novel dosage forms with application against biofilm producing and fluconazole resistant strains contributing to a better therapeutic management of candidiasis.
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Effect of Film-Forming Polymers on Release of Naftifine Hydrochloride from Nail Lacquers. INT J POLYM SCI 2017. [DOI: 10.1155/2017/1476270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The successful topical therapy of onychomycosis depends on effective drug release and penetration into nail, which can be achieved by using an adequately developed delivery system. This study evaluated and compared effect of film-forming polymers Eudragit RL100, Eudragit RS100, and ethyl cellulose on naftifine hydrochloride release from experimental nail lacquer formulations. Quality of formulations was evaluated by determining drying time and water resistance. Interactions between active pharmaceutical ingredient and excipients were investigated using microcalorimetry and FT-IR. Optimization of nail lacquer formulations was performed by naftifine hydrochloride release testing. Release of naftifine hydrochloride increased with increasing concentration of Eudragit RL100. Plasticizer triacetin affected the release of naftifine hydrochloride, when Eudragit RS100 polymer was used. Ethyl cellulose polymer was determined to be not applicable for naftifine hydrochloride nail lacquer formulations. Two compositions of nail lacquers were optimized and could be used in further development of transungual delivery systems.
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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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Akhtar N, Sharma H, Pathak K. Onychomycosis: Potential of Nail Lacquers in Transungual Delivery of Antifungals. SCIENTIFICA 2016; 2016:1387936. [PMID: 27123362 PMCID: PMC4829734 DOI: 10.1155/2016/1387936] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 05/24/2023]
Abstract
Onychomycosis constitutes the most common fungal infection of the nail (skin beneath the nail bed) that affects the finger as well as toe nails. It is an infection that is initiated by yeasts, dermatophytes, and nondermatophyte molds. Nail lacquers are topical solutions intended only for use on fingernails as well as toenails and have been found to be useful in the treatment of onychomycosis. Thus, in the present review an attempt has been made to focus on the treatment aspects of onychomycosis and the ungual delivery of antifungals via nail lacquer. Several patents issued on nail lacquer till date have also been discussed. Penetration efficiency was assessed by several researchers across the human nail plate to investigate the potentiality of nail lacquer based formulations. Various clinical trials have also been conducted in order to evaluate the safety and efficacy of nail lacquers in delivering antifungal agents. Thus, it can be concluded that nail lacquer based preparations are efficacious and stable formulations. These possess tremendous potential for clinical topical application to the nail bed in the treatment of onychomycosis.
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Affiliation(s)
- Nida Akhtar
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, P.O. Chhatikara, Mathura, Uttar Pradesh 281001, India
| | - Hemlata Sharma
- Department of Pharmaceutics, Rajiv Academy for Pharmacy, P.O. Chhatikara, Mathura, Uttar Pradesh 281001, India
| | - Kamla Pathak
- Department of Pharmaceutics, Pharmacy College Saifai, Saifai, Etawah, Uttar Pradesh 206130, 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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Bseiso EA, Nasr M, Sammour OA, Abd El Gawad NA. Novel nail penetration enhancer containing vesicles "nPEVs" for treatment of onychomycosis. Drug Deliv 2015; 23:2813-2819. [PMID: 26447337 DOI: 10.3109/10717544.2015.1099059] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
CONTEXT The systemic treatment of onychomycosis has been hampered by the reported side effects of antifungals in addition to the limited blood circulation to the affected nails. Topical ungual treatment would circumvent the limitations of systemic onychomycosis treatment. OBJECTIVE Preparation and characterization of nail penetration enhancer containing nanovesicles (nPEVs) loaded with sertaconazole for topical treatment of onychomycosis. MATERIALS AND METHODS nPEVs were prepared using different nail penetration enhancers (N-acetyl-L-cysteine, thioglycolic acid, thiourea and ethanol) by the thin film hydration method, and characterized for their particle size, zeta potential, entrapment efficiency (EE%), elasticity, viscosity, physical stability and morphology. The selected nPEVs formula and the marketed Dermofix® cream were compared in terms of nail hydration, transungual drug uptake and antifungal activity against Trichophyton rubrum. RESULTS N-acetyl-l-cysteine was the optimum nail penetration enhancer for incorporation within vesicles. nPEVs showed high EE% of sertaconazole ranging from 77 to 95%, a size ranging from 38-538 nm and a zeta potential ranging from +48 to +72 mV. The selected nPEVs formula displayed spherical morphology and good storage stability. Compared to the conventional marketed cream, the selected nPEVs formula showed 1.4-folds higher hydration and drug uptake enhancement into nail clippings. Furthermore, it showed significantly higher zone of inhibition for Trichophyton rubrum (20.9 ± 0.25 mm) than the marketed cream (11.6 ± 0.44 mm). CONCLUSION Nail penetration enhancer containing nanovesicles (nPEVs) present a very promising option, worthy of clinical experimentation on onychomycotic patients.
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Affiliation(s)
- Eman A Bseiso
- a Department of Pharmaceutics , Faculty of Pharmacy, October 6 University , Cairo , Egypt
| | - Maha Nasr
- b Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Ain Shams University , Cairo , Egypt , and
| | - Omaima A Sammour
- b Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Ain Shams University , Cairo , Egypt , and
| | - Nabaweya A Abd El Gawad
- a Department of Pharmaceutics , Faculty of Pharmacy, October 6 University , Cairo , Egypt.,c Department of Pharmaceutics and Industrial Pharmacy , Faculty of Pharmacy, Cairo University , Cairo , Egypt
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Thatai P, Tiwary AK, Sapra B. Progressive development in experimental models of transungual drug delivery of anti-fungal agents. Int J Cosmet Sci 2015; 38:1-12. [PMID: 25919363 DOI: 10.1111/ics.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/15/2015] [Indexed: 12/31/2022]
Abstract
Pre-clinical development comprises of different procedures that relate drug discovery in the laboratory for commencement of human clinical trials. Pre-clinical studies can be designed to recognize a lead candidate from a list to develop the procedure for scale-up, to choose the unsurpassed formulation, to determine the frequency, and duration of exposure; and eventually make the foundation of the anticipated clinical trial design. The foremost aim in the pharmaceutical research and industry is the claim of drug product quality throughout a drug's life cycle. The particulars of the pre-clinical development process for different candidates may vary; however, all have some common features. Typically in vitro, in vivo or ex vivo studies are elements of pre-clinical studies. Human pharmacokinetic in vivo studies are often supposed to serve as the 'gold standard' to assess product performance. On the other hand, when this general assumption is revisited, it appears that in vitro studies are occasionally better than in vivo studies in assessing dosage forms. The present review is compendious of different such models or approaches that can be used for designing and evaluation of formulations for nail delivery with special reference to anti-fungal agents.
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Affiliation(s)
- P Thatai
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
| | - A K Tiwary
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
| | - B Sapra
- Pharmaceutics Division, Department of Pharmaceutical Sciences & Drug Research, Punjabi University, Patiala, India
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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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Elkeeb R, Hui X, Murthy N, Maibach HI. Emerging Topical Onychomycosis Therapies –Quo Vadis? Expert Opin Emerg Drugs 2014; 19:489-95. [DOI: 10.1517/14728214.2014.975206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Thatai P, Sapra B. Transungual delivery: deliberations and creeds. Int J Cosmet Sci 2014; 36:398-411. [PMID: 24888698 DOI: 10.1111/ics.12142] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/21/2014] [Indexed: 12/13/2022]
Abstract
Although considered as trifling illness, nail diseases have a reasonably high occurrence and a noteworthy impact on the patients' quality of life. Furthermore, there is a need to improve the topical treatment for nail diseases to avoid drug interactions and to reduce side effects associated with oral therapy. Topical drug delivery to the nails has established amplified consideration lately. Strategies (such as chemical enhancers, formulation strategies, physical and mechanical methods) are being investigated in order to improve drug permeability across the nail plate. The rationale of this review is to present contemporary information on the structure of human nail along with its comparison with animal hooves. Precincts of nail permeability have been briefly discussed with respect to factors like permeant's molecular size, hydrophilicity, charge and the nature of the vehicle. These factors affect drug uptake and permeation through the nail. Formulations like nail lacquers which mimic cosmetic varnish and colloidal carriers along with nail substitutes that can be utilized for transungual delivery have also been discussed.
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Affiliation(s)
- P Thatai
- Pharmaceutics Division, Department of Pharmaceutical Sciences, Punjabi University, Patiala, India
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Abstract
Topical therapy is at the forefront in treating nail ailments (especially onychomycosis and nail psoriasis) due to its local effects, which circumvents systemic adverse events, improves patient compliance and reduces treatment cost. However, the success of topical therapy has been hindered due to poor penetration of topical therapeutics across densely keratinized nail plate barrier. For effective topical therapy across nail plate, ungual drug permeation must be enhanced. Present review is designed to provide an insight into prime aspects of transungual drug delivery viz. nail structure and physiology, various onychopathies, techniques of nail permeation enhancement and in vitro models for trans-nail drug permeation studies. Updated list of drug molecules studied across the nail plate and key commercial products have been furnished with sufficient depth. Patents pertinent to, and current clinical status of transungual drug delivery have also been comprehensively reviewed. This is the first systematic critique encompassing the detailed aspects of transungual drug delivery. In our opinion, transungual drug delivery is a promising avenue for researchers to develop novel formulations, augmenting pharmaceutical industries to commercialize the products for nail disorders.
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Affiliation(s)
- Manish V Saner
- Department of Pharmaceutics, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, North Maharshtra University , Maharashtra , India
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