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Prudkin L, Cedirian S, Santamaria J, Jourdan E, Piraccini BM. Exposome Impact on Nail Health. Skin Appendage Disord 2024; 10:186-198. [PMID: 38835707 PMCID: PMC11147530 DOI: 10.1159/000536573] [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: 12/02/2023] [Accepted: 01/25/2024] [Indexed: 06/06/2024] Open
Abstract
Background The nail unit is a complex system with various components, each serving distinct functions. The exposome, encompassing external and internal factors such as UV radiation, air pollution, dietary habits, and cosmetic product usage, substantially influences nail health and can lead to premature nail aging. Summary Internal and external exposomal factors can impact differently on nail health, inducing a variety of different clinical conditions. Effective therapeutic strategies exist, but a comprehensive understanding of how the exposome affects nails is lacking. This article aims to bridge this knowledge gap by exploring the relationship between the exposome and nail health, emphasizing it as a central focus of our analysis. Key Messages (1) The exposome, comprising various external and internal factors, may significantly influence nail health negatively, leading to premature nail aging. (2) Different nail conditions may arise due to the exposomal influence on nails. (3) Understanding the exposome's impact on nail health is crucial for developing solutions to mitigate negative effects and improve overall nail well-being.
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Affiliation(s)
| | - Stephano Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | - Eric Jourdan
- Innovation and Development, ISDIN, Barcelona, Spain
| | - Bianca Maria Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
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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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3
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Bellmann T, Luber R, Kischio L, Karl B, Pötzinger Y, Beekmann U, Kralisch D, Wiegand C, Fischer D. Bacterial nanocellulose patches as a carrier for hydrating formulations to improve the topical treatment of nail diseases. Int J Pharm 2022; 628:122267. [DOI: 10.1016/j.ijpharm.2022.122267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 10/31/2022]
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Ohta R, Ryu Y, Sano C. The Relationship Between the Presence of White Nails and Readmission Among Rural Older Admitted Patients: A Prospective Cohort Study. Cureus 2022; 14:e24297. [PMID: 35602847 PMCID: PMC9120933 DOI: 10.7759/cureus.24297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Nail changes can indicate systemic changes within the body. According to previous studies, white nails, characterized by the whitening of the proximal nails with the absence of a lunula, were related to in-hospital mortality in rural community hospitals. Hence, this study aimed to investigate the relationship between the presence of white nails and readmissions among rural older patients who had previously been discharged from rural community hospitals. Methodology The relationship between white nails and readmissions among admitted older patients discharged from community hospitals was investigated. This was a single-center prospective study. All patients >65 years admitted from April 2020 to March 2021 and readmitted between April 2020 and June 2021 were included in the study. Upon admission, all patients’ nails were evaluated by trained evaluators for whitening. The presence of white nails was correlated with readmission using a multivariate logistic regression model. Results Approximately 28.7% of all participants were readmitted to the hospital during the study period; 41.1% had white nails, and 24.6% did not. Cox hazard model was used to analyze the relationship between readmission and white nails. Of all 637 participants, 24.8% had white nails. Significant variables for readmission were cancer (hazard ratio, HR = 1.52, p = 0.033), dementia (HR = 1.52, p = 0.037), heart failure (HR = 1.53, p = 0.033), home discharge (HR = 0.32, p ≤ 0.001), duration of previous hospitalization (HR = 0.99, p = 0.0026), and white nails (HR = 2.07, p ≤ 0.001). Conclusions White nails may be associated with readmission among previously admitted older patients. Identifying white nails in older admitted patients may enhance awareness of readmission risk; however, this needs further research.
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Rizi K, Xu K, Begum T, Faull J, Bhakta S, Murdan S. A drug-in-adhesive anti-onychomycotic nail patch: Influence of drug and adhesive nature on drug release, ungual permeation, in vivo residence in human and anti-fungal efficacy. Int J Pharm 2022; 614:121437. [PMID: 34973408 DOI: 10.1016/j.ijpharm.2021.121437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/11/2021] [Accepted: 12/26/2021] [Indexed: 11/17/2022]
Abstract
A nail patch is an attractive option for the topical treatment of onychomycosis, although no product is commercially available. We previously identified optimal nail patch formulations for two anti-onychomycotic drugs, based on their properties, as well as those of the other patch components. In this paper, our aim was to further investigate the potential of the patch formulations as topical nail medicines, in particular, whether the drug-in-adhesive patches release drug which then permeates into and through the nail plate and show anti-fungal efficacy, and whether and to what extent they remain adhered to the human nail plate in vivo when tested over 2 week durations. In addition, the influence of the drug (amorolfine HCl, ciclopirox olamine) and PSA (Duro-Tak 2852 or Duro-Tak 202A) on these parameters was determined. We found that both the nature of the drug and of the PSA influenced in vitro drug release. The nature of the drug, but not that of the PSA, influenced ungual drug permeation through human nail clippings, with considerably greater (almost double) permeation for ciclopirox olamine, the smaller and less lipophilic molecule. In vivo residence, tested with 3 out of the 4 patches, excluding the patch where ciclopirox olamine degraded with time, showed greater residence on toenails compared to fingernails reflecting their far lesser exposure to environmental stresses during daily activities. In vivo residence was enhanced when the patch was cut to the shape of the nail, was applied at bedtime, and when a clear colourless nail varnish was applied on top of the patch to 'seal' it into place on the nail. Comparison of the patches indicated greater residence of Duro-Tak 202A containing patches over those containing Duro-Tak 2852. Amorolfine HCl in Duro-Tak 202A based patch also showed antifungal efficacy in contrast to Duro-Tak 2852-based patch, and is particularly promising for further development as a potential toenail medicine, remaining almost fully adhered to toenails for at least two weeks.
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Affiliation(s)
- K Rizi
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - K Xu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - T Begum
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - J Faull
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
| | - S Bhakta
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London WC1E 7HX, UK
| | - S Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
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Printing Drugs onto Nails for Effective Treatment of Onychomycosis. Pharmaceutics 2022; 14:pharmaceutics14020448. [PMID: 35214182 PMCID: PMC8879958 DOI: 10.3390/pharmaceutics14020448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Inkjet printing (IJP) is an emerging technology for the precision dosing of medicines. We report, for the first time, the printing of the antifungal drug terbinafine hydrochloride directly onto nails for the treatment of onychomycosis. A commercial cosmetic nail printer was modified by removing the ink from the cartridge and replacing it with an in-house prepared drug-loaded ink. The drug-loaded ink was designed so that it was comparable to the commercial ink for key printability properties. Linear drug dosing was shown by changing the lightness of the colour selected for printing (R2 = 0.977) and by printing multiple times (R2 = 0.989). The drug loads were measured for heart (271 µg), world (205 µg) and football (133 µg) shapes. A disc diffusion assay against Trpytophan rubrum showed inhibition of fungal growth with printed-on discs. In vitro testing with human nails showed substantial inhibition with printed-on nails. Hence, this is the first study to demonstrate the ability of a nail printer for drug delivery, thereby confirming its potential for onychomycosis treatment.
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The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9121611. [PMID: 34946339 PMCID: PMC8702063 DOI: 10.3390/healthcare9121611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
White nails are a sign of various physical deteriorations, including poor nutrition, organ damage, and aging. During a physical examination, white nails can be a helpful health indicator in older patients with vague and multiple symptoms. In this prospective cohort study of patients admitted to the Department of General Medicine in a rural community hospital, we investigated the relationship between white nails and patient mortality. Patient data, including age, sex, condition, and bloodwork results, were collected. Trained family physicians confirmed the presence of white nails. Logistic regression analysis was performed to determine the relationship between white nails and death during hospitalization. Of 711 study participants, 74 died during hospitalization. White nails, male sex, and caregiver dependence were associated with high in-hospital mortality (odds ratio (OR) = 3.47, p < 0.001; OR 2.05, p = 0.01; OR 1.92, p = 0.049, respectively). High albumin concentration was associated with low in-hospital mortality (OR = 0.44, p < 0.001). White nails, along with serum albumin concentration, male sex, and caregiver dependence, are associated with mortality. The identification of white nails can predict the deterioration of patients. Various professionals should learn to identify the presence of white nails to facilitate the care of elderly patients.
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Ricardo JW, Lipner SR. Nail Psoriasis in Older Adults: Epidemiology, Diagnosis, and Topical Therapy. Dermatol Clin 2021; 39:183-193. [PMID: 33745632 DOI: 10.1016/j.det.2020.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nail involvement is common in patients with cutaneous psoriasis, which is prevalent among older adults. Nail psoriasis greatly impacts patients' quality of life and self-esteem. Concomitant psoriatic arthritis is common. Treating nail psoriasis in the geriatric population may be challenging. General nail care measures may prevent exacerbations. Topical therapy is relatively effective, with a low rate of adverse events and little to no risk of systemic toxicity or drug interactions. However, application under occlusion may be cumbersome. There is a need for randomized controlled clinical trials in the elderly population to make more evidence-based treatment guidelines.
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Affiliation(s)
- Jose W Ricardo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, 1305 York Avenue, New York, NY 10021, USA.
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Ricardo JW, Lipner SR. Nail Psoriasis in Older Adults: Intralesional, Systemic, and Biological Therapy. Dermatol Clin 2021; 39:195-210. [PMID: 33745633 DOI: 10.1016/j.det.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psoriasis may affect the skin, scalp, joints, and nails and is common in older adults. Intramatrical injections with triamcinolone acetonide are safe and effective in older individuals. Conventional systemic medications are relatively effective, but side effects, including laboratory abnormalities and drug interactions, are particularly common among older adults. Biologic medications have shown excellent efficacy in treating nail psoriasis. Their safety profile is favorable, but data assessing long-term safety are lacking. Randomized controlled trials in older adults exclusively are necessary to develop evidence-based treatment guidelines in this population.
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Affiliation(s)
- Jose W Ricardo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA.
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Çatıker A, Zincir H, Seviğ EÜ. The effect of foot care protocol applied to older people on foot health problems and foot care behaviours: a randomised controlled trial in a nursing home. Scand J Caring Sci 2021; 35:1278-1289. [PMID: 33393104 DOI: 10.1111/scs.12949] [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: 08/16/2020] [Revised: 11/11/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to develop a protective and improving protocol for foot health of the older people and to assess the effect of this protocol on foot problems, foot care knowledge levels and foot care behavior. METHODS This randomized controlled trial that was conducted in a nursing home in Turkey. The research was completed with 57 older people (28 intervention group, 29 control group) over the age of 60 living in a nursing home who met the eligibility criteria. Data were collected using the Older Person Identification Form, Foot Examination Form, Foot Care Knowledge Level Form, and Foot Care Behavior Scale at baseline and 6 months later. When assessing the study data; Descriptive statistics, Student t-test, Mann Whitney U test, Wilcoxon signed ranks test, chi-square test, continuity (Yates) correction, Fisher exact chi-square test, McNemar test and GEE were used. RESULTS At the end of the research, there were statistically significant improvements in problems related to dermatology (appearance, hygiene, and moisture); problems related to circulation (temperature); problems related to sensory issues (feeling and pain); problems related to footwear; and problems related to self-care between the intervention and control groups. Also, there were statistically significant improvements in problems related to dermatology (appearance and hygiene); problems related to circulation (temperature, color, and edema); and problems related to sensory issues (feeling and pain) for the posttest compared to the pretest in the intervention group (p < 0.05). In terms of foot care knowledge level and foot care behavior scale mean scores, statistically significant differences were found between the groups and for the intervention group pretest and posttest mean scores. CONCLUSION The foot care protocol applied to older people was identified to reduce foot problems by a significant level, and increase mean points for knowledge levels about foot care and the foot care behavior scale.
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Affiliation(s)
- Aslıhan Çatıker
- Department of Nursing, Ordu University Faculty of Health Sciences, Ordu, Turkey
| | - Handan Zincir
- Faculty of Health Sciences, Department of Nursing, Public Health Nursing Department, Erciyes University, Kayseri, Turkey
| | - Emine Ümit Seviğ
- Faculty of Nursing, Public Health Nursing Department, Near East University, Nicosia/TRNC, Cyprus
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Alberdi E, Gómez C. Methylene blue vs methyl aminolevulinate photodynamic therapy in the treatment of mild-to-moderate toenail onychomycosis: Short- and medium-term effects. Dermatol Ther 2020; 33:e14280. [PMID: 32890444 DOI: 10.1111/dth.14280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/25/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022]
Abstract
Photodynamic therapy (PDT) has emerged as an interesting alternative option for onychomycosis treatment. The impact of a specific photosensitizer (PS) on the final result is an important factor to consider. We conducted a short- and medium-term controlled trial to compare the effectiveness of PDT in the treatment of mild-to-moderate onychomycosis when it is mediated by two different PSs. Twenty patients were randomized to receive nine sessions of PDT distributed over 16 weeks mediated either by methylene blue (MB/PDT group) or methyl aminolevulinate (MAL/PDT group). Onychomycosis severity index (OSI) and nail involvement were checked along the study. Complete cure, treatment success, and clinical improvement were tabulated at 16 and 40-week follow-ups. OSI scores decreased significantly along the study, from 12.1 ± 5.4 to 3.6 ± 3.2 (MB/PDT group) and from 14.8 ± 6.0 to 5.4 ± 4.4 (MAL/PDT group). At 16-week follow-up, only 20% of the patients in the MB/PDT group reached complete cure and none in the group of MAL/PDT. At 40-week follow-up, complete cure rates were 70% and 40% in the MB/PDT group and MAL/PDT group respectively. Both modalities showed good outcomes in treatment of moderate toenail onychomycosis. MB/PDT showed a faster action but with relapse rates slightly higher than MAL/PDT.
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Affiliation(s)
| | - Clara Gómez
- Institute of Physical Chemistry Rocasolano, CSIC, Madrid, Spain
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12
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Gao J, Shen C, Ko R, Guo Y, Shen X, Cui Y, Yang C. Clinical Observation and Follow-Up of Subungual Splinter Hemorrhages of Toenails in Chinese Adults. Indian J Dermatol 2020; 65:11-16. [PMID: 32029933 PMCID: PMC6986115 DOI: 10.4103/ijd.ijd_193_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Subungual splinter hemorrhage (SSH) is a common nail disorder and is difficult to differentiate from other nail diseases because of their similar characteristics. The epidemiological study of SSH is lacking and it is unclear whether SSH needs treatment or not. Aims: The aims of this study were to observe the clinical characteristics of SSH of toenails in Chinese adults and to provide a reference for the diagnosis and prognosis of patients with SSH. Materials and Methods: We collected and followed up 63 SSH patients who were diagnosed through dermoscopic examination. The clinical and dermoscopic characteristics, disease course, and recovery results were recorded. Data sets were analyzed through the use of SPSS 16.0. Literature concerning SSH were reviewed and compared with the results in this study. Results: Sixty-three SSH patients were included with an age range of 17–58 years. Nearly 93.7% of SSH patients occurred in the right, left, or right and left first toenails; 66.7% of SSH patients occurred only in one toenail; there were 60.3% of SSH patients with a clear stimulus causing it and 31.8% of SSH patients with five types of comorbidities. The common characteristics of dermoscopy showed a reddish brown or brown stain with a clear boundary visible under the nail in which the color gradually faded outward from the center, with no blue or white structure. After following up for 24 weeks, the disappearance of hemorrhage was observed in 95.2% of SSH patients. For the recovered SSH patients, data analysis showed no significant difference in the course of SSH in males and females (P = 0.645); the statistical analysis showed that there was no significant correlation (r2 = −0.002) between age and course in recovered SSH patients (P = 0.986). Conclusions: It is unnecessary to do any special treatment during the 1st year. Measures ought to be taken for SSH patients if the course of the disease exceeds more than 1 year.
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Affiliation(s)
- Jing Gao
- Department of Dermatology, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Changbing Shen
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Randy Ko
- Department of Biochemistry, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yajun Guo
- Department of Dermatology, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Xue Shen
- Department of Dermatology, The First Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chunjun Yang
- Department of Dermatology, The Second Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
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13
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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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14
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Kerai LV, Bardés J, Hilton S, Murdan S. Two strategies to enhance ungual drug permeation from UV-cured films: Incomplete polymerisation to increase drug release and incorporation of chemical enhancers. Eur J Pharm Sci 2018; 123:217-227. [DOI: 10.1016/j.ejps.2018.07.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
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Rizi K, Mohammed IK, Xu K, Kinloch AJ, Charalambides MN, Murdan S. A systematic approach to the formulation of anti-onychomycotic nail patches. Eur J Pharm Biopharm 2018. [PMID: 29530581 DOI: 10.1016/j.ejpb.2018.02.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nail patches have a potential role as drug carriers for the topical treatment of nail diseases such as onychomycosis, a common condition. Our aim was therefore to develop a systematic and novel approach to the formulation of a simple drug-in-adhesive ungual patch. Twelve pressure-sensitive adhesives (PSAs), four backing membranes, two release liners and three drugs were screened for pharmaceutical and mechanical properties. From this initial screening, two PSAs, two drugs, one backing membrane and one release liner were selected for further investigation. Patches were prepared by solvent-casting and characterised. The patches had good uniformity of thickness and of drug content, and showed minimal drug crystallisation during six months of storage. Meanwhile, the drug stability in the patch upon storage and patch adhesion to the nail was influenced by the nature of the drug, the PSA and the backing membrane. The reported methodology paves the way for a systematic formulation of ungual nail patches to add to the armamentarium of nail medicines. Further, from this work, the best patch formulation has been identified.
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Affiliation(s)
- K Rizi
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - I K Mohammed
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - K Xu
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK
| | - A J Kinloch
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - M N Charalambides
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - S Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, UK.
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Kaul S, Yadav S, Dogra S. Treatment of Dermatophytosis in Elderly, Children, and Pregnant Women. Indian Dermatol Online J 2017; 8:310-318. [PMID: 28979861 PMCID: PMC5621188 DOI: 10.4103/idoj.idoj_169_17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dermatophytic infection of the skin and its appendages is a common occurrence. Though usually straightforward, treatment of dermatophytosis becomes notably challenging in certain population groups - pregnant women, children, and elderly. Treatment with topical azoles/allylamines alone is effective in limited cutaneous disease in all three groups. Terbinafine is the preferred oral agent in elderly population for treatment of extensive cutaneous disease and onychomycosis due to its lack of cardiac complications and lower propensity for drug interactions. If required, additional physical/mechanical modalities can be employed for symptomatic onychomycosis. Data for systemic therapy in children mainly pertains to the treatment of tinea capitis. At present, very little data exists regarding the safety of systemic antifungals in pregnancy and there is an effort to restrict treatment to topical therapies because of their negligible systemic absorption.
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Affiliation(s)
- Subuhi Kaul
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Savita Yadav
- Department of Dermatology and Venereology, AIIMS, New Delhi, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh, India
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Kerai LV, Hilton S, Maugueret M, Kazi BB, Faull J, Bhakta S, Murdan S. UV-curable gels as topical nail medicines:In vivo residence, anti-fungal efficacy and influence of gel components on their properties. Int J Pharm 2016; 514:244-254. [PMID: 27863669 DOI: 10.1016/j.ijpharm.2016.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022]
Abstract
UV-curable gels, used as nail cosmetics for their in vivo durability, were reported to be promising as topical nail medicines. Our first aim was thus to investigate whether such durability applies to drug-loaded formulations. This was found to be true. However, ethanol inclusion in the pharmaceutical formulation (to enable drug loading) reduced the in vivo residence. The second aim was therefore to determine any other effects of ethanol, and if ethanol could be avoided by the choice of monomers. Thus, three methacrylate monomers, ethyl methacrylate, isobornyl methacrylate and 2-hydroxyethyl methacrylate (HEMA) were selected, and their influence on the formulation properties were determined. Ethanol and the methacrylate monomer influenced some (but not all) of the formulation properties. The most significant was that HEMA could dissolve drug and enable the preparation of ethanol-free, drug-loaded formulations, which would benefit in vivo residence. The absence of ethanol reduced drug loading, release and ungual flux, but had no negative impact on the in vitro anti-fungal efficacy. Thus, judicious selection of gel components enabled the exclusion of ethanol. The long in vivo residence, little residual monomers, sufficient ungual permeation and in vitro anti-fungal activity of the gels indicates their potential as anti-onychomycotic topical medicines.
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Affiliation(s)
- L V Kerai
- UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - S Hilton
- UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK
| | - M Maugueret
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK
| | - B B Kazi
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK
| | - J Faull
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK
| | - S Bhakta
- Department of Biological Sciences, Institute of Structural and Molecular Biology, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK
| | - S Murdan
- UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK.
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