1
|
Saraswat A, Dogra S, Shenoy M, Verma S, K S, Ghate S, Ganjoo A, Aurangabadkar S, Tiwari A, Poojary S, Inamdar A, Majid I, Girdhar M, Shah B, Varma S, Ramamoorthy R, Dhoot D, Barkate H. Clinical Use of Super-Bioavailable Itraconazole for the Management of Dermatophytosis: Consensus Statement by Dermatologists from India via the Modified Delphi Technique. Dermatology 2024:1-13. [PMID: 38697027 DOI: 10.1159/000538080] [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: 04/25/2023] [Accepted: 02/26/2024] [Indexed: 05/04/2024] Open
Abstract
Super-bioavailable itraconazole (SB ITZ) overcomes the limitations of conventional itraconazole (CITZ) such as interindividual variability and reduced bioavailability. It has been approved for systemic mycoses in Australia and Europe as 50 mg and the USA as 65 mg and in India as 50 mg, 65 mg, 100 mg, and 130 mg. However, data on the ideal dose and duration of SB ITZ treatment in managing dermatophytosis are insufficient. This consensus discusses the suitability, dosage, duration of treatment, and relevance of using SB ITZ in managing dermatophytosis in different clinical scenarios. Sixteen dermatologists (>15 years of experience in the field and ≥2 years clinical experience with SB ITZ), formed the expert panel. A modified Delphi technique was employed, and a consensus was reached if the concordance in response was >75%. A total of 26 consensus statements were developed. The preferred dose of SB ITZ is 130 mg once daily and if not tolerated, 65 mg twice daily. The preferred duration for treating naïve dermatophytosis is 4-6 weeks and that for recalcitrant dermatophytosis is 6-8 weeks. Moreover, cure rates for dermatophytosis are a little better with SB ITZ than with CITZ with a similar safety profile as of CITZ. Better patient compliance and efficacy are associated with SB ITZ than with CITZ, even in patients with comorbidities and special needs such as patients with diabetes, extensive lesions, corticosteroid abuse, adolescents, and those on multiple drugs. Expert clinicians reported that the overall clinical experience with SB ITZ was better than that with CITZ.
Collapse
Affiliation(s)
- Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manjunath Shenoy
- Department of Dermatology, Yenepoya Medical College, Mangalore, India
| | - Shyam Verma
- Department of Dermatology, Nirvan Skin Clinic, Vadodara, India
| | - Seetharam K
- Department of Dermatology, GSL Medical College, Rajamundry, India
| | - Sunil Ghate
- Department of Dermatology, Dr Ghate's Skin, Hair and LASER Centre, Mumbai, India
| | - Anil Ganjoo
- Department of Dermatology, Skinnovation Clinics, New Delhi, India
| | - Sanjeev Aurangabadkar
- Department of Dermatology, Dr. Aurangabadkar's Skin and Laser Clinics, Hyderabad, India
| | - Anurag Tiwari
- Department of Dermatology, Center for Skin Diseases and Laser Treatment, Bhopal, India
| | - Shital Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, India
| | - Arun Inamdar
- Department of Dermatology, Sri B M Patil Medical College, BLDE Deemed University, Vijayapur, India
| | - Imran Majid
- Department of Dermatology, Cutis Institute of Dermatology, Srinagar, India
| | - Mukesh Girdhar
- Department of Dermatology, Max Super Specialty Hospital, Ppg, Delhi, India
| | - Bela Shah
- Department of Dermatology, BJ Medical College and Civil Hospital, Ahmedabad, India
| | - Sachin Varma
- Department of Dermatology, Skinvita Clinic, Kolkata, India
| | | | - Dhiraj Dhoot
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, India
| | - Hanmant Barkate
- Department of Global Medical Affairs, Glenmark Pharmaceuticals Ltd., Mumbai, India
| |
Collapse
|
2
|
Navarro-Pérez D, Tardáguila-García A, García-Oreja S, López-Moral M, García-Madrid M, Lázaro-Martínez JL. Onychomycosis associated with diabetic foot syndrome: A systematic review. Mycoses 2023; 66:459-466. [PMID: 36790078 DOI: 10.1111/myc.13577] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/14/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND A systematic review was conducted to investigate the prevalence of onychomycosis in patients with diabetes. The association of onychomycosis with risk factors in patients with diabetic foot syndrome was also examined. METHODS The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied, and the included studies were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) method. Searches were conducted in October 2022 using PubMed (Medline) and Scopus for clinical studies, clinical trials, comparative studies, observational studies, and randomised clinical trials or controlled clinical trials addressing the prevalence and consequences of onychomycosis in patients with diabetes, diagnoses or treatments. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussion with a third reviewer. RESULTS The systematic review included ten studies that met the inclusion criteria, and these studies enrolled 5664 patients with diabetes. Among these patients, 29.18% had onychomycosis that was mainly caused by Trichophyton rubrum. A significant association was found between the occurrence of onychomycosis and the presence of diabetic neuropathy (p = .012) and elevated glycosylated haemoglobin values (p = .039). There was no significant association between onychomycosis and ulceration (p = .185). Eight studies had a grade 4 level of evidence and a grade C recommendation, and one study had a grade 1b level of evidence and a grade A recommendation. CONCLUSION The information described in the literature is insufficient and heterogeneous regarding the association of risk factors and ulceration in patients with diabetic foot compared with developing onychomycosis. There is also a need to implement onychomycosis diagnostic testing instead of relying only on a clinical diagnosis. Additional prospective, randomised, comparative studies are needed to increase the quality of studies in the literature.
Collapse
Affiliation(s)
- David Navarro-Pérez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Aroa Tardáguila-García
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Sara García-Oreja
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Mateo López-Moral
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta García-Madrid
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
3
|
Antifungal Nail Lacquer for Enhanced Transungual Delivery of Econazole Nitrate. Pharmaceutics 2022; 14:pharmaceutics14102204. [PMID: 36297639 PMCID: PMC9607990 DOI: 10.3390/pharmaceutics14102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
The fungal disease of the nail, onychomycosis, which is also the most prevalent nail disturbance, demands effective topical treatment options considering the possible adverse effects of systemic antifungal therapy. The current work is focused on development of an adhesive and resistant, drug-delivering and permeation-enhancing polymeric film containing econazole nitrate (ECN) for topical antifungal treatment. The development of the lacquer formulation was guided by the Quality by Design approach to achieve the critical quality attributes needed to obtain the product of desired quality. Eudragit RSPO at 10% w/w was found to be the ideal adhesive polymer for the application and an optimal permeation-enhancing lacquer formulation was achieved by the optimization of other formulation excipients, such as plasticizer and the solvent system. Additionally, novel experimental enhancements introduced to the research included refined D50 drying time and drying rate tests for lacquer characterization as well as a multi-mechanism permeation-enhancing pre-treatment. Moreover, a practical implication was provided by a handwashing simulation designed to test the performance of the lacquer during actual use. In vitro drug release testing and ex vivo nail permeation testing demonstrated that the optimized nail lacquer performed better than control lacquer lacking the permeation enhancer by achieving a faster and sustained delivery of ECN. It can be concluded that this is a promising drug delivery system for topical antifungal treatment of onychomycotic nails, and the novel characterization techniques may be adapted for similar formulations in the future.
Collapse
|
4
|
Nishiyama Y, Maeda M, Yamada T. Effect of Topical Antifungal Luliconazole on Hyphal Morphology of Trichophyton mentagrophytes Grown on in vitro Onychomycosis Model. Mycopathologia 2022; 187:491-496. [PMID: 36057744 DOI: 10.1007/s11046-022-00661-6] [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: 07/21/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Abstract
Luliconazole, recently launched in Japan, is a novel topical imidazole antifungal agent for the treatment of onychomycosis. Using in vitro onychomycosis model, the effect of luliconazole on the morphology of the growing hyphae of Trichophyton mentagrophytes was investigated by scanning electron microscopy (SEM). The model was produced by placing human nail pieces on an agar medium seeded with conidia of T. mentagrophytes. After incubating the agar medium for 3 days, luliconazole was applied to the surface of the nail in which hyphal growth was recognized, then cultured for up to 24 h. The initial change after treatment with the drug was the formation of fine wrinkles on the surface of the hyphae, eventually, the hyphae were flattened, and after that, no hyphal growth was observed. On the other hand, when the nails were pretreated with luliconazole for 1 h, no hyphal growth was observed even after culturing for 24 h. This study suggests that luliconazole has a strong antifungal activity by inhibiting the ability of fungi to grow and the drug has both excellent nail permeation and retention properties.
Collapse
Affiliation(s)
- Yayoi Nishiyama
- Teikyo University Institute of Medical Mycology, 359 Otsuka, Hachioji, Tokyo, 192-0395, Japan.
| | - Mari Maeda
- Teikyo University Institute of Medical Mycology, 359 Otsuka, Hachioji, Tokyo, 192-0395, Japan
| | - Tsuyoshi Yamada
- Teikyo University Institute of Medical Mycology, 359 Otsuka, Hachioji, Tokyo, 192-0395, Japan
| |
Collapse
|
5
|
Aljurbui S, Hussain A, Yusuf M, Ramzan M, Afzal O, Almohaywi B, Yasmin S, Altamimi ASA. Impact of Composition and Morphology of Ketoconazole-Loaded Solid Lipid Nanoparticles on Intestinal Permeation and Gastroplus-Based Prediction Studies. ACS OMEGA 2022; 7:22406-22420. [PMID: 35811933 PMCID: PMC9260901 DOI: 10.1021/acsomega.2c01272] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/01/2022] [Indexed: 05/30/2023]
Abstract
Ketoconazole (KTZ) is a potential oral antifungal agent to control systemic and local infections. This study addresses the impact of composition (tween 80 and compritol as CATO) and morphology on permeation (stomach, jejunum, and ileum) profiles of KTZ-loaded solid lipid nanoparticles (SLNs) in rats followed by in vivo pharmacokinetic prediction and simulation using GastroPlus. The selected formulations were characterized for size, size distribution, zeta potential, entrapment efficiency, total drug content, morphology, in vitro drug release, ex vivo permeation and drug deposition, penetration potential, and GastroPlus-based in vivo prediction in rats. The results showed that there was considerable impact of pH, composition (CATO and tween 80), size, total drug content, and entrapment efficiency on in vitro drug release and permeation across the stomach, jejunum, and ileum. Ex vivo findings suggested pH, composition, size, and permeability coefficient-dependent permeation of SLNs across the stomach, jejunum, and ileum. Confocal laser scanning microscopy (CLSM) confirmed a relatively high degree of penetration of the optimized formulation "K-SLN4" (66.1% across the stomach, 51.5% across the jejunum, and 47.9% across the ileum) as compared to KSUS (corresponding values of 21.7%, 18.2%, and 17.4%). Finally, GastroPlus predicted in vivo dissolution/absorption as 0.012 μg/mL of K-SLN4 as compared to KSUS (the drug suspension with 0.0058 μg/mL) and a total regional absorption of 80.0% by K-SLN4 as compared to 60.1% of KSUS. There was only an impact of dose on C max (maximum plasma concentration) and area under the curve (AUC) in rats. Thus, the present strategy could be a promising alternative to parenteral and topical delivery systems for long-term therapy against systemic and local mycoses with high patient compliance.
Collapse
Affiliation(s)
- Shaya
Jubran Aljurbui
- Department
of Pharmacy, Riyadh Military Hospital, P.O. Box 7897, Riyadh 11159, Saudi Arabia
| | - Afzal Hussain
- Department
of Pharmaceutics, College of Pharmacy, King
Saud University, Riyadh 11451, Saudi Arabia
| | - Mohammad Yusuf
- Department
of Clinical Pharmacy, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mohhammad Ramzan
- Department
of Pharmaceutics, University Institute of Pharmaceutical Sciences, Panjab University, Chandigarh, Punjab 160014, India
| | - Obaid Afzal
- Department
of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
| | - Basmah Almohaywi
- Department
of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University (KKU), Abha 61421, Saudi
Arabia
| | - Sabina Yasmin
- Department
of Pharmaceutical Chemistry, College of Pharmacy, King Khalid University (KKU), Abha 61421, Saudi
Arabia
| | | |
Collapse
|
6
|
Nasr M, Abd-Elhamid N, Abd-Allah D, Elkholy BM. Acitretin: Could it be a new therapeutic player in the field of onychomycosis? Mycoses 2022; 65:402-410. [PMID: 35103343 DOI: 10.1111/myc.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onychomycosis represents a therapeutic challenge. The complete cure rate with itraconazole pulse therapy remains unsatisfactory implying the need for an effective therapeutic regimen. Given the successful treatment of recurrent dermatophytosis with isotretinoin and itraconazole, we investigated the therapeutic use of acitretin in onychomycosis. AIM To evaluate and compare the efficacy of combined itraconazole and acitretin versus monotherapy with each in onychomycosis. PATIENTS AND METHODS The study included 135 adult patients with finger- and/or toe-nail onychomycosis. They were equally subdivided into 3 groups: Itraconazole pulse therapy, acitretin, and combined itraconazole/acitretin therapy. The drugs were administered for 3 months. Evaluation of severity was done by onychomycosis severity index score. Potassium hydroxide microscopy and culture were performed at baseline and at the end of the study. RESULTS Mycological and complete cure of onychomycosis was observed in 51.1% and 20% of the itraconazole group, 28.9% and 28.9% of the acitretin group, and 80% and 53.3% of the combined group. There was a statistically-significant difference between groups in favor of the combined itraconazole/acitretin therapy (P ≤ 0.05). LIMITATIONS Small sample and short therapy duration. CONCLUSIONS Acitretin could be a powerful therapeutic player in the field of onychomycosis, with greater efficacy when combined with itraconazole.
Collapse
Affiliation(s)
- Mohamed Nasr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla Abd-Elhamid
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dina Abd-Allah
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Basma M Elkholy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
7
|
Adaptive Management of Multimodal Biometrics—A Deep Learning and Metaheuristic Approach. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
8
|
Inactivation of Dermatophytes Causing Onychomycosis and Its Therapy Using Non-Thermal Plasma. J Fungi (Basel) 2020; 6:jof6040214. [PMID: 33050542 PMCID: PMC7712512 DOI: 10.3390/jof6040214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/18/2020] [Accepted: 10/01/2020] [Indexed: 11/28/2022] Open
Abstract
Onychomycosis is one of the most common nail disorders. Its current treatment is not satisfactorily effective and often causes adverse side effects. This study aims to determine the optimal conditions for non-thermal plasma (NTP) inactivation of the most common dermatophytes in vitro and to apply it in patient`s therapy. The in vitro exposure to NTP produced by negative DC corona discharge caused full inactivation of Trichophyton spp. if applied during the early growth phases. This effect decreased to negligible inactivation with the exposure applied six days after inoculation. In a group of 40 patients with onychomycosis, NTP therapy was combined with nail plate abrasion and refreshment (NPAR) or treatment with antimycotics. The cohort included 17 patients treated with NPAR combined with NTP, 11 patients treated with antimycotics and NTP, and 12 patients treated with NPAR alone. The combination of NPAR and NTP resulted in clinical cure in more than 70% of patients. The synergistic effect of NPAR and NTP caused 85.7% improvement of mycological cure confirmed by negative microscopy and culture of the affected nail plate. We conclude that NTP can significantly improve the treatment of onychomycosis.
Collapse
|
9
|
Alberdi E, Gómez C. Methylene blue vs methyl aminolevulinate photodynamic therapy in combination with oral terbinafine in the treatment of severe dermatophytic toenail onychomycosis: Short- and long-term effects. Mycoses 2020; 63:859-868. [PMID: 32506733 DOI: 10.1111/myc.13125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) kills target microorganisms via reactive oxygen species (ROS) production. PDT seems to be a good alternative treatment option for onychomycosis. OBJECTIVE To compare the efficacy of combined therapies based on oral terbinafine (TN) plus adjunctive PDT mediated by methylene blue (MB) (TN + MB/PDT) or methyl aminolevulinate (MAL) (TN + MAL/PDT) in the treatment of onychomycosis. METHODS Twenty patients affected by severe dermatophyte onychomycosis in the nails of the big toe (>60% disease involvement of target nail) received oral TN for 12 weeks and concomitantly were randomly allocated to receive nine sessions, separated by 2-week intervals, of urea (40%) plus a PDT protocol mediated by MB (TN + MB/PDT: group I) or mediated by MAL (TN + MAL/PDT: group II). Clinical and mycological efficacy was evaluated at 16-, 40- and 52-week follow-up. RESULTS Both protocols showed a significant decrease in Onychomycosis Severity Index (OSI) scores (P < .05), from 24.2 ± 4.6 to 0.7 ± 0.6 (group I)) and from 18.5 ± 10.1 to 2.1 ± 2.0 (group II). No side effects or complications were reported in any of the combinations used. Mycological cure rates were significantly higher during the last third of the evaluated period of time, reaching 100% and 90% in group I and group II, respectively, at the 52-week follow-up. In both modalities, complete cure was achieved in 70% of the patients at the 52-week follow-up. CONCLUSIONS TN + MB/PDT and TN + MAL/PDT show similar outcomes in the treatment of toenails with severe onychomycosis. PDT is an effective method to accelerate the TN-mediated healing process.
Collapse
Affiliation(s)
| | - Clara Gómez
- Institute of Physical Chemistry Rocasolano, CSIC, Madrid, Spain
| |
Collapse
|
10
|
Aggarwal R, Targhotra M, Sahoo P, Chauhan MK. Onychomycosis: Novel strategies for treatment. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
11
|
Zhou LL, Nurmohamed S, Au S, Beecker J, Green P, Robertson L, Mydlarski R. The Canadian Dermatology Association's Top Five Choosing Wisely Canada Recommendations. J Cutan Med Surg 2020; 24:461-467. [PMID: 32431167 DOI: 10.1177/1203475420928904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION In this article, we present the Canadian Dermatology Association's (CDA) Choosing Wisely Canada (CWC) list of top "Five Things Physicians and Patients Should Question in Dermatology" and the evidence in support of each recommendation. METHODS Using a nominal technique, the CDA Working Group and Task Force generated an initial list based on literature review and expert consultation. After several rounds of list refinement via a modified Delphi process, a final list of recommendations was generated. These were approved by the CDA Board of Directors, presented at the CDA 93rd Annual Conference in 2018, and published by CWC in 2019. RESULTS The top five recommendations are as follows: (1) Don't routinely prescribe antibiotics for bilateral lower leg redness and swelling; (2) Don't routinely prescribe topical combination corticosteroid/antifungal products; (3) Don't routinely use topical antibiotics on a surgical wound; (4) Don't prescribe systemic antifungals without mycological confirmation of dermatophyte infection; and (5) Don't use oral antibiotics for acne vulgaris for more than 3 months without assessing efficacy. DISCUSSION This list of recommendations aims to encourage both physicians and patients to reevaluate ineffective, yet common, practices in treating dermatologic conditions. These recommendations represent actionable changes in practice, and therefore have considerable potential to enhance value-based care in dermatology. CONCLUSIONS This list was developed to identify tangible changes in practice within dermatology that may reduce inefficiencies, prevent potential patient harm, and improve care. Future advocacy work may include updates, feedback obtainment, and patient care handouts, to continue to promote value-based healthcare and best practices.
Collapse
Affiliation(s)
- Linghong Linda Zhou
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Sabrina Nurmohamed
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Sheila Au
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jennifer Beecker
- 6363 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, ON, Canada
| | - Peter Green
- 12361 Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lynne Robertson
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Regine Mydlarski
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Elmorsy EH, Abou Khadr NA, Taha AA, Abdel Aziz DM. Long‐Pulsed Nd:YAG (1,064 nm) Laser Versus Q‐Switched Nd:YAG (1,064 nm) Laser for Treatment of Onychomycosis. Lasers Surg Med 2019; 52:621-626. [DOI: 10.1002/lsm.23200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/10/2022]
|
14
|
Khammo N, Chesters D, Goldstone L, Kennedy G, Buckley C. A prospective study using image analysis to assess the efficacy of a topical treatment kit for mild onychomycosis. Mycoses 2019; 63:233-240. [PMID: 31595998 DOI: 10.1111/myc.13016] [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: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a fungal infection of the nails and is one of the most common dermatological infections worldwide. Infection occurs predominantly in the nails of the feet and if left untreated patients, particularly in at-risk populations, can develop more serious complications, including pain, fissuring and secondary infections. Fungal infections are also contagious and may spread to other nails or to family members. Topical treatments can be effective for mild cases of the disease and typically have fewer contraindications. However, generation of robust efficacy data for topical therapies is often hindered by the difficulties associated with monitoring progression of mild onychomycosis using the conventional methods of mycological culture to obtain confirmation of podiatrist assessments. OBJECTIVES The aim of this study was to demonstrate image analysis as an effective method to monitor progression of fungal nail infections. METHODS A novel digital image analysis technique was used to evaluate improvement in the visual signs of onychomycosis, when using a topical treatment kit for mild fungal nail infections in 60 participants over a 280-day period. RESULTS Image analysis demonstrated a significant (P < .0001) reduction from baseline of the affected nail area throughout the study period, results which were also perceived by the subjects themselves. Use of the treatment kit also limited the deterioration of the infection and prevented transmission to other nails. CONCLUSIONS Image analysis was established as a viable method to monitor the progression of fungal nail infections over long periods and demonstrate a clinical benefit following treatment.
Collapse
|
15
|
Hom Choudhury S, Kumar A, Laskar SH. Biometric Authentication through Unification of Finger Dorsal Biometric Traits. Inf Sci (N Y) 2019. [DOI: 10.1016/j.ins.2019.05.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
16
|
Take a multifaceted approach when treating onychomycosis. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
17
|
Hamed Khater M, Khattab FM. Combined long-pulsed Nd-Yag laser and itraconazole versus itraconazole alone in the treatment of onychomycosis nails. J DERMATOL TREAT 2019; 31:406-409. [PMID: 31157575 DOI: 10.1080/09546634.2019.1623861] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Oral antifungal therapies are effective for onychomycosis but it was complicated by systemic effects. Effective and safe therapy is needed to improve esthetic appearance of nails.Objective: The present study is an attempt to evaluate and compare the efficacy of of combined treatment of onychomycosis with 1,064-nm long-pulsed Nd-Yag laser and pulse itraconazole therapy versus pulse itraconazole alone.Methods: Thirty onychomycosis patients were divided into two groups: Groups I and II. Patients of Group I are treated by itraconazole pulse therapy. Patients of Group II received six laser sessions with long-pulsed Nd:Yag laser and itraconazole pulse therapy. The investigators rated clearance using "Onychomycosis Severity Index (OSI)", photographs, and mycology at 6 and 9 months after treatment.Results: Group I's clinical improvement response was excellent in two cases, good in six cases, moderate in five cases, and mild in two cases. Mycological improvement response was excellent in two cases, good in two cases, moderate in six cases, and mild in five cases (OSI before treatment was 13.4 ± 3.02 and after was 6.67 ± 3.6). Group II's clinical improvement response was excellent in 10, good in 3, moderate in 1, and mild in 1. Mycological improvement's response was excellent in two cases, good in two cases, moderate in six cases, and mild in five cases (OSI before treatment was 13.33 ± 3.11 and after was 5.07 ± 4.15). There were no adverse effects. The clinical response showed best results with Group II, but the mycological cure was equal in both groups.Conclusions: The use of combined long-pulsed Nd-Yag laser and itraconazole pulse therapy gives the best clinical results and patient's satisfaction.
Collapse
Affiliation(s)
- Mohamed Hamed Khater
- Faculty of Medicine, Department of Venereology and Andrology, Zagazig University, Zagazig, Egypt
| | - Fathia M Khattab
- Faculty of Medicine, Department of Venereology and Andrology, Zagazig University, Zagazig, Egypt
| |
Collapse
|
18
|
Zhang L, Xu H, Shi Y, Yu J, Tao Y, Li X. An exploration of the optimum dosage and number of cycles of itraconazole pulse therapy for severe onychomycosis. Mycoses 2018; 61:736-742. [PMID: 29893422 DOI: 10.1111/myc.12799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/14/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
Although standard itraconazole pulse therapy is a well-established regimen for toenail onychomycosis, the cure rate for onychomycosis remains low. To evaluate the efficacy and safety of different cycles of itraconazole pulse therapy, determine the optimal dosage and number of cycles for onychomycosis. A total of 90 outpatients of our hospital with onychomycosis were randomised into three treatment groups: (1) standard itraconazole pulse therapy (200 mg twice per day, 1 week each month for three pulses); (2) long-term pulse therapy (200 mg twice per day, 1 week each month for six pulses); (3) low-dose and long-term pulse therapy (200 mg/d, 1 week per month for six pulses) and were followed up for 15 months. Of the initial patients, the trial was completed by 81 patients. The complete cure rates were 32.43% for three cycles and 75% for six cycles (P < .001). For six cycles, despite the administration of half-dose for patients weighing no more than 55 kg, there was no statistical difference in the complete cure rate (P = .862). Long-term therapy is effective and safe for the treatment of toenail onychomycosis. For patients weighing no more than 55 kg, long-term half-dose itraconazole pulse therapy is recommended .
Collapse
Affiliation(s)
- Li Zhang
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, P.R.China
| | - Hui Xu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, P.R.China
| | - Yuling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, P.R.China
| | - Jing Yu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, P.R.China
| | - Yunjiao Tao
- Dermatology, Zhangjiagang second people's hospital, Suzhou, China
| | - Xiuli Li
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, P.R.China
| |
Collapse
|
19
|
Clinical Diagnostic Accuracy of Onychomycosis: A Multispecialty Comparison Study. Dermatol Res Pract 2018; 2018:2630176. [PMID: 30057595 PMCID: PMC6051116 DOI: 10.1155/2018/2630176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/18/2018] [Accepted: 06/05/2018] [Indexed: 11/18/2022] Open
Abstract
Although onychomycosis can be diagnosed clinically, many guidelines still recommend pathologic confirmation of the diagnosis prior to initiation of systemic treatment. We retrospectively reviewed results from 541 toenail clippings (160 by dermatologists, 198 by podiatrists, and 183 by other provider types) sent to the Brigham and Women's Department of Dermatopathology between January 2000 and December 2013 for confirmatory periodic acid-Schiff (PAS) testing of clinically diagnosed onychomycosis. Of these, 93 (58.1%), 125 (63.1%), and 71 (38.8%) were sent for confirmation of onychomycosis (as opposed to diagnosis of onychodystrophy) by dermatologists, podiatrists, and other provider types, respectively. Confirmatory PAS stains were positive in 70 (75.3%), 101 (80.8%), and 47 (66.2%) of samples ordered by dermatologists, podiatrists, and other providers, respectively. Our study demonstrates that clinical diagnosis of onychomycosis in the appropriate clinical setting is accurate across specialties. Further prospective investigation on the accuracy of clinical diagnosis of onychomycosis may be beneficial.
Collapse
|
20
|
Markinson B, Ghannoum M, Winter T, Rycerz A, Rock F, Gupta AK. Examining the Benefits of the Boron-Based Mechanism of Action and Physicochemical Properties of Tavaborole in the Treatment of Onychomycosis. J Am Podiatr Med Assoc 2018; 108:12-19. [PMID: 29547036 DOI: 10.7547/16-154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Onychomycosis is a fungal infection of the nail primarily caused by the dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. The topical-based treatment of onychomycosis remains a challenge because of the difficulty associated with penetrating the dense, protective structure of the keratinized nail plate. Tavaborole is a novel small-molecule antifungal agent recently approved in the United States for the topical treatment of toenail onychomycosis. The low molecular weight, slight water solubility, and boron chemistry of tavaborole maximize nail penetration after topical application, allowing for effective targeting of the infection in the nail bed. The efficacy of tavaborole is associated with its novel mechanism of action, whereby it inhibits the fungal leucyl-tRNA synthetase (LeuRS) enzyme. Because LeuRS is an essential component in fungal protein synthesis, inhibition of LeuRS ultimately leads to fungal cell death. Tavaborole is the first boron-based antifungal medication approved for the treatment of mild-to-moderate onychomycosis and presents patients with a new topical option. Previously, ciclopirox and efinaconazole were the only approved topical treatments for onychomycosis. This article details the properties that are at the core of the clinical benefits associated with tavaborole.
Collapse
Affiliation(s)
| | - Mahmoud Ghannoum
- Department of Dermatology, Case Western Reserve University, Cleveland, OH
| | | | | | - Fernando Rock
- Anacor Pharmaceuticals Inc, a wholly owned subsidiary of Pfizer, Inc, New York, NY
| | | |
Collapse
|
21
|
Yamaguchi H. Potential of Ravuconazole and its Prodrugs as the New OralTherapeutics for Onychomycosis. Med Mycol J 2017; 57:E93-E110. [PMID: 27904057 DOI: 10.3314/mmj.16-00006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Onychomycosis is a fungal infection of the nail apparatus caused by dermatophytes, Candida and non-dermatophytic molds. It is highly prevalent in the general population worldwide and also responsible for significant morbidity and complications and does not usually cure itself. Thus, the condition needs to be treated in view of physical and psychological problems produced. Currently, oral medications using terbinafine are the most effective therapy, but it has relatively limited therapeutic success, particularly for long-term management. Such existing oral therapies are associated with high recurrence rates and treatment failure, as well as with potential adverse events and drug-drug interactions. In the light of these issues, development of more efficacious and safer alternatives for the treatment of onychomycosis is warranted.Ravuconazole and its prodrugs are promising new drug candidates for oral therapy of onychomycosis, among which a water-soluble prodrug, mono-lysine phosphoester derivative (E1224 or BFE1224) is in the most advanced stage of clinical development; a Phase II dose-finding study has been successfully completed and Phase III comparative studies are in progress in Japan.This review aims to summarize our current status of knowledge and information on ravuconazole and its prodrugs, particularly BFE1224, as the potential oral treatment option for onychomycosis. It also summarize the clinical features of onychomycosis with particular stress on its etiology, epidemiology, and current therapeutic options and their limitations. Given its clinical usefulness, BFE1224 may become a valuable addition to the current armamentarium for the treatment of onychomycosis.
Collapse
|
22
|
Goto T, Nakagami G, Takehara K, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Examining the accuracy of visual diagnosis of tinea pedis and tinea unguium in aged care facilities. J Wound Care 2017; 26:179-183. [PMID: 28379097 DOI: 10.12968/jowc.2017.26.4.179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of this study was to examine the accuracy of visual diagnosis of tinea pedis (Athlete's foot) and tinea unguium (fungal nail infection), as well as to provide information on skin abnormalities that could help identify these diseases in aged care facilities (long-term care facilities (LTCFs) and nursing homes). METHOD A multicentre, cross-sectional observational study was conducted in a LTCF and two nursing homes. A dermatologist observed the skin abnormalities in the participants' interdigital and plantar areas, to screen for tinea pedis, and in the participants' toenails, to screen for tinea unguium. If abnormalities were noted, samples such as scales or toenails were collected and examined using direct microscopy. The accuracy of the macroscopic observation for each skin abnormality was examined. RESULTS A total of 173 residents were recruited. The accuracy of clinical diagnosis using macroscopic observation was relatively low. The sensitivities and specificities for clinical diagnosis were 0.37 and 0.95 for tinea pedis in the interdigital areas, 0.47 and 0.94 for tinea pedis in the plantar areas, and 0.80 and 0.61 for tinea unguium in toenails, respectively. Scales in the plantar areas and discoloration of the toenails were more frequently observed in residents with tinea pedis and tinea unguium than in those without them. CONCLUSION Several skin abnormalities were observed in the residents recruited in this study, but there was insufficient correlation with tinea pedis and tinea unguium to be used for screening.
Collapse
Affiliation(s)
- T Goto
- PhD student, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Japan Society for the Promotion of Science, Tokyo, Japan; Global Leadership Initiative for an Age-Friendly Society, The University of Tokyo, Tokyo, Japan
| | - G Nakagami
- Lecturer, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - K Takehara
- Lecturer, Department of Advanced Clinical Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - T Nakamura
- Physician, Shukokai Medical Corporation, Tokyo, Japan
| | - M Kawashima
- Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Tsunemi
- Associate Professor, Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - H Sanada
- Professor, Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
23
|
Aluja Jaramillo F, Quiasúa Mejía DC, Martínez Ordúz HM, González Ardila C. Nail unit ultrasound: a complete guide of the nail diseases. J Ultrasound 2017; 20:181-192. [PMID: 28900518 DOI: 10.1007/s40477-017-0253-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/02/2017] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION The nails have a functional and esthetic importance for patients. Almost always, the nail disorders are diagnosed on the basis of clinical findings, but imaging methods may be required for a better assessment. These imaging methods, such as ultrasound and magnetic resonance, may help to establish an accurate diagnosis. Magnetic resonance imaging is not widely available and sometimes may be very expensive; that is why, ultrasound is an excellent imaging modality. Our objective is to expose the nail unit anatomy, the nail unit anatomy in ultrasound, and some of the frequent pathologies found in our daily practice. METHODS A review of the literature was done to review the anatomy, technical aspects, and different findings in normal and abnormal nail unit ultrasound. RESULTS Ultrasound offers an appropriate alternative for the evaluation of the nail unit, allows a real-time evaluation of each one of the components of the nail unit with an optimal visualization of these structures, and allows the evaluation of the thickness of the components, the vascularity, and blood flow by Doppler application. In addition, the nail unit disorder, such as infectious diseases, inflammatory and rheumatologic conditions, nail tumors, among others, may be assessed, not only in the diagnosis but also in the follow-up. Pre-surgical evaluation, surgical follow-up, and some procedures, such as biopsies, may be done by this technique. CONCLUSIONS Ultrasound is an excellent technique for evaluation of normal anatomy, diagnosis, and follow-up of patients with nail unit diseases. This is an alternative for other imaging methods and may be used for an accurate diagnosis approach.
Collapse
Affiliation(s)
- Felipe Aluja Jaramillo
- Radiology Department, Country Scan LTDA, Carrera 16 # 84a- 09 Cons. 323, Bogotá, Colombia
| | - Diana Carolina Quiasúa Mejía
- Dermatology Department, Instituto de Pós-graduação Médica Carlos Chagas-Policlínica Geral do Rio de Janeiro, Rio De Janeiro, Brazil.,Carrera 21 No 122-87, Bogotá, Colombia
| | | | - Cesar González Ardila
- Dermatology Department, Clínica Universitaria Colombia, Calle 23b # 66-46, Bogotá, Colombia
| |
Collapse
|
24
|
Hafirassou AZ, Valero C, Gassem N, Mihoubi I, Buitrago MJ. Usefulness of techniques based on real time PCR for the identification of onychomycosis-causing species. Mycoses 2017; 60:638-644. [DOI: 10.1111/myc.12629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Anissa Z. Hafirassou
- Laboratory of Mycology; Biotechnology and Microbial Activities; Frères-Mentouri, Constantine University; Constantine Algeria
| | - Clara Valero
- Mycology Department; Centro Nacional de Microbiología; Instituto de Salud Carlos III; Madrid Spain
| | - Nadia Gassem
- Laboratory of Parasitology and Medical Mycology; CHU Ben Badis; Constantine Algeria
| | - Ilhem Mihoubi
- Laboratory of Mycology; Biotechnology and Microbial Activities; Frères-Mentouri, Constantine University; Constantine Algeria
| | - Maria J. Buitrago
- Mycology Department; Centro Nacional de Microbiología; Instituto de Salud Carlos III; Madrid Spain
| |
Collapse
|
25
|
Molecular Diagnostic Techniques for Onychomycosis: Validity and Potential Application. Am J Clin Dermatol 2017; 18:281-286. [PMID: 28160226 DOI: 10.1007/s40257-016-0248-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnosis of onychomycosis requires positive findings by direct microscopy and fungal culture. Fungal culture is slow and difficult, with low yields. We compared two dermatophyte identification methods, one using a real-time polymerase chain reaction (PCR) method, and the other using fungal culture to validate the molecular method. METHODS Nail specimens were collected from 149 patients with distal and lateral subungual onychomycosis who were positive for fungal elements by direct microscopy using potassium hydroxide. Each specimen was subjected to the modified real-time PCR assay of Miyajima et al. and fungal culture. RESULTS Of 149 specimens, 142 (95.3%) were positive for Trichophyton rubrum or Trichophyton mentagrophytes including Trichophyton interdigitale by PCR, while only 104 (69.8%) were positive by fungal culture performed simultaneously. No specimen was negative by PCR, but positive by culture. All specimens positive for T. rubrum or T. mentagrophytes by culture were also positive by PCR, showing complete concordance for Trichophyton species. The culture of 17 specimens yielded fungi other than T. rubrum or T. mentagrophytes, whereas PCR identified T. rubrum in 11 of these specimens. Among 28 culture-negative specimens, 23 showed T. rubrum and four showed T. mentagrophytes by PCR. PCR allowed more rapid identification of causative fungi (≤2 days vs. ≤28 days). CONCLUSION Real-time PCR achieved a higher dermatophyte identification rate and showed complete concordance with conventional culture for two Trichophyton species. Specimens never yielded both T. mentagrophytes and T. rubrum simultaneously, suggesting that mixed infection is uncommon.
Collapse
|
26
|
Elsherif NI, Shamma RN, Abdelbary G. Terbinafine Hydrochloride Trans-ungual Delivery via Nanovesicular Systems: In Vitro Characterization and Ex Vivo Evaluation. AAPS PharmSciTech 2017; 18:551-562. [PMID: 27138036 DOI: 10.1208/s12249-016-0528-9] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/03/2016] [Indexed: 11/30/2022] Open
Abstract
Treating a nail infection like onychomycosis is challenging as the human nail plate acts as a formidable barrier against all drug permeation. Available oral and topical treatments have several setbacks. Terbinafine hydrochloride (TBH), belonging to the allylamine class, is mainly used for treatment of onychomycosis. This study aims to formulate TBH in a nanobased spanlastic vesicular carrier that enables and enhances the drug delivery through the nail. The nanovesicles were formulated by ethanol injection method, using either Span® 60 or Span® 65, together with Tween 80 or sodium deoxycholate as an edge activator. A full factorial design was implemented to study the effect of different formulation and process variables on the prepared TBH-loaded spanlastic nanovesicles. TBH entrapment efficiency percentages, particle size diameter, percentage drug released after 2 h and 8 h were selected as dependent variables. Optimization was performed using Design-Expert® software to obtain an optimized formulation with high entrapment efficiency (62.35 ± 8.91%), average particle size of 438.45 ± 70.5 nm, and 29.57 ± 0.93 and 59.53 ± 1.73% TBH released after 2 and 8 h, respectively. The optimized formula was evaluated using differential scanning calorimetry and X-ray diffraction and was also morphologically examined using transmission electron microscopy. An ex vivo study was conducted to determine the permeation and retainment of the optimized formulation in a human cadaver nail plate, and confocal laser scanning microscope was used to show the extent of formulation permeation. In conclusion, the results confirmed that spanlastics exhibit promising results for the trans-ungual delivery of TBH.
Collapse
|
27
|
Superficial Fungal Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
28
|
Mahtab A, Anwar M, Mallick N, Naz Z, Jain GK, Ahmad FJ. Transungual Delivery of Ketoconazole Nanoemulgel for the Effective Management of Onychomycosis. AAPS PharmSciTech 2016; 17:1477-1490. [PMID: 26857516 DOI: 10.1208/s12249-016-0488-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/22/2016] [Indexed: 11/30/2022] Open
Abstract
Ketoconazole (KCZ) nanoemulgel containing permeation enhancer was formulated as a vehicle for transungual drug delivery, and its efficacy to inhibit the growth of onychomycotic dermatophytes was investigated in vitro. Different components of oil-in-water nanoemulsions were moderately agitated by classical titration method and passed through a high-pressure homogenizer to formulate various nanoemulsions, which were further identified by constructing pseudo-ternary phase diagrams. Stress-stability testing was carried out for the nanoemulsions, and those that passed these tests were characterized for mean droplet size, zeta potential, morphology, pH, refractive index, viscosity and transmittance. Mean droplet size and zeta potential of the optimized nanoemulsion (NE3) were found to be 77.52 ± 0.92 nm (polydispersity index (PDI) = 0.128 ± 0.035) and -5.44 ± 0.67 mV, respectively. Optimized nanoemulsion was converted into nanoemulgel (NEG1) with 1% (w/w) of gelling agent (Carbopol® Ultrez 21) and 1%-2% (v/v) thioglycolic acid as permeation enhancer, and evaluated for pH, viscosity, spreadability, extrudability, tensile strength and bio-adhesion measurement. In vitro cumulative drug released at the end of 24 h from NE3, NEG1 and drug suspension were found to be 98.87 ± 1.29, 84.42 ± 2.78% and 54.86 ± 2.19%, respectively. Ex vivo transungual permeation values for KCZ through goat hooves from NE3, NEG1 and drug suspension were found to be 62.49 ± 2.98, 77.54 ± 2.88% and 38.54 ± 2.54%, respectively, in 24 h. The antifungal effect of NEG1 on Trichophyton rubrum and Candida albicans showed a significant (p < 0.05) zone of inhibition as compared to drug solution. Skin irritation and histopathology studies on rat skin showed the safe topical use and enhanced permeation of formulated nanoemulgel.
Collapse
|
29
|
Shin MK, Kim TI, Kim WS, Park HK, Kim KS. Changes in nail keratin observed by Raman spectroscopy after Nd:YAG laser treatment. Microsc Res Tech 2016; 80:338-343. [PMID: 27481603 DOI: 10.1002/jemt.22734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/13/2016] [Accepted: 07/09/2016] [Indexed: 11/09/2022]
Abstract
Lasers and photodynamic therapy have been considered a convergence treatment for onychomycosis, which is a fungal infection on the nail bed and nail plate. Laser therapies have shown satisfactory results without significant complications for onychomycosis; however, the mechanism of clearing remains unknown. In this work, we investigated changes in the chemical structure of nail keratin induced by Nd:YAG laser using Raman spectroscopy. Toe nails with onychomycosis were treated with 1064 nm Nd:YAG laser. After laser treatment, the disulfide band (490-590 cm-1 ) of nail keratin was rarely observed or was reduced in intensity. The amide I band (1500-1700 cm-1 ) also showed changes induced by the laser. The α-helical (1652 cm-1 ) structures dominated the β-sheet (1673 cm-1 ) in nontreated nail, but the opposite phenomenon was observed after laser treatment.
Collapse
Affiliation(s)
- Min Kyung Shin
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae In Kim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan Sun Kim
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea
| | - Hun-Kuk Park
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea.,Program of Medical Engineering, Kyung Hee University, Seoul, Korea.,Healthcare Industry Research Institute, Kyung Hee University, Seoul, Korea
| | - Kyung Sook Kim
- Department of Biomedical Engineering, Graduate school, Kyung Hee University, Seoul, Korea.,Program of Medical Engineering, Kyung Hee University, Seoul, Korea
| |
Collapse
|
30
|
Abstract
INTRODUCTION Onychomycosis is a fungal nail infection that accounts for half of all nail diseases. Oral drugs on the market have adverse effects, while it is difficult for traditional topical drugs to penetrate the nail plate to reach the diseased nail bed. Tavaborole is a new drug that addresses the unmet needs of currently available treatments. Tavaborole (5%) is FDA approved for treating toenail onychomycosis and has shown antifungal activities against yeast, moulds and dermatophytes. AREAS COVERED The objective of this article is to review the efficacy, pharmacokinetics, pharmacodynamics, and safety of tavaborole for treatment of toenail onychomycosis. Expert commentary: Tavaborole, with its unique mechanism, may be a good candidate for use in treating children with fungal infections, diabetic individuals, and treating mixed infections. Tavaborole may be paired with other therapies to potentially increase cure rates.
Collapse
Affiliation(s)
- Aditya K Gupta
- a Department of Medicine , University of Toronto School of Medicine , Toronto , ON , Canada.,b Mediprobe Research Inc ., London , ON , Canada
| | | |
Collapse
|
31
|
Abstract
PURPOSE The purpose of this article is to review the safety, efficacy, and role of efinaconazole and tavaborole in the treatment of onychomycosis. SUMMARY Onychomycosis is a fungal infection of the nail caused by dermatophytes, yeasts, and nondermatophyte fungi. Distal and lateral subungual onychomycosis (DLSO) accounts for the majority of the cases. These infections cause structural damage to the nail which makes treatment difficult. Both oral and topical agents exist for the treatment of onychomycosis. Oral medications have generally been more effective, yet adverse effects and drug interactions limit their use in some patients. Food and Drug Administration (FDA)-approved agents in the United States for oral therapies include terbinafine, itraconazole, and griseofulvin. The only topical product available up to recently was ciclopirox. CONCLUSION This article will review efinaconazole and tavaborole, 2 new topical antifungal agents released in 2014.
Collapse
Affiliation(s)
- Mara Poulakos
- 1 Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Yasmin Grace
- 1 Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Jade D Machin
- 1 Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
| | - Erin Dorval
- 1 Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
| |
Collapse
|
32
|
Abstract
Background: Onychomycosis is a persistent fungal nail infection that is notoriously hard to treat. Approximately 20% to 25% of patients with onychomycosis do not respond to treatment, and 10% to 53% of patients relapse. As such, successful treatment is imperative for long-term disease management. Objective: To identify ways to improve cure rates for onychomycosis. Method: The literature on onychomycosis treatment and recurrence was reviewed to summarize treatment approaches and suggest strategies to increase cure rates. Results and Conclusion: To improve treatment success in onychomycosis, we suggest the following measures be followed: (1) onychomycosis must be correctly diagnosed, (2) the treatment regimen should be tailored to the individual patient, (3) the efficacy of antifungals must be maximized, and (4) recurrence must be prevented.
Collapse
Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mediprobe Research, Inc, London, ON, Canada
| | | | | |
Collapse
|
33
|
Ngo HX, Garneau-Tsodikova S, Green KD. A complex game of hide and seek: the search for new antifungals. MEDCHEMCOMM 2016; 7:1285-1306. [PMID: 27766140 PMCID: PMC5067021 DOI: 10.1039/c6md00222f] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fungal infections directly affect millions of people each year. In addition to the invasive fungal infections of humans, the plants and animals that comprise our primary food source are also susceptible to diseases caused by these eukaryotic microbes. The need for antifungals, not only for our medical needs, but also for use in agriculture and livestock causes a high demand for novel antimycotics. Herein, we provide an overview of the most commonly used antifungals in medicine and agriculture. We also present a summary of the recent progress (from 2010-2016) in the discovery/development of new agents against fungal strains of medical/agricultural relevance, as well as information related to their biological activity, their mode(s) of action, and their mechanism(s) of resistance.
Collapse
Affiliation(s)
- Huy X. Ngo
- University of Kentucky, Department of Pharmaceutical Sciences, 789 South Limestone Street, Lexington, KY, USA. Fax: 859-257-7585; Tel: 859-218-1686
| | - Sylvie Garneau-Tsodikova
- University of Kentucky, Department of Pharmaceutical Sciences, 789 South Limestone Street, Lexington, KY, USA. Fax: 859-257-7585; Tel: 859-218-1686
| | - Keith D. Green
- University of Kentucky, Department of Pharmaceutical Sciences, 789 South Limestone Street, Lexington, KY, USA. Fax: 859-257-7585; Tel: 859-218-1686
| |
Collapse
|
34
|
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.
Collapse
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
| |
Collapse
|
35
|
Patel MM, Vora ZM. Formulation development and optimization of transungual drug delivery system of terbinafine hydrochloride for the treatment of onychomycosis. Drug Deliv Transl Res 2016; 6:263-75. [DOI: 10.1007/s13346-016-0287-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
Ranawaka RR, Nagahawatte A, Gunasekara TA, Weerakoon HS, de Silva SHP. Randomized, double-blind, comparative study on efficacy and safety of itraconazole pulse therapy and terbinafine pulse therapy on nondermatophyte mold onychomycosis: A study with 90 patients. J DERMATOL TREAT 2015; 27:364-72. [PMID: 26651495 DOI: 10.3109/09546634.2015.1119781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Nondermatophyte mold (NDM) onychomycosis shows poor response to current topical, oral or device-related antifungal therapies. This study was aimed to determine the efficacy and safety of itraconazole and terbinafine pulse therapy on NDM onychomycosis. METHODS Mycologically proven subjects were treated with itraconazole 400 mg daily or terbinafine 500 mg daily for 7 days/month; two pulses for fingernails and three pulses for toenails(SLCTR/2013/013). RESULTS One-hundred seventy-eight patients underwent mycological studies and 148 had positive fungal isolates. NDM were the prevailing fungi, 68.2%, followed by candida species 21.6%, and dermatophytes made up only 10.1%. Out of NDM Aspergillus spp (75.1%) predominated followed by 8.9% Fusarium spp and 4.95% Penicillium spp. The clinical cure at completion of pulse therapy was statistically significant 9.2% versus 2.0% (p < 0.05) in itraconazole group. But no statistically significant difference was detected between the two regimens at the end of 12 months; 65.1% versus 54.64%. Recurrences observed in both groups (6.5% vs. 4.1%) were not statistically significant. With itraconazole pulse 68.22% Aspergillus spp, 50.0% Fusarium spp and 84.6% Penicillium spp showed clinical cure, while terbinafine pulse cured 55.0% Aspergillus spp and 50.0% Fusarium spp. CONCLUSIONS NDM was the prevailing fungi in onychomycosis in Sri Lanka. Both itraconazole and terbinafine were partially effective on NDM onychomycosis showing a clinical cure of 54-65%. Future research should focus on searching more effective antifungal for NDM onychomycosis.
Collapse
Affiliation(s)
| | - Ajith Nagahawatte
- b Department of Microbiology , University of Ruhuna , Galle , Sri Lanka , and
| | | | - Hema S Weerakoon
- a Department of Dermatology , Base Hospital Homagama , Sri Lanka
| | - S H Padmal de Silva
- c Department of Evaluation and Research , National Institute of Health Sciences , Kalutara , Sri Lanka
| |
Collapse
|
37
|
Falahati M, Ghojoghi A, Abastabar M, Ghasemi Z, Farahyar S, Roudbary M, Hedayati MT, Armaki MT, Hoseinnejad A. The First Case of Total Dystrophic Onychomycosis Caused by Aspergillus clavatus Resistant to Antifungal Drugs. Mycopathologia 2015; 181:273-7. [PMID: 26474550 DOI: 10.1007/s11046-015-9954-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/04/2015] [Indexed: 10/22/2022]
Abstract
Onychomycosis is a common fungal infection of nails which is mainly caused by dermatophyte species and less often by yeasts and non-dermatophyte molds. We present a case of onychomycosis due to Aspergillus clavatus for the first time worldwide. The patient was an immunocompetent 32-year-old woman who identified with Psoriasis of the nail. The presence of A. clavatus in a nail sample was confirmed using microscopic and culture analysis followed by PCR of the β-tubulin gene. After antifungal susceptibility test, it is revealed that the isolate was resistant to the majority of common antifungal drugs, but finally the patient was treated with itraconazole 200 mg daily. A. clavatus and drug-resistant A. clavatus have not previously been reported from onychomycosis.
Collapse
Affiliation(s)
- Mehraban Falahati
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Ghojoghi
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abastabar
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran.
| | - Zeinab Ghasemi
- Department of Medical Mycology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Farahyar
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Roudbary
- Department of Medical Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Mojtaba Taghizadeh Armaki
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| | - Akbar Hoseinnejad
- Invasive Fungi Research Center (IFRC), Department of Medical Mycology and Parasitology, School of Medicine, Mazandaran University of Medical Sciences, P.O. Box 48175-1665, Sari, Iran
| |
Collapse
|
38
|
Tsunemi Y, Takehara K, Miura Y, Nakagami G, Sanada H, Kawashima M. Diagnosis of tinea pedis by the Dermatophyte Test Strip. Br J Dermatol 2015; 173:1323-4. [DOI: 10.1111/bjd.13978] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Y. Tsunemi
- Department of Dermatology; Tokyo Women's Medical University; 8-1 Kawada-cho Shinjuku-ku Tokyo 162-8666 Japan
| | - K. Takehara
- Department of Nursing Administration; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Y. Miura
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - G. Nakagami
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - H. Sanada
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - M. Kawashima
- Department of Dermatology; Tokyo Women's Medical University; 8-1 Kawada-cho Shinjuku-ku Tokyo 162-8666 Japan
| |
Collapse
|
39
|
Dolenc-Voljč M. Dermatophyte Infections in Humans: Current Trends and Future Prospects. Med Mycol 2015. [DOI: 10.1201/b18707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
40
|
Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2015; 171:937-58. [PMID: 25409999 DOI: 10.1111/bjd.13358] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 12/12/2022]
Affiliation(s)
- M Ameen
- Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, U.K
| | | | | | | | | |
Collapse
|
41
|
Gupta AK, Daigle D, Foley KA. Network Meta-Analysis of Onychomycosis Treatments. Skin Appendage Disord 2015; 1:74-81. [PMID: 27170937 DOI: 10.1159/000433473] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many onychomycosis treatments have not been directly compared in head-to-head clinical trials. OBJECTIVE To determine the relative efficacy of onychomycosis treatments using network meta-analysis (NMA). METHODS We conducted a systematic review and NMA of mycological cure rates. RESULTS Nineteen trials were included in the network. Terbinafine 250 mg was significantly superior to all treatments except itraconazole 400 mg pulse therapy. The itraconazole 400 mg pulse regimen was significantly superior to all topicals except efinaconazole 10% nail solution. Itraconazole 200 mg was significantly superior to all topical treatments, while fluconazole 150-450 mg, efinaconazole 10% nail solution, tavaborole 5% nail solution, ciclopirox nail lacquer 8%, terbinafine nail solution, and amorolfine 5% nail lacquer were significantly superior to placebo. CONCLUSIONS Newly developed topicals have improved the odds ratios (ORs) of mycological cure, yet these ORs were not significantly greater than preexisting topical treatments. Further experience with these agents will reveal their clinical significance, and head-to-head trials are warranted. © 2015 S. Karger AG, Basel.
Collapse
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, University of Toronto, Toronto, Ont., Canada; Mediprobe Research Inc., London, Ont., Canada
| | | | | |
Collapse
|
42
|
Martínez-Herrera EO, Arroyo-Camarena S, Tejada-García DL, Porras-López CF, Arenas R. Onychomycosis due to opportunistic molds. An Bras Dermatol 2015; 90:334-7. [PMID: 26131862 PMCID: PMC4516115 DOI: 10.1590/abd1806-4841.20153521] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 06/10/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Onychomycosis are caused by dermatophytes and Candida, but rarely by non-
dermatophyte molds. These opportunistic agents are filamentous fungi found as soil
and plant pathogens. OBJECTIVES: To determine the frequency of opportunistic molds in onychomycosis. METHODS: A retrospective analysis of 4,220 cases with onychomycosis, diagnosed in a
39-month period at the Institute of Dermatology and Skin surgery "Prof. Dr.
Fernando A. Cordero C." in Guatemala City, and confirmed with a positive KOH test
and culture. RESULTS: 32 cases (0.76%) of onychomycosis caused by opportunistic molds were confirmed.
The most affected age group ranged from 41 to 65 years (15 patients, 46.9%) and
females were more commonly affected (21 cases, 65.6%) than males. Lateral and
distal subungual onychomycosis (OSD-L) was detected in 20 cases (62.5%). The
microscopic examination with KOH showed filaments in 19 cases (59.4%),
dermatophytoma in 9 cases (28.1%), spores in 2 cases (6.25%),
and filaments and spores in 2 cases (6.25%). Etiologic agents: Aspergillus
sp., 11 cases (34.4%); Scopulariopsis
brevicaulis, 8 cases (25.0%); Cladosporium sp., 3
cases (9.4%); Acremonium sp., 2 cases (6.25%);
Paecilomyces sp., 2 cases (6.25%); Tritirachium
oryzae, 2 cases (6.25%); Fusarium sp.,
Phialophora sp., Rhizopus sp. and Alternaria
alternate, 1 case (3.1%) each. CONCLUSIONS: We found onychomycosis by opportunistic molds in 0.76% of the cases and DLSO was
present in 62.5%. The most frequent isolated etiological agents were:
Aspergillus sp. and Scopulariopsis
brevicaulis.
Collapse
Affiliation(s)
| | | | | | | | - Roberto Arenas
- 'Dr. Manuel Gea González' General Hospital, Mexico City, Mexico
| |
Collapse
|
43
|
Abstract
INTRODUCTION Onychomycosis is a fungal infection of the nail unit. Anatomical and physiological characteristics of the nail apparatus impose the need for long-term treatment to achieve complete cure. GOAL The main goal of this project is to study the effectiveness of several treatment protocols for onychomycosis based on Scoring Clinical Index for Onychomycosis (SCIO). MATERIAL AND METHODS The study included 133 patients with onychomycosis, diagnosed by KOH microscopy and culture. Based on disease severity, patients were grouped into groups with SCIO values: 6-9, and 12-16. These groups were randomly subdivided to 5 subgroups according to the given treatment protocols: fluconazole 150 mg 1x weekly, itraconazole continual therapy, itraconazole pulse therapy, terbinafine 250 mg/d, and terbinafine + ciclopirox 8% lacquer, respectively. The cure rate was evaluated at the end of 48 week. RESULTS The obtained cure rates according to the above mentioned protocols were: 92.30%, 81.81%, 83.33%, 90.90%, and 100%, respectively for groups of patients with SCIO values 6 - 9. Within patients with SCIO values 12-16, were achieved cure rates as follows: 78.57%, 78.57%, 75%, 80%, and 86.66%. CONCLUSIONS There was no statistically significant difference in cure rate between five treatment protocols applied in this study. In patients with high SCIO values is expected a decrease in cure rate.
Collapse
Affiliation(s)
| | - Ermira Vasili
- Clinic of Dermatology, UHC "Mother Teresa", Tirana, Albania
| |
Collapse
|
44
|
Kushwaha A, Murthy RN, Murthy SN, Elkeeb R, Hui X, Maibach HI. Emerging therapies for the treatment of ungual onychomycosis. Drug Dev Ind Pharm 2015; 41:1575-81. [PMID: 25997365 DOI: 10.3109/03639045.2015.1033426] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Onychomycosis, a common fungal infection in the finger and toe nails, affects approximately 2-8% of the worldwide population. Fungal infection is more complicated in those who suffer from conditions, such as diabetes, peripheral vascular diseases and compromised immune diseases. AREA COVERED Onychomycosis treatment has been classified on the basis of location of infection in the toes and fingers and infectious agents (dermatophytes fungi, yeast and non-dermatophyte molds). In this review, the available therapies (traditional and device based) and their limitations for the treatment of onychomycosis have been discussed. EXPERT OPINION The success rate with topical nail products has been minimal. The main reason for this poor success rate could be attributed to the lack of complete understanding of the pathophysiology of the disease and clinical pharmacokinetic data of drugs in the infected nail apparatus.
Collapse
Affiliation(s)
- Avadhesh Kushwaha
- a Institute for Drug Delivery and Biomedical Research , Bangalore , India .,b Department of Pharmaceutics , University of Mississippi, University , MS , USA , and
| | - Reena N Murthy
- a Institute for Drug Delivery and Biomedical Research , Bangalore , India
| | - S Narasimha Murthy
- a Institute for Drug Delivery and Biomedical Research , Bangalore , India .,b Department of Pharmaceutics , University of Mississippi, University , MS , USA , and
| | - Rania Elkeeb
- c Department of Dermatology , University of California , San Francisco , CA , USA
| | - X Hui
- c Department of Dermatology , University of California , San Francisco , CA , USA
| | - Howard I Maibach
- c Department of Dermatology , University of California , San Francisco , CA , USA
| |
Collapse
|
45
|
Jung MY, Shim JH, Lee JH, Lee JH, Yang JM, Lee DY, Jang KT, Lee NY, Lee JH, Park JH, Park KK. Comparison of diagnostic methods for onychomycosis, and proposal of a diagnostic algorithm. Clin Exp Dermatol 2015; 40:479-84. [DOI: 10.1111/ced.12593] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- M. Y. Jung
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J. H. Shim
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J. H. Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J. H. Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J. M. Yang
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - D.-Y. Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - K.-T. Jang
- Department of Pathology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - N. Y. Lee
- Laboratory Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J.-H. Lee
- Laboratory Medicine; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - J.-H. Park
- Department of Dermatology; Kangbuk Samsung Hospital; Seoul Korea
| | - K. K. Park
- Division of Dermatology; Loyola University Medical Center; Maywood IL USA
| |
Collapse
|
46
|
Gupta AK, Daigle D. Potential role of tavaborole for the treatment of onychomycosis. Future Microbiol 2014; 9:1243-50. [DOI: 10.2217/fmb.14.76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Systemic antifungal treatments are believed to be more effective than topicals for the treatment of onychomycosis; however, they are associated with more risks of adverse events. Tavaborole is the first member of a new class of antifungals that has been developed as a new topical nail solution for the treatment of toenail onychomycosis caused by dermatophytes. During Phase I–III clinical trials, tavaborole 5.0% nail solution showed a favorable safety and efficacy profile. Tavaborole 5.0% received US FDA market approval on 8 July 2014.
Collapse
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, University of Toronto, ON, Canada
- Mediprobe Research, Inc., London, ON, Canada
| | | |
Collapse
|
47
|
Miura Y, Takehara K, Nakagami G, Amemiya A, Kanazawa T, Kimura N, Kishi C, Koyano Y, Tamai N, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Screening for tinea unguium by thermography in older adults with subungual hyperkeratosis. Geriatr Gerontol Int 2014; 15:991-6. [DOI: 10.1111/ggi.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Yuka Miura
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Japan Society for the Promotion of Science; The University of Tokyo; Tokyo Japan
| | - Kimie Takehara
- Department of Nursing Administration; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Ayumi Amemiya
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Japan Society for the Promotion of Science; The University of Tokyo; Tokyo Japan
| | - Toshiki Kanazawa
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Nao Kimura
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Makoto Kawashima
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - Yuichiro Tsunemi
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| |
Collapse
|
48
|
Shemer A, Sakka N, Baran R, Scher R, Amichai B, Norman L, Farhi R, Magun R, Brazilai A, Daniel R. Clinical comparison and complete cure rates of terbinafine efficacy in affected onychomycotic toenails. J Eur Acad Dermatol Venereol 2014; 29:521-6. [DOI: 10.1111/jdv.12609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Shemer
- Department of Dermatology; Chaim Sheba Medical Center; Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - N. Sakka
- Department of Dermatology; Chaim Sheba Medical Center; Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - R. Baran
- Department of Dermatology; Nail Disease Centre; University of Franche-Comté; Cannes France
| | - R. Scher
- Department of Dermatology; College of Physicians and Surgeons Columbia University; New York NY USA
| | - B. Amichai
- Department of Dermatology; Meir Medical Center Kfar Saba; Tel Aviv University; Tel Aviv Israel
| | - L. Norman
- Tel Aviv University; Tel Aviv Israel
| | - R. Farhi
- Department of Dermatology; Faculdade Tecnico Educacional Souza Marques; Santa Casa da Misericordia do Rio de Janeiro; Rio de Janeiro Brazil
| | - R. Magun
- Department of Dermatology and Venereology; Faculty of Health Sciences; Soroka Medical Center; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - A. Brazilai
- Department of Dermatology; Chaim Sheba Medical Center; Sackler School of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - R. Daniel
- Department of Medicine (Dermatology); University of Mississippi; Oxford USA
- Department of Dermatology; University of Alabama Birmingham; Birmingham USA
| |
Collapse
|
49
|
Kawada A, Aragane Y, Tezuka T. Clinical and Pharmacokinetic Studies of Continuous Itraconazole for the Treatment of Onychomycosis. J Dermatol 2014; 31:104-8. [PMID: 15160863 DOI: 10.1111/j.1346-8138.2004.tb00516.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2003] [Accepted: 10/07/2003] [Indexed: 11/30/2022]
Abstract
Itraconazole, a triazole antifungal agent, has been widely used for onychomycosis with high cure rates. Unchanged itraconazole and a major metabolite hydroxy-itraconazole reach the nail with a strong affinity for keratin. The aim of this study was to elucidate clinical effectiveness and pharmacokinetic profiles of a 6-month continuous itraconazole treatment at a daily dose of 100 mg. Nail growth, the decrease in nail turbidity, and the nail concentrations of unchanged- and hydroxy-itraconazole were investigated. The affected nails we examined demonstrated nail growth proportional to the decrease in turbidity and a quick increase in drug concentration with a long duration of a high concentration after cessation. Our results support the hypothesis that this continuous therapy is a good modality for onychomycosis.
Collapse
Affiliation(s)
- Akira Kawada
- Department of Dermatology, Kinki University School of Medicine, Osaka-Sayama City, Japan
| | | | | |
Collapse
|
50
|
Chan HH, Wong ET, Yeung CK. Psychosocial perception of adults with onychomycosis: a blinded, controlled comparison of 1,017 adult Hong Kong residents with or without onychomycosis. Biopsychosoc Med 2014; 8:15. [PMID: 25057286 PMCID: PMC4107486 DOI: 10.1186/1751-0759-8-15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background A survey was conducted amongst 1,017 Hong Kong residents ages 18 and over to determine their knowledge of fungal nail infections (onychomycosis) and the psychosocial impact of the disease on the relationships, social lives and careers of sufferers. Methods The Fungal Nail Perception Survey was conducted by email and online between May 29th and June 10th, 2013. Participants were shown three photographs of people with and without onychomycosis of the toenails. Respondents were asked ten questions (repeated for each picture) to ascertain their perceptions of the people in the pictures. Questions were related to perceptions around the ability of sufferers and non-sufferers to form relationships with others, social activities of sufferers and non-sufferers, perceptions of the effect of the disease on the potential for career success, and awareness of fungal nail disease and health. The sub-population who themselves suffered from onychomycosis were asked about self-perception as well as their perception of others with onychomycosis. Results Compared with non-sufferers, survey respondents perceived those with onychomycosis as less likely to be able to form good relationships. They also indicated that they would be more likely to exclude sufferers than non-sufferers from social activities and that they would be more likely to feel uncomfortable when sitting or standing beside an infected person than beside an uninfected person. Respondents perceived people with onychomycosis to be less able to perform well in their chosen career than with someone without onychomycosis. Interestingly, those respondents who themselves were infected felt socially excluded, upset and embarrassed by their infection. Conclusions Onychomycosis may lead to stigmatization and social exclusion. Misconceptions of onychomycosis are high and education about the disease needs to be improved. Early recognition and treatment of the disease is essential to avoid complications and improve treatment outcomes, which would lead to reduced psychosocial impact on those with fungal nail infections.
Collapse
Affiliation(s)
- Henry Hl Chan
- Division of Dermatology, Department of Medicine, The University of Hong Kong, 4/F Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, Hong Kong
| | - Emma T Wong
- 4B, Valiant Commercial Building, 22-24 Prat Avenue, TsimShaTsui, Kowloon, Hong Kong
| | - Chi Keung Yeung
- Division of Dermatology, Department of Medicine, The University of Hong Kong, 4/F Professorial Block, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, Hong Kong
| |
Collapse
|