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Eftekhari H, Haghdar Saheli Y, Ashoobi MT, Mahjoob M, Kazemnezhad Leyli E, Bagheri Toolaroud P. The prevalence of onychomycosis in patients with chronic renal failure undergoing dialysis: A cross-sectional study. Heliyon 2024; 10:e25737. [PMID: 38434055 PMCID: PMC10906168 DOI: 10.1016/j.heliyon.2024.e25737] [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: 07/03/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Onychomycosis is one of the most common cutaneous symptoms in patients with chronic renal failure. In the present study, we aimed to investigate the prevalence and determine the factors likely associated with developing onychomycosis among dialysis patients. This cross-sectional study was conducted between 2022 and 2023 with 312 chronic renal failure patients undergoing dialysis visiting the dialysis departments of Guilan University of Medical Sciences. Participants were selected by consecutive sampling method. A dermatologist subjected the patients to a detailed clinical assessment of the fingernails and toenails to find evidence of Onychomycosis. Periodic acid-Schiff (PAS) staining was performed in case of suspicion of Onychomycosis. A total of 312 inpatients were investigated during the time frame of the present study. Among study patients, 62.5% were male, the average age of the patients was 59.3 ± 13.9 years, and the mean duration of dialysis was 37.5 ± 38.5 months. A total of 12.8% (n = 40) of patients undergoing dialysis had Onychomycosis. Diabetes mellitus was present in 37.5% of dialysis patients. Diabetes and Onychomycosis were significantly associated, so the prevalence rate of Onychomycosis in diabetic patients was almost twice that of non-diabetic patients (17.9% vs. 9.7%; P < 0.001). Logistic regression analysis revealed that age, sex, education level, and type of dialysis access were the predictors of Onychomycosis development. Onychomycosis puts people at risk for more severe infections, including erysipelas, cellulitis, and amputations; thus, dialysis patients need to learn how to take care of their toenails properly.
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Affiliation(s)
- Hojat Eftekhari
- Skin Research Center, Department of Dermatology, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yalda Haghdar Saheli
- Department of Internal Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Taghi Ashoobi
- Razi Clinical Research Development Unit, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Mahsa Mahjoob
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leyli
- Department of Biostatistics, School of Health, Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Parissa Bagheri Toolaroud
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
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2
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Borba OSM, Ogawa MM, Kirsztajn GM, Tomimori J. Onychomycosis in immunocompromised population: Phenotypic and molecular identification. Mycoses 2023; 66:1018-1024. [PMID: 37488648 DOI: 10.1111/myc.13634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Abstract
Onychomycosis is common among immunosuppressed individuals. Renal transplant recipients (RTR) and lupus nephritis (LN) patients are submitted to corticosteroid and other immunosuppressive therapy; and diabetes mellitus (DM) patients are intrinsically immunocompromised. OBJECTIVES The aim of this study was to characterise and identify fungal infections on the nails (feet and hands) in immunocompromised patients. METHODS The clinical material, nail scales (foot and/or hand), was collected from 47 RTR, 66 LN, 67 DM, and 78 immunocompetent individuals (control group). Phenotypic and molecular analyses were performed. RESULTS A total of 258 patients were examined. There was a female predominance, except in the RTR. The average age was 52 years old. Lateral distal subungual onychomycosis (OSDL) (75.2%), mainly affecting the hallux nail, was frequent. The predominance of dermatophyte on toenails and Candida species on fingernails was statistically significant. A higher frequency of fingernail involvement in LN and DM, and for LN, the difference was significant (p = .0456). Infections by Candida spp. were more frequent in DM. Using molecular methods, 87.2% of diagnoses were confirmed, identifying fungal agents at the species level. Dermatophytes, Trichophyton rubrum and Trichophyton interdigitale and the species of Candida, C. parapsilosis and C. albicans, were the most frequent fungal agents. CONCLUSIONS Molecular techniques (sequencing of ITS regions of rDNA) offer greater accuracy, although there is no difference, regarding the detection. Clinical presentation and fungal species may differ somewhat from the general population. Immunosuppression did not increase fungal detection positivity.
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Affiliation(s)
- Orion Sant'Anna Motter Borba
- Program in Translational Medicine, Department of Medicine, Laboratory of Cellular Biology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marilia Marufuji Ogawa
- Department of Dermatology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gianna Mastroianni Kirsztajn
- Discipline of Nephrology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jane Tomimori
- Department of Dermatology, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
Changes in nail color can provide important clues of underlying systemic and skin disease. In particular, white discoloration (leukonychia) has a high prevalence with a wide array of potential relevant causes, from simple manicure habits to life-threatening liver or kidney failure. Therefore, a reliable assessment of the patient with leukonychia is essential. In the past, two classifications for leukonychia have been presented. The morphological classifies the nail according to the distribution of the white lines: total, partial, transversal, and longitudinal leukonychia. Mees’ and Muehrcke’s lines are examples of transversal leukonychia, while Terry’s and Lindsay’s nails are examples of total and partial leukonychia. The anatomical classifies according to the structure responsible for the white color: the nail plate in true leukonychia, the nail bed in apparent leukonychia, and the surface only in pseudoleukonychia. In this review, both morphological and anatomical features have been combined in an algorithm that enables clinicians to approach leukonychia efficiently and effectively.
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Kentley J, Allawh R, Rao S, Doyle A, Ahmad A, Nadhan K, Proby C, Harwood CA, Chung CL. The burden of cutaneous disease in solid organ transplant recipients of color. Am J Transplant 2021; 21:1215-1226. [PMID: 32659869 DOI: 10.1111/ajt.16210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTRs) are at increased risk of cutaneous malignancy. Skin disorders in OTRs of color (OTRoC) have rarely been systematically assessed. We aimed to ascertain the burden of skin disease encountered in OTRoC by prospectively collecting data from OTRs attending 2 posttransplant skin surveillance clinics: 1 in London, UK and 1 in Philadelphia, USA. Retrospective review of all dermatological diagnoses was performed. Data from 1766 OTRs were analyzed: 1024 (58%) white, 376 (21%) black, 261 (15%) Asian, 57 (3%) Middle Eastern/Mediterranean (ME/M), and 48 (2.7%) Hispanic; and 1128 (64%) male. Viral infections affected 45.1% of OTRs, and were more common in white and ME/M patients (P < .001). Fungal infections affected 28.1% and were more common in ME/M patients (P < .001). Inflammatory skin disease affected 24.5%, and was most common in black patients (P < .001). In addition, 26.4% of patients developed skin cancer. There was an increased risk of skin cancer in white vs nonwhite OTRs (HR 4.4, 95% CI 3.5-5.7, P < .001): keratinocyte cancers were more common in white OTRs (P < .001) and Kaposi sarcoma was more common in black OTRs (P < .001). These data support the need for programs that promote targeted dermatology surveillance for all OTRs, regardless of race/ethnicity or country of origin.
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Affiliation(s)
- Jonathan Kentley
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - Rina Allawh
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
| | - Swati Rao
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Alden Doyle
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Amar Ahmad
- Department of Cancer Intelligence, Cancer Research UK, London, UK
| | - Kumar Nadhan
- Department of Dermatology, John H Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Charlotte Proby
- Jacqui Wood Cancer Centre, School of Medicine, University of Dundee, Dundee, UK
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, UK.,Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Christina L Chung
- Montgomery Dermatology, Lankenau Institute for Medical Research, King of Prussia, Wynnewood, Pennsylvania, USA
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Kanitakis J, Petruzzo P, Baran R, Gazarian A, Badet L, Morelon E. Nail changes in upper extremity allotransplantation: onychomadesis as the presenting sign of allograft rejection - a retrospective study. Transpl Int 2020; 33:1274-1281. [PMID: 32621769 DOI: 10.1111/tri.13689] [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] [Received: 04/21/2020] [Revised: 06/03/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
Upper extremity allotransplantation (UEA) is the more common type of vascularized composite allotransplantation of which more than 80 patients have benefited worldwide. These allografts include - along with the skin - the nail unit, a specialized epithelial appendage which may be the target of graft rejection. We report an UEA recipient who developed, as an initial manifestation of graft rejection, onychomadesis, that is shedding of the nail plate starting from the proximal nail bed. On this occasion, we reviewed the nail changes we have observed in a series of eight patients with UEA who were grafted and followed in our hospital since 1998 (mean follow-up period of 9.75 years). We also reviewed the relevant literature reporting nail changes in UEA recipients. A brief discussion on the significance of these changes in the context of UEA is provided with emphasis on onychomadesis, a finding usually related to graft rejection in this specific setting.
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Affiliation(s)
- Jean Kanitakis
- Department of Dermatology, Edouard Herriot Hospital Group, Lyon cedex 03, France
| | | | | | | | - Lionel Badet
- Department of Transplantation Surgery, Edouard Herriot Hospital Group, Lyon cedex 03, France
| | - Emmanuel Morelon
- Department of Transplantation Immunology, Edouard Herriot Hospital Group, Lyon cedex 03, France
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6
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Zarei F, Hashemi SJ, Salehi M, Mahmoudi S, Zibafar E, Ahmadinejad Z, Rahimi Foroushani A, Ardi P, Daie Ghazvini R. Molecular characterization of fungi causing colonization and infection in organ transplant recipients: A one-year prospective study. Curr Med Mycol 2020; 6:30-35. [PMID: 32420505 PMCID: PMC7217253 DOI: 10.18502/cmm.6.1.2505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: Organ transplant recipients are vulnerable to fungal infections. The aim of this study was to determine the prevalence of fungal colonization and infections among patients who underwent various transplantations and molecularly characterize the etiological agents. Materials and Methods: This study was conducted on candidates for transplantation in Imam Khomeini Hospital, Tehran, Iran, from April 2017 to April 2018. All patients were monitored for fungal colonization or infections before and after transplantation. Isolated fungi were identified using molecular methods. Results: A total of 125 patients, including 86 males and 39 females, with the mean age of 52.2 years participated in the study (age range: 15-75 years). Out of 125 patients, 84 (67.2%) cases had fungal colonization that appeared pre- and post-transplantation in 21 and 63 cases, respectively (alone or concurrent with another infection in 55 and 29 cases, respectively). In addition, a total of 39 episodes of fungal infections were diagnosed in 36 (28.8%) recipients (alone or concurrent with colonization in 7 and 29 cases, respectively). Out of the 39 fungal infections, 9 cases appeared pre-transplantation, while the other 30 cases occurred post-transplantation. However, no fungal colonization or infection was observed in 34 (27.2%) patients. Oral candidiasis (n=20) was the most common type of infection, followed by funguria (n=7), onychomycosis (n=5), candidemia (n=3), rhinocerebral mucormycosis (n=1), cutaneous mucormycosis (n=1), cutaneous aspergillosis (n=1), and peritonitis (n=1). Six yeast species were recovered from colonization cases with the dominance of Candida albicans both before and after transplantation. The observed fungal infections were caused by 11 distinct species, including the members of Candida (i.e., C. albicans, C. glabrata, C. parapsilosis, C. tropicalis, and C. krusei), Aspergillus (i.e., A. oryzae and A. candidus), Rhizopus (i.e., R. oryzae and R. microsporus), Trichosporon asahii, and Trichophyton interdigitale. The results also indicated that the development of a fungal infection post-transplantation was associated with fungal colonization (r=0.0184; P=0.043). Conclusion: Based on the results, fungal colonization was a common finding in transplant recipients at Imam Khomeini Hospital. However, the incidence of fungal infections was comparable with those of other centers. As the oral cavity was the most common site of colonization and infection, it might be beneficial to take further care about the oral health of patients using effective mouthwash.
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Affiliation(s)
- Fereshteh Zarei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Salehi
- Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Mahmoudi
- Department of Medical Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ensieh Zibafar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ahmadinejad
- Liver Transplantation Research Center, Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Ardi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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7
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Gursu M, Uzun S, Topcuoğlu D, Koc LK, Yucel L, Sumnu A, Cebeci E, Ozkan O, Behlul A, Koc L, Ozturk S, Kazancioglu R. Skin disorders in peritoneal dialysis patients: An underdiagnosed subject. World J Nephrol 2016; 5:372-377. [PMID: 27458566 PMCID: PMC4936344 DOI: 10.5527/wjn.v5.i4.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/02/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit.
METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis.
RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using.
CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked.
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8
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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.
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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
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9
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Abstract
INTRODUCTION Onychomycosis causes approximately one-half of all nail disorders and its prevalence has been steadily increasing. It is difficult to treat, partly due to the subungual location and the inability of both oral and topical antifungals to reach the site of infection. Published cure rates with oral drugs are < 50% and even lower with topical drugs. Pathogenic factors include the diversity of fungal organisms and the difficulty of drugs penetrating the nail plate. Tavaborole is a broad-spectrum oxaborole antifungal agent with low molecular weight, permitting optimal nail plate penetration. In vitro and ex vivo studies have demonstrated the superior nail-penetrating properties of tavaborole compared to existing topical antifungal medications approved for the treatment of onychomycosis. AREAS COVERED The clinical characteristics and prevalence of onychomycosis, currently available treatments, and the chemistry, safety and pharmacokinetic properties of tavaborole for the treatment of onychomycosis. EXPERT OPINION Tavaborole is a novel, topical antifungal pharmaceutical agent pending FDA approval for the treatment of toenail onychomycosis due to dermatophytes. Efficacy has been demonstrated by a clinical development program including in vitro data and two large Phase III trials that enrolled ∼ 1200 patients. When approved, tavaborole topical solution, 5% may become a safe and effective option for the treatment of onychomycosis.
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Affiliation(s)
- Boni E Elewski
- University of Alabama, Department of Dermatology , EFH 414, 1530 3rd Avenue South, Birmingham, AL 35294-0009 , USA +1 205 934 5188 ;
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10
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Anbar T, Hay RA, Abdel-Rahman AT, Moftah NH, Al-Khayyat MA. Clinical study of nail changes in vitiligo. J Cosmet Dermatol 2013; 12:67-72. [PMID: 23438144 DOI: 10.1111/jocd.12022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
Abstract
Both vitiligo and alopecia areata (AA) are associated together, associated with other autoimmune diseases, and autoimmunity is one of the important theories in their etiology. Nail changes are a known association with AA, thus we hypothesized that nail changes can be found in vitiligo patients. On revising the literature, only two types of nail changes were described in association with vitiligo. Our aim was to study the frequency and types of nail changes among vitiligo patients in comparison with normal healthy volunteers. This multi-centric study was carried on 91 patients with vitiligo, as well as 91 normal healthy control subjects who were age- and sex-matched. Nails were examined for changes in nail plates as regards striations, texture, curvature, dystrophy, and pigmentation. The presence or absence of the thumb lunula was also reported. Nail changes were observed in 62 patients (68.1%) and 46 (50.5%) control subjects with a statistically significant difference (P = 0.016). Longitudinal ridging and absent lunula were significantly higher in patients than in the controls (P = 0.001 and 0.037, respectively). Other reported nail abnormalities in the current study included punctate leukonychia, pitting, flag sign, and Terry's nails. Awareness of this association will widen the clinician's perspective to carefully examine the nail changes in vitiligo patients and conversely examine patients with nail changes for vitiligo.
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Affiliation(s)
- Tag Anbar
- Dermatology Department, Al-Minya University, Al-Minya, Egypt.
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11
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Irimie M, Tătaru A, Oantă A, Moga M. In vitrosusceptibility of dermatophytes isolated from patients with end-stage renal disease: a case-control study. Mycoses 2013; 57:129-34. [DOI: 10.1111/myc.12114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Marius Irimie
- Department of Dermatology; Transilvania University; Brasov Romania
| | - Alexandru Tătaru
- Department of Dermatology; University of Medicine and Pharmacy; Cluj-Napoca Romania
| | - Alexandru Oantă
- Department of Dermatology; Transilvania University; Brasov Romania
| | - Marius Moga
- Department of Gynecology; Transilvania University; Brasov Romania
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12
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Abstract
Device-based therapies are the most rapidly expanding area of onychomycosis treatment. Traditional pharmacotherapy of onychomycosis has a low to moderate efficacy and is associated with adverse reactions and drug interactions that limit its use in many patients. These new therapies include laser systems, photodynamic therapy, iontophoresis, and ultrasound. Device-based therapies are procedures conducted in the clinic by a trained professional, which mitigates the requirement for long-term patient compliance. In addition, the drug component of these therapies is topical, preventing the adverse events associated with systemic antifungal administration, and potentially allowing for the treatment of individuals who were previously excluded due to drug interactions. Device-based therapy is a nascent field, so clinical data is still in an emergent stage; however, preliminary clinical trials of laser, photodynamic therapy, and iontophoresis suggest that some devices may have a degree of efficacy. More studies are required to better determine their ability to treat onychomycosis.
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13
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Cheng CY, Lin BYJ, Chang KH, Shu KH, Wu MJ. Awareness of Memory Impairment Increases the Adherence to Immunosuppressants in Kidney Transplant Recipients. Transplant Proc 2012; 44:746-8. [PMID: 22483484 DOI: 10.1016/j.transproceed.2011.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C-Y Cheng
- Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
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14
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Magagnin CM, Stopiglia CDO, Vieira FJ, Heidrich D, Machado M, Vetoratto G, Lamb FM, Scroferneker ML. Antifungal susceptibility of dermatophytes isolated from patients with chronic renal failure. An Bras Dermatol 2012; 86:694-701. [PMID: 21987135 DOI: 10.1590/s0365-05962011000400011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 09/17/2010] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The prevalence of dermatophytosis in the general population is high, particularly in patients with chronic renal failure. Treatment requires the use of topical and/or systemic antifungal drugs. The efficacy of antifungal agents for the treatment of dermatophytosis has yet to be evaluated. Studies evaluating the in vitro activity of antifungal agents are rare, particularly in filamentous fungi. OBJECTIVE To evaluate the susceptibility profile of different species of dermatophytes isolated from patients with chronic renal failure to nine antifungal drugs available on the market for the treatment of dermatophytosis. METHODS Twenty-six isolates of dermatophytes obtained from patients with chronic renal failure were analyzed with respect to their susceptibility to nine antifungal agents (ketoconazole, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, miconazole, piroctone olamine, terbinafine and tioconazole), using the broth microdilution method proposed by the Clinical and Laboratory Standards Institute (CLSI) and adapted for dermatophytes. RESULTS Of the antifungal agents tested, the best results in terms of sensitivity were found with terbinafine and tioconazole, while the antifungal activity of fluconazole was found to be weak, particularly against strains of M. gypseum. Ciclopirox olamine, although less effective than terbinafine, also yielded satisfactory results. CONCLUSIONS In general, the sensitivity profile of the antifungal agents tested in this study was similar to results obtained in previous studies, confirming the need to determine which species is causing the dermatophytosis given that antifungal susceptibility varies from one species to another. Furthermore, the present findings show the importance of conducting in vitro sensitivity tests, since the sensitivity profile may differ among isolates of the same species.
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15
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Romero FA, Deziel PJ, Razonable RR. Majocchi's granuloma in solid organ transplant recipients. Transpl Infect Dis 2011; 13:424-32. [PMID: 21272168 DOI: 10.1111/j.1399-3062.2010.00596.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Superficial fungal infections are fairly prevalent in transplant recipients and the incidence increases with more intense graft-conserving immunosuppressive therapy. Majocchi's granuloma is a deep folliculitis caused by dermatophytes that involves deeper layers of the dermis. Only a few case reports of the condition have been documented in transplant recipients. After an extensive review of the medical literature, 21 cases were retrieved and are summarized here, together with a new case that occurred in a recent heart transplant recipient from our institution. This report aims to provide a comprehensive analysis of Majocchi's granuloma in solid organ transplant (SOT) recipients, with special focus on potential risk factors, offending pathogens, clinical presentation, therapeutic approaches, and outcome. General observations are presented emphasizing the relevance of close clinical and dermatologic follow-up in high-risk SOT patients with specific comments regarding treatment regimens and outcomes.
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Affiliation(s)
- F A Romero
- Division of Infectious Diseases and the William J von Liebig Transplant Center, Mayo Clinic, Rochester, Minnesota 55905, USA
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