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Eijkenboom QL, Daxenberger F, Gust C, Hartmann D, Guertler A, Steckmeier S, Deussing M, French LE, Welzel J, Schuh S, Sattler EC. Line-field confocal optical coherence tomography, a novel non-invasive tool for the diagnosis of onychomycosis. J Dtsch Dermatol Ges 2024; 22:367-375. [PMID: 38279541 DOI: 10.1111/ddg.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND AND OBJECTIVES Onychomycosis is common and important to distinguish from other nail diseases. Rapid and accurate diagnosis is necessary for optimal patient treatment and outcome. Non-invasive diagnostic tools have increasing potential for nail diseases including onychomycosis. This study evaluated line-field confocal optical coherence tomography (LC-OCT) as a rapid non-invasive tool for diagnosing onychomycosis as compared to confocal laser scanning microscopy (CLSM), optical coherence tomography (OCT), and conventional methods. PATIENTS AND METHODS In this prospective study 86 patients with clinically suspected onychomycosis and 14 controls were examined using LC-OCT, OCT, and CLSM. KOH-preparation, fungal culture, PCR, and histopathology were used as comparative conventional methods. RESULTS LC-OCT had the highest sensitivity and negative predictive value of all methods used, closely followed by PCR and OCT. Specificity and positive predictive value of LC-OCT were as high as with CLSM, while OCT scored much lower. The gold standard technique, fungal culture, showed the lowest sensitivity and negative predictive value. Only PCR and culture allowed species differentiation. CONCLUSIONS LC-OCT enables quick and non-invasive detection of onychomycosis, with advantages over CLSM and OCT, and similar diagnostic accuracy to PCR but lacking species differentiation. For accurate nail examination, LC-OCT requires well-trained and experienced operators.
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Affiliation(s)
| | - Fabia Daxenberger
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Charlotte Gust
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Daniela Hartmann
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Stephanie Steckmeier
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Maximilian Deussing
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
| | - Lars Einar French
- Department of Dermatology and Allergy, LMU University Hospital, LMU, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, USA
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
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Eijkenboom QL, Daxenberger F, Gust C, Hartmann D, Guertler A, Steckmeier S, Deussing M, French LE, Welzel J, Schuh S, Sattler EC. Konfokale Line-Field optische Kohärenztomographie, ein innovatives nichtinvasives Instrument zur Diagnose der Onychomykose: Line-field confocal optical coherence tomography, a novel non-invasive tool for the diagnosis of onychomycosis. J Dtsch Dermatol Ges 2024; 22:367-376. [PMID: 38450988 DOI: 10.1111/ddg.15310_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/24/2023] [Indexed: 03/08/2024]
Abstract
ZusammenfassungHintergrund und ZieleOnychomykose ist weit verbreitet und sollte von anderen Nagelerkrankungen unterschieden werden. Eine rasche und genaue Diagnostik ist für die optimale Behandlung des Patienten und ein bestmögliches Ergebnis erforderlich. Nichtinvasive Techniken haben ein wachsendes Potenzial bei der Diagnose von Nagelerkrankungen, einschließlich Onychomykose. In dieser Studie wurde die konfokale Line‐Field optische Kohärenztomographie (LC‐OCT) als schnelle nichtinvasive Methode zur Diagnose von Onychomykose im Vergleich zur konfokalen Laserscanmikroskopie (KLM), optischen Kohärenztomographie (OCT) und konventionellen Methoden bewertet.Patienten und MethodikIn dieser prospektiven Studie wurden 86 Patienten mit klinischem Verdacht auf Onychomykose und 14 Kontrollen mittels LC‐OCT, OCT und KLM untersucht. KOH‐Präparation, Pilzkultur, PCR und Histopathologie wurden als vergleichende konventionelle Methoden eingesetzt.ErgebnisseLC‐OCT hatte die höchste Sensitivität und den höchsten negativen Vorhersagewert aller verwendeten Methoden, dicht gefolgt von PCR und OCT. Die Spezifität und der positive Vorhersagewert der LC‐OCT waren genauso hoch wie bei der KLM, während OCT deutlich schlechter abschnitt. Das Goldstandardverfahren Pilzkultur zeigte die geringste Sensitivität und den niedrigsten negativen Vorhersagewert. Nur PCR und Kultur ermöglichten eine Differenzierung der Pilzspezies.SchlussfolgerungenLC‐OCT ermöglicht eine schnelle und nichtinvasive Diagnostik von Onychomykose, mit Vorteilen gegenüber KLM und OCT und ähnlicher diagnostischer Genauigkeit wie die PCR, aber ohne Differenzierung der Pilzarten. Für eine genaue Nageluntersuchung erfordert die LC‐OCT gut geschulte und erfahrene Anwender.
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Affiliation(s)
| | - Fabia Daxenberger
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Charlotte Gust
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Daniela Hartmann
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Anne Guertler
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Stephanie Steckmeier
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Maximilian Deussing
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
| | - Lars Einar French
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, USA
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Sandra Schuh
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Elke Christina Sattler
- Klinik und Poliklinik für Dermatologie und Allergologie der LMU München, München, Deutschland
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Khan SS, Hay RJ, Saunte DML. A Review of Antifungal Susceptibility Testing for Dermatophyte Fungi and It's Correlation with Previous Exposure and Clinical Responses. J Fungi (Basel) 2022; 8:jof8121290. [PMID: 36547624 PMCID: PMC9785514 DOI: 10.3390/jof8121290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: An increase in the number of recurrent and recalcitrant dermatophytoses calls for a tool to guide the clinician to correlate in vitro minimum inhibitory concentration (MIC) data, antifungal treatment with clinical outcomes. This systematic review aims to explore a possible correlation between one aspect of this, previous antifungal exposure, and clinical outcomes. Methods: A systematic literature search for articles on previous antifungal treatment, treatment outcome, susceptibility methods used, organism (genus/species), and MIC values was conducted. Results: A total of 720 records were identified of which 19 articles met the inclusion criteria. Forty percent of the cases had contact with or travel to India, 28% originated from or had traveled to other countries where treatment unresponsive tinea infections had been reported. Tinea corporis was the most common clinical presentation and the species involved were Trichophyton (T.) indotineae and T. rubrum, followed by T. mentagrophyte/interdigitale complex and T. tonsurans. Nearly all patients had previously been exposed to one or more antifungals. The studies were too heterogeneous to perform a statistical analysis to test if previous antifungal exposure was related to resistance. Conclusions: Only a few studies were identified, which had both sufficient and robust data on in vitro susceptibility testing and clinical treatment failure. Further research on the value of susceptibility testing to improve clinical practice in the management of dermatophyte infections is needed.
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Affiliation(s)
- Sidra Saleem Khan
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Roderick James Hay
- St. John’s Institute of Dermatology, King’s College London, London SE1 9RT, UK
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital, DK-4000 Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, DK-1350 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-47322600; Fax: +45-47322698
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Puri V, Froelich A, Shah P, Pringle S, Chen K, Michniak-Kohn B. Quality by Design Guided Development of Polymeric Nanospheres of Terbinafine Hydrochloride for Topical Treatment of Onychomycosis Using a Nano-Gel Formulation. Pharmaceutics 2022; 14:pharmaceutics14102170. [PMID: 36297605 PMCID: PMC9611585 DOI: 10.3390/pharmaceutics14102170] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/29/2022] [Accepted: 10/07/2022] [Indexed: 11/28/2022] Open
Abstract
Superficial fungal diseases of the skin and nails are an increasingly common occurrence globally, requiring effective topical treatment to avoid systemic adverse effects. Polymeric nanoparticles have demonstrated sustained and effective drug delivery in a variety of topical formulations. The aim of this project was to develop polymeric antifungal nanospheres containing terbinafine hydrochloride (TBH) to be loaded into a hydrogel formulation for topical nail drug delivery. A quality by design (QbD) approach was used to achieve optimized particles with the desired quality target product profile (QTPP). Polyvinyl alcohol (PVA) at 2% w/v and a drug to polymer ratio of 1:4, together with a robust set of processes and material attributes, resulted in nanoparticles of 108.7 nm with a polydispersity index (PDI) of 0.63, 57.43% recovery, and other desirable characteristics such as zeta potential (ZP), particle shape, aggregation, etc. The nanospheres were incorporated into a carbomer-based gel, and the delivery of TBH through this formulation was evaluated by means of in vitro drug release testing (IVRT) and ex vivo nail permeation study. The gel containing the TBH nanospheres demonstrated a slower and controlled drug release profile compared with the control gel, in addition to a more efficient delivery into the nail. These antifungal nanospheres can be utilized for topical therapy of a multitude of superficial fungal infections.
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Affiliation(s)
- Vinam Puri
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08855, USA
- Center for Dermal Research, Life Science Building, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Anna Froelich
- Chair and Department of Pharmaceutical Technology, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland
| | - Parinbhai Shah
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08855, USA
- Center for Dermal Research, Life Science Building, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Shernelle Pringle
- Department of Biomedical Sciences, School of Graduate Studies, Rutgers, The State University of New Jersey, Piscataway, NJ 08855, USA
| | - Kevin Chen
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08855, USA
- Center for Dermal Research, Life Science Building, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
| | - Bozena Michniak-Kohn
- Department of Pharmaceutics, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, NJ 08855, USA
- Center for Dermal Research, Life Science Building, Rutgers, The State University of New Jersey, Piscataway, NJ 08854, USA
- Correspondence: ; Tel.: +1-(848)-445-3589
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Preliminary Evidence of the Efficacy of Nitric Acid Treatment in Onychomycosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413371. [PMID: 34948980 PMCID: PMC8706868 DOI: 10.3390/ijerph182413371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022]
Abstract
Onychomycosis is the main cause of toenail disorders and is produced by a fungal infection. It is becoming more prevalent because of new lifestyles and immunosuppression statuses. The therapeutic approach to onychomycosis is under considerable study because of the lengthy treatments that require strong patient commitment, the limited efficacy of treatments, the inclusion of active substances that can be hepatotoxic and cause pharmacological interactions, and/or the questionable efficacy of treatments due to a lack of clinical trials. This study responds to the demand for rapid treatment with minimal pharmacological interactions. Methods: The efficacy of nitric acid 60% treatment in patients with onychomycosis was monitored and studied. The antifungal efficacy of nitric acid was measured by microbiological culture before and after treatment and the clinical evolution of nail dystrophy was quantitatively measured by monitoring with the Onychomycosis Severity Index (OSI). Results: The results show that, with the protocol used, nitric acid 60% painlessly cured 40% (microbiologic cure) of the cases treated, and in all cases, clinical improvement was observed (p = 0.011). Conclusions: The treatment with nitric acid 60% is as efficient as conventional treatments, requires less patient compliance of the treatment and produces no pharmacological interactions, providing alternative treatment in the case of hepatotoxicity.
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Gupta AK, Venkataraman M, Quinlan EM, Gupta MA, Anbalagan N, Lyons R. More than Nail Deep: The Effect of Efinaconazole 10% Treatment on the Quality of Life in Patients with Onychomycosis: A post hoc Study. Skin Appendage Disord 2021; 7:272-279. [PMID: 34307474 PMCID: PMC8280442 DOI: 10.1159/000514361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Onychomycosis is a common, difficult-to-treat fungal nail infection. Clinical signs include nail discoloration and thickening, which patients often find embarrassing, causing a negative impact on their quality of life (QOL). METHODS In this post hoc study, we analyze the effect of efinaconazole 10% solution on a patient's QOL using patient-reported scores from the OnyCOE-t™ questionnaire (appearance, stigma, physical problems, symptom frequency, symptom bothersomeness, treatment satisfaction, and overall problem). Higher scores corresponded to better functioning, thus higher QOL. RESULTS Efinaconazole 10% treatment and clinical efficacy were positively correlated with improved QOL in all domains for all groups, except with symptom bothersomeness (how much the onychomycosis symptoms worried or concerned the patient) for female patients <40 years. While still showing improvement in most domains during efficacious treatment, female and younger patients reported lower QOL scores than their male and older counterparts, despite having better clinical outcomes at follow-ups. DISCUSSION Female and younger patients appear to be more emotionally bothered by their symptoms, regardless of treatment success or improvement of their nail's appearance, suggesting that onychomycosis is more than nail deep and has a greater psychological effect on these patients. Therefore, younger female patients may require more assurance and mental support.
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Affiliation(s)
- Aditya K. Gupta
- Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Mediprobe Research Inc., London, Ontario, Canada
| | | | | | - Madhulika A. Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Rachel Lyons
- Ortho-Dermatologics, Bridgewater, New Jersey, USA
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Translation and Cross-Cultural Adaptation of Quality of Life Scale in Patients with Onychomycosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115793. [PMID: 34071246 PMCID: PMC8198911 DOI: 10.3390/ijerph18115793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Onychomycosis (OM) is a fungal nail infection, considered a risk factor for diabetic foot ulcers. It is associated with changes in quality of life, in terms of pain, self-confidence and self-esteem. The aim was to translate and adapt the OM quality of life questionnaire "OnyCOE-tTM-Quality Of Life Questionnaire Onychomycosis (Nail Fungal Condition)". (2) Methods: This study followed the guidelines proposed by Beaton et al. (2000), where two English to Portuguese translations were performed and, after an expert consensus, a common version was obtained. This was followed by two back-translations. The expert committee achieved semantic equivalence, idioms and concepts. The pre-test was applied to 49 people. The final version and processed data were sent to the authors. (3) Results: We adapted terms semantically, modified statements syntactically, altering items from interrogative to affirmative. (4) Conclusions: The translated version of the "Quality of life-Onychomycosis" questionnaire suggested that it can be used for further studies to test validity and reliability in this population.
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Bowornsathitchai N, Thammahong A, Shoosanglertwijit J, Kitsongsermthon J, Wititsuwannakul J, Asawanonda P, Boontaveeyuwat E. Methylene blue-mediated photodynamic therapy may be superior to 5% amorolfine nail lacquer for non-dermatophyte onychomycosis. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:183-191. [PMID: 33145834 DOI: 10.1111/phpp.12624] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/15/2020] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Methylene blue-mediated photodynamic therapy as an antimicrobial has been reported to improve onychomycosis. OBJECTIVES To compare the short-term efficacy of methylene blue-mediated photodynamic therapy (MB-PDT) and 5% amorolfine nail lacquer (AMO) for toenail onychomycosis using higher intensity and shorter total treatment period than previously reported. METHODS Twenty-seven toenails with onychomycosis were randomized to receive either six biweekly sessions of MB-PDT or AMO for twelve weeks. Dermoscopic photography was used for onychomycosis severity index assessment under a dermoscopic inspection (d-OSI) at baseline, weeks 6, 10, 14 and 22 as well as microscopic and microbiological tests. Adverse events were recorded. RESULTS All subjects completed the study. Causative organisms found were exclusively non-dermatophytes including Fusarium spp., Asperillus spp.,and yeasts. Fifteen toenails received MB-PDT, whilst 12 received AMO. D-OSI showed greater improvement in MB-PDT than in AMO groups at weeks 6, 10, 14 as well as 22, with median changes of -2, -3, -4 (P = .055). and - 3 respectively in the MB-PDT group. The AMO group displayed the median d-OSI change of 0 throughout the study period. Mycological cure rate at 22 weeks in MB-PDT and AMO group was 73.3% and 66.67% (P > .05). Clinical cure rate at 22 weeks in MB-PDT (26.7%) was higher than AMO (16.7%), (P > .05). All patients only felt comfortably warm during the MB-PDT treatment. No major adverse events were found in both groups. CONCLUSIONS MB-PDT appeared to be more efficacious for non-dermatophyte onychomycosis than AMO particularly in a limited period and moderately severe onychomycosis.
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Affiliation(s)
- Natthamon Bowornsathitchai
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Arsa Thammahong
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jittida Shoosanglertwijit
- Department of Manufacturing Pharmacy, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Jutarat Kitsongsermthon
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Jade Wititsuwannakul
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pravit Asawanonda
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Einapak Boontaveeyuwat
- Photodermatology Unit, Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Leung AKC, Lam JM, Leong KF, Hon KL, Barankin B, Leung AAM, Wong AHC. Onychomycosis: An Updated Review. ACTA ACUST UNITED AC 2020; 14:32-45. [PMID: 31738146 PMCID: PMC7509699 DOI: 10.2174/1872213x13666191026090713] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
Abstract
Background: Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results: Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use.Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Shatin, Hong Kong
| | | | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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Urban K, Chu S, Scheufele C, Giesey RL, Mehrmal S, Uppal P, Delost GR. The global, regional, and national burden of fungal skin diseases in 195 countries and territories: A cross-sectional analysis from the Global Burden of Disease Study 2017. JAAD Int 2020; 2:22-27. [PMID: 34409349 PMCID: PMC8362308 DOI: 10.1016/j.jdin.2020.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2020] [Indexed: 10/24/2022] Open
Abstract
Introduction Fungal skin diseases are highly prevalent worldwide, but few existing studies focus on the burden of dermatomycoses. Methods An analysis of fungal skin disease trends in 2017 in 195 countries worldwide was conducted using the Global Burden of Disease Study database, including prevalence rates, age and sex patterns, and fungal burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017. Results The age-specific fungal skin disease DALYs in 2017 showed a right-skewed distribution, with a peak between 1 and 5 years of age. The world region with the greatest burden of fungal skin disease was sub-Saharan Africa (DALY rate 89.3 per 100,000 males, 78.42 for females), and the individual country with the greatest DALY rate was Mali (122). The Global Burden of Disease super region with the lowest fungal skin disease burden had high incomes (DALY rate 33.12 per 100,000 males, 30.16 for females), which includes southern Latin America, western Europe, high-income North America, Australasia, and high-income southern Pacific. Conclusion Skin mycoses place a substantial burden on patients worldwide. This burden is the greatest in resource-poor countries, tropical regions, and children between 1 and 5 years of age. DALYs can potentially serve as a purposeful measure for directing health policy resources to improve the global impact of fungal skin disease.
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Affiliation(s)
- Katelyn Urban
- Lake Erie College of Osteopathic Medicine, Greensburg, Pennsylvania
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific-Northwest, Lebanon, Oregon
| | - Christian Scheufele
- Cutaneous oncology fellow, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Rachel L Giesey
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Sino Mehrmal
- Department of Internal Medicine, Alameda Health System - Highland Hospital, Oakland, California
| | - Prabhdeep Uppal
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.,Department of Family Medicine, Christiana Care Health System, Newark, Delaware
| | - Gregory R Delost
- Apex Dermatology and Skin Surgery Center, Mayfield Heights, Ohio.,Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania
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Martucci J, Vlahovic TC. Perceptions Surrounding Onychomycosis in the Health Professions Student Population: The Disease, Treatments, and Quality of Life. J Am Podiatr Med Assoc 2020; 110:447711. [PMID: 33179067 DOI: 10.7547/18-071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Discolored toenails is a common complaint presented to podiatric physicians, dermatologists, and primary-care physicians. Although various local and systemic conditions influence changes in nails, nearly 50% is due to fungal infections. We surveyed the health professions student population to gain insight into how future medical professionals may approach this condition and to explore perceptions of onychomycosis, treatments, and effects on quality of life. METHODS The primary outcome measure was a self-reported online Google Forms survey developed by the authors and sent to podiatric, allopathic, and osteopathic medical students and nursing students in Philadelphia, Pennsylvania. RESULTS Of the 245 respondents, 92% agreed that toenail fungus is both a health and a cosmetic concern. Seventy-seven percent of respondents said "yes" when asked if they would seek treatment, and 67% would wait 1 month to 1 year to see a medical professional. When seeking treatment, 57% reported that they would see a primary-care physician initially, and 27% and 5% would seek care from a podiatric physician or dermatologist, respectively. A total of 91% would spend up to $300 annually for treatment, with only 4% willing to spend more than $500 per year. Respondents' greatest concern would be physical appearance. CONCLUSIONS Although agreement exists among the health professions students surveyed that toenail fungus presents both a cosmetic and a health concern, inconsistencies regarding time to treatment, treating professional, and effects on quality of life persist. It is not reasonable for all medical professionals to effectively recognize and treat nail disease, but it is paramount that patients are directed to medical professionals who can accurately exclude other conditions to alleviate social and financial burdens patients may face due to onychomycosis.
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Mavrogiorgou P, Mersmann C, Gerlach G, Herpertz S, Juckel G. Skin Diseases in Patients with Primary Psychiatric Disorders. Psychiatry Investig 2020; 17:157-162. [PMID: 32093459 PMCID: PMC7046994 DOI: 10.30773/pi.2019.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The few psychodermatological studies of primary psychiatric populations so far suggest that parasitic-infectious skin diseases are the most common dermatological comorbidity in more than 70% of psychiatric patients, which should be studied here in a large data bank outside dermatological treatment facilities. METHODS In a descriptive-explorative and retrospective study, more than 17,000 patients with primary psychiatric disorders were examined to investigate dermatological comorbidities. RESULTS The proportion of patients with primary mental disorders and additional dermatological disease was 1.24% (n=212). Here, psoriasis (35.4%) and atopic dermatitis (22.6%) were the most frequent dermatological diseases among these 212 patients. Infectious-parasitic skin diseases were present in 13.2% of comorbid patients. The most common mental disorder was a depressive illness, seen in 42.5% (n=90) of patients. CONCLUSION Our results confirmed the frequent association of depression with psoriasis and atopic dermatitis, indicating the need for the early detection and treatment of such comorbid patients. In contrast, psychiatric inpatients do not appear to suffer from predominantly infectious-parasitic dermatoses.
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Affiliation(s)
- Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Corinna Mersmann
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Gabriele Gerlach
- Department of Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-Universitätsklinikum, Bochum, Germany
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Gregoriou S, Mpali N, Vrioni G, Hatzidimitriou E, Chryssou SE, Rigopoulos D. Epidemiology of Onychomycosis in an Academic Nail Unit in South Greece during a Three-Year Period. Skin Appendage Disord 2019; 6:102-107. [PMID: 32258053 DOI: 10.1159/000504812] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Background Onychomycosis is the most common disease of the nails. Objective This retrospective study aimed at evaluating the epidemiology of onychomycosis in adult patients in South Greece during the 2015-2017 period. Material and Methods A total of 3,226 patients with clinical signs of possible onychomycosis were included. Diagnosis was confirmed by microscopy with KOH 20% and by culture in Sabouraud agar with and without actidione. Results Diagnosis of onychomycosis was confirmed in 27.99% of the patients. Men were infected more often (40.04%) than women (23.30%). Toenails (68.77%) were infected more than fingernails (31.23%) in both sexes. Onychomycosis in fingernails was more common among women (39.74%) than men (18.51%). Men were more often diagnosed with onychomycosis in toenails (81.49%) than women (60.26%). Dermatophytes were the most frequently isolated fungi (34.11%), followed by Candida(29.79%) and non-dermatophyte molds (NDM) (7.20%). In fingernails, the most frequently isolated fungus was Candida spp. (84.04%), followed by dermatophytes (3.55%) and NDM (0.71%). In toenails, dermatophytes (47.99%) were more commonly identified, followed by NDM (10.14%) and Candida spp. (5.15%). Conclusion Onychomycosis in Greece follows a pattern of higher incidence in males, with toenails more frequently infected with T. rubrum and fingernails more frequently infected with C. albicans in the present era.
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Affiliation(s)
- Stamatios Gregoriou
- National and Kapodistrian University of Athens 1st Department of Dermatology and Venereology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Nikoletta Mpali
- National and Kapodistrian University of Athens 1st Department of Dermatology and Venereology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Georgia Vrioni
- National and Kapodistrian University of Athens 1st Department of Dermatology and Venereology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece.,Department of Microbiology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Eleni Hatzidimitriou
- National and Kapodistrian University of Athens 1st Department of Dermatology and Venereology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Stella-Eugenia Chryssou
- Department of Microbiology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Dimitrios Rigopoulos
- National and Kapodistrian University of Athens 1st Department of Dermatology and Venereology, A. Sygros Hospital for Skin and Venereal Diseases, Athens, Greece
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Abstract
Onychomycosis is a common disorder that is difficult to cure. Prevalence is lower in children (0.7%), but athletes are 2.5-fold more likely to develop the disease, with infections of the toenails seven times more prevalent than those of the fingernails. This is a concern for athletes as it can interfere with their performance. The risk of developing onychomycosis is increased by the warm environment of many sports activities; the use of occlusive footwear; the warm, moist environment associated with socks and sweating; shared, close quarters among athletes; and trauma to the foot and toenail. Once infected, onychomycosis treatment requires a long duration of treatment with strict compliance, a potential problem for younger patients. Treatment carries the risk of significant side effects, and recurrence rates remain high. Avoiding infection can be a potent first line of defense and may circumvent the need for treatment. Preventive recommendations such as keeping toenails short and proper washing of laundry, to name a few, can be effective and are discussed here. Technological improvements such as synthetic, moisture-wicking socks and well-ventilated, mesh shoes have also been shown to reduce moisture and injury. Education about preventing fungal spread and improving hygiene in the locker room, gym, and pool are of critical importance. This overview of onychomycosis focuses primarily on the preventive measures and innovative changes in athletic gear. It also provides a compact step-by-step guide to prevention intended to be useful for both the general public and the professional. It can be reproduced to use as a handout for athletes, trainers, and coaches.
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Nweze EI, Eke IE. Dermatophytes and dermatophytosis in the eastern and southern parts of Africa. Med Mycol 2018; 56:13-28. [PMID: 28419352 DOI: 10.1093/mmy/myx025] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 01/04/2017] [Indexed: 01/16/2023] Open
Abstract
Dermatophytosis is currently a disease of global importance and a public health burden. It is caused by dermatophytes, which attack and grow on dead animal keratin. Dermatophytes belong to three genera, namely, Epidermophyton, Microsporum, and Trichophyton. The predominant clinical forms and causative agents vary from one region of the world to another. Poor socioeconomic status, high population densities, and poor sanitary conditions are some of the factors responsible for the high prevalence of dermatophytosis in many developing countries, which include countries in southern and eastern Africa, the focus of this review. To the best of our knowledge, there is currently no review article on published findings on dermatophytosis in the eastern and southern parts of Africa. This information will be of interest to the medical and research community since the world has become a global village. This review covers published research findings in eastern and southern regions of Africa until this date. The countries covered in the current review include Kenya, Ethiopia, Tanzania, South Africa, Mozambique, Madagascar, Malawi, Rwanda, Burundi, Uganda, Zambia, Zimbabwe, and Botswana. T. violaceum is the most common human etiological agent in all the countries under review with prevalence ranging from 56.7% to 95%, except for Madagascar (M. langeronii, reclassified as M. audouinii), Uganda (M. gypseum) and Malawi (M. audouinii). Tinea capitis was the most clinical type, followed by tinea corporis. Etiological agents of animal dermatophytoses were variable in the countries where they were reported. Major risk factors for dermatophytoses are age, climatic, and socioeconomic factors.
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Affiliation(s)
- E I Nweze
- Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - I E Eke
- Department of Microbiology, University of Nigeria, Nsukka, Enugu State, Nigeria
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Gupta AK, Mays RR. The Impact of Onychomycosis on Quality of Life: A Systematic Review of the Available Literature. Skin Appendage Disord 2018; 4:208-216. [PMID: 30410887 DOI: 10.1159/000485632] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/23/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Onychomycosis is a nail disorder that is increasing in prevalence worldwide. The psychological and social limitations caused by onychomycosis can potentially undermine the work and social lives of those experiencing these negative effects. This review aimed to evaluate the randomized controlled trials (RCTs) available in the current literature on the impact onychomycosis has on quality of life (QoL). Methods A systematic review was performed using the databases PubMed, PsycINFO, Scopus, ClinicalTrials.gov, and Cochrane Library on July 18, 2017. Only RCTs with clinical effects described in English were included for review. Results Ten RCTs reported QoL outcomes for patients suffering from onychomycosis. Treatment satisfaction was statistically significant from baseline to end of treatment in 100.0% (4/4) measures which reported on satisfaction with treatment; mental health was also significant in 100.0% (3/3), symptoms index rating in 100.0% (2/2), symptom frequency in 75.0% (3/4), overall problems in 75.0% (3/4), functional activities in 75.0% (6/8), appearance problems in 66.7% (2/3), symptom distress in 57.1% (4/7), and stigma in 40.0% (2/5). The OnyCOE-tTM and the NailQoL were the most used common outcome measures to describe QoL. Conclusion The study sanctions that onychomycosis physically and psychologically distresses patients' lives. Further research should include validated outcome measures to more effectively treat onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada.,Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada
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Piraccini BM, Starace M, Toft A. Early Visible Improvements during K101-03 Treatment: An Open-Label Multicenter Clinical Investigation in Patients with Onychomycosis and/or Nail Psoriasis. Dermatology 2017; 233:178-183. [PMID: 28787710 DOI: 10.1159/000478257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/02/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Onychomycosis and nail psoriasis can be embarrassing to patients, so improving the appearance of affected nails should be one of the key short-term goals of treatment. METHODS An 8-week open-label multicenter study was conducted to assess whether K101-03, a marketed topical treatment containing propylene glycol, glycerol, urea, and lactic acid, could produce rapid cosmetic improvements in affected nails. Adult patients with a big toenail or thumbnail (the "target" nail) affected by onychomycosis (n = 72) or psoriasis (n = 34) or both (n = 1) applied K101-03 to their affected nails once a day for 8 weeks. During and after treatment, patients rated the overall appearance of their target nail on a 4-point scale. They also assessed whether thickening, discoloration, brittleness, and softness of the target nail had improved since baseline. Adverse events (AEs) that occurred between the first application of K101-03 and the end of treatment were recorded and categorized according to severity and relationship to K101-03. RESULTS After 8 weeks of K101-03 treatment, 92.2% of patients (95% confidence interval [CI] 87.06-97.40) reported at least some improvement in the target nail. After 1 week of treatment, 78.3% of patients with onychomycosis (95% CI 68.53-87.99) reported at least some improvement in the target nail, and 55.1% of them reported that discoloration of their target nail had improved. Three patients reported a total of 5 AEs, none of which were judged to be related to K101-03. CONCLUSIONS In summary, K101-03 was well tolerated in patients with onychomycosis or nail psoriasis and rapidly improved their nails.
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Affiliation(s)
- Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Università di Bologna, Bologna, Italy
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Sigurgeirsson B, Ghannoum MA, Osman‐Ponchet H, Kerrouche N, Sidou F. Application of cosmetic nail varnish does not affect the antifungal efficacy of amorolfine 5% nail lacquer in the treatment of distal subungual toenail onychomycosis: results of a randomised active‐controlled study and
in vitro
assays. Mycoses 2016; 59:319-26. [DOI: 10.1111/myc.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/15/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - M. A. Ghannoum
- Center for Medical Mycology University Hospitals of Cleveland/Case Western Reserve University Cleveland OH USA
| | | | | | - F. Sidou
- Galderma R & D SNC Sophia Antipolis France
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Ghannoum M, Sevin K, Sarkany M. Amorolfine 5% Nail Lacquer Exhibits Potent Antifungal Activity Compared to Three Acid-Based Devices Indicated for the Treatment of Onychomycosis: An In Vitro Nail Penetration Assay. Dermatol Ther (Heidelb) 2016; 6:69-75. [PMID: 26833478 PMCID: PMC4799031 DOI: 10.1007/s13555-016-0093-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Onychomycosis is the most common infectious disease involving nails. The aim of this study was to evaluate the antifungal activity of amorolfine 5% nail lacquer and three different acid-based medical devices indicated in the treatment of onychomycosis using an in vitro nail penetration assay. Methods Four products were tested in vitro: (a) amorolfine 5% nail lacquer; (b) ethyl lactate and acetic acid; (c) citric acid and urea; (d) ethyl lactate, glycerin, lactic acid, and citric acid. Test products were applied to healthy human cadaver nails and allowed to dry. Disks were cut from each piece of nail and placed on seeded agar plates of Trichophyton rubrum. Following incubation at 30 °C, zones of inhibition were measured. Results Amorolfine-treated nails exhibited inhibitory activity against T. rubrum with a mean zone of inhibition of 59.2 mm in diameter. In contrast, all three acid-based medical devices and the untreated controls showed no zones of inhibition (mean effective zones of 0 mm). Conclusion In this in vitro nail penetration model, head-on, comparative study, we showed that amorolfine 5% nail lacquer possesses potent antifungal activity, whereas no antifungal activity was detected for three commercially available acid-based medical devices under identical assay conditions. Funding Galderma. Electronic supplementary material The online version of this article (doi:10.1007/s13555-016-0093-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mahmoud Ghannoum
- Center for Medical Mycology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH, USA.
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Lipner SR, Scher RK. Efinaconazole 10% topical solution for the topical treatment of onychomycosis of the toenail. Expert Rev Clin Pharmacol 2015; 8:719-31. [PMID: 26325488 DOI: 10.1586/17512433.2015.1083418] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Efinaconazole 10% topical solution is a new antifungal therapy for the topical treatment of mild to moderate toenail onychomycosis. In vitro and in vivo data have shown significant antifungal activity against dermatophytes, Candida spp. and nondermatophyte molds, and its mechanism of action is through inhibition of fungal lanosterol 14α-demethylase. In two parallel, double-blind, randomized, controlled, Phase III trials, complete cure rates were 17.8 and 15.2%, respectively, and mycological cure rates were 55.2 and 53.4%, respectively, for efinaconazole 10% topical solution, which were superior to vehicle, with minimal adverse events. This drug profile reviews the most recent basic science and clinical data for efinaconazole in the treatment of toenail onychomycosis.
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Affiliation(s)
| | - Richard K Scher
- a Department of Dermatology, Weill Cornell Medical College , NY, USA
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Abstract
Efinaconazole 10% topical solution is a new triazole recently approved for the treatment of onychomycosis. It inhibits fungal lanosterol 14α-demethylase in the ergosterol biosynthesis pathway, has potent antifungal activity against dermatophytes, as well as activity against Candida spp. and non-dermatophyte molds, and showed promising results in clinical trials. This review summarizes the mechanism of action, in vitro and in vivo data, clinical trials, safety, and quality-of-life data of efinaconazole as it applies to the treatment of onychomycosis.
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Affiliation(s)
- Shari R Lipner
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
| | - Richard K Scher
- Department of Dermatology, Weill Cornell Medical College, New York, NY, USA
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Gupta AK, Paquet M. A retrospective chart review of the clinical efficacy of Nd:YAG 1064-nm laser for toenail onychomycosis. J DERMATOL TREAT 2014; 26:376-8. [DOI: 10.3109/09546634.2014.975671] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gupta AK, Simpson FC. Efinaconazole (Jublia) for the treatment of onychomycosis. Expert Rev Anti Infect Ther 2014; 12:743-52. [DOI: 10.1586/14787210.2014.919852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc.,
645 Windermere Rd., London, ON, Canada
- Department of Medicine, University of Toronto,
Toronto, ON, Canada
| | - Fiona C Simpson
- Mediprobe Research Inc.,
645 Windermere Rd., London, ON, Canada
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