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Chen B, Zhang J, Li J, Qian Y, Huang B, Wu X. Comparative Transcriptome Analysis of T. rubrum, T. mentagrophytes, and M. gypseum Dermatophyte Biofilms in Response to Photodynamic Therapy. Mycopathologia 2024; 189:59. [PMID: 38890181 DOI: 10.1007/s11046-024-00865-y] [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: 12/12/2023] [Accepted: 05/16/2024] [Indexed: 06/20/2024]
Abstract
Dermatophyte biofilms frequently count for inadequate responses and resistance to standard antifungal treatments, resulting in refractory chronic onychomycosis infection. Although antimicrobial photodynamic therapy (aPDT) has clinically proven to exert significant antifungal effects or even capable of eradicating dermatophyte biofilms, considerably less is known about the molecular mechanisms underlying aPDT and the potential dysregulation of signaling networks that could antagonize its action. The aim of this study is to elucidate the molecular mechanisms underlining aPDT combat against dermatophyte biofilm in recalcitrant onychomycosis and to decipher the potential detoxification processes elicited by aPDT, facilitating the development of more effective photodynamic interventions. We applied genome-wide comparative transcriptome analysis to investigate how aPDT disrupting onychomycosis biofilm formed by three distinct dermatophytes, including Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum gypseum, the most frequently occurring pathogenic species. In total, 352.13 Gb of clean data were obtained for the transcriptomes of dermatophyte biofilms with or without aPDT treatment, resulting in 2,422.42 million reads with GC content of 51.84%, covering 99.9%, 98.5% and 99.4% of annotated genes of T. rubrum, T. mentagrophytes, and M. gypseum, respectively. The genome-wide orthologous analysis identified 6624 transcribed single-copy orthologous genes in all three species, and 36.5%, 6.8% and 17.9% of which were differentially expressed following aPDT treatment. Integrative orthology analysis demonstrated the upregulation of oxidoreductase activities is a highly conserved detoxification signaling alteration in response to aPDT across all investigated dermatophyte biofilms. This study provided new insights into the molecular mechanisms underneath anti-dermatophyte biofilm effects of aPDT and successfully identified a conserved detoxification regulation upon the aPDT application.
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Affiliation(s)
- Borui Chen
- Dermatology Institute of Fuzhou, Dermatology Hospital of Fuzhou, Xihong Road 243, Fuzhou, 350025, China
- Department of Dermatology, First Hospital and Research Center for Medical Mycology, Peking University, Beijing, 100034, China
| | - Jinyan Zhang
- Department of Dermatology, First Hospital and Research Center for Medical Mycology, Peking University, Beijing, 100034, China
- Department of Dermatology, Fujian Provincial Geriatric Hospital, Fuzhou, 350025, China
| | - Juanjuan Li
- Dermatology Institute of Fuzhou, Dermatology Hospital of Fuzhou, Xihong Road 243, Fuzhou, 350025, China
| | - Yuwen Qian
- Fujun Genetics Technologies Company Limited, Fuzhou, 350003, China
| | - Binbin Huang
- Dermatology Institute of Fuzhou, Dermatology Hospital of Fuzhou, Xihong Road 243, Fuzhou, 350025, China
| | - Xiaomo Wu
- Dermatology Institute of Fuzhou, Dermatology Hospital of Fuzhou, Xihong Road 243, Fuzhou, 350025, China.
- Department of Biomedicine, University of Basel, Klingelbergstrass 70, 4056, Basel, Switzerland.
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Gómez C, Alberdi E. [Translated article] Fractional Laser for Ablative Resurfacing in Onychomycosis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T221-T223. [PMID: 38224733 DOI: 10.1016/j.ad.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/30/2023] [Indexed: 01/17/2024] Open
Affiliation(s)
- C Gómez
- Instituto de Química Física Blas Cabrera, CSIC, Madrid, Spain.
| | - E Alberdi
- Clínica privada Dr. Alberdi, Madrid, Spain
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Gómez C, Alberdi E. Fractional Laser for Ablative Resurfacing in Onychomycosis. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:221-223. [PMID: 37852370 DOI: 10.1016/j.ad.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- C Gómez
- Instituto de Química Física Blas Cabrera, CSIC, Madrid, España.
| | - E Alberdi
- Clínica privada Dr. Alberdi, Madrid, España
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Gómez C, Schuele G, Alberdi E. Medium-term antifungal effects of methylene blue versus flavin mononucleotide in the treatment of moderate toenail onychomycosis. Mycoses 2024; 67:e13661. [PMID: 37840157 DOI: 10.1111/myc.13661] [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: 09/04/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Methylene blue (MB) and flavin mononucleotide (FMN)-mediated photodynamic therapy (PDT) have demonstrated local antimicrobial effect, but no direct comparative study has been published so far for the treatment of toenail onychomycosis. OBJECTIVES To directly compare the short and medium-term efficacy of MB versus FMN as photosensitizers in PDT for toenail onychomycosis by applying them in a 40% w/w urea cream in two different dye concentrations. METHODS Forty toenails with distal and lateral subungual moderate onychomycosis due to dermatophyte fungi were randomised to receive 10 weekly sessions of PDT mediated by four topical formulations including MB or FMN at two different concentrations: Group I: 0.1% w/w MB; Group II: 2% w/w MB; Group III: 0.1% w/w FMN; and Group IV: 2% w/w FMN. Photographs were used for onychomycosis severity index (OSI) estimation allowing clinical assessment at any point of the study. Microscopic and microbiological evaluations were carried out at baseline, 27- and 35-week follow-ups. Side effects were recorded along with patient satisfaction. RESULTS At week 27, mycological cure rates were 60%, 30%, 50% and 40% and complete cure rates were 0%, 20%, 10% and 20%, for Groups I, II, III and IV respectively. At week 35, mycological cure rates were 70%, 70%, 70% and 60% and complete cure rates were 30%, 50%, 70% and 30%, for Groups I, II, III and IV respectively. All cream formulations were safe and patients were fairly satisfied. CONCLUSIONS Results of the present work confirm PDT as a therapeutic alternative for onychomycosis. Although all cream formulations were safe and effective, with a good degree of satisfaction, higher cure rates were obtained with 2% w/w MB cream and 0.1% w/w FMN cream.
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Affiliation(s)
- Clara Gómez
- Institute of Physical Chemistry Blas Cabrera, CSIC, Madrid, Spain
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Yazdanpanah S, Jabrodini A, Motamedi M, Zomorodian K, Kharazi M, Shabanzadeh S, Ghasemi F, Shariat S, Rezaei Arab M. Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species. Antonie Van Leeuwenhoek 2023; 117:6. [PMID: 38153531 DOI: 10.1007/s10482-023-01914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 12/29/2023]
Abstract
Candida onychomycosis is a common fungal infection affecting the nails, primarily caused by Candida (C.) species. Regarding the increasing trend of Candida onychomycosis and the antifungal resistant phenomenon in recent years, this study aims to evaluate the epidemiological characteristics of Candida onychomycosis, the distribution of emerging species, and the antifungal susceptibility profiles of isolates. Onychomycosis caused by yeast species was confirmed through direct examination and culture of nail scraping among all individuals suspected to have onychomycosis and referred to a medical mycology laboratory between June 2019 and March 2022. Species of yeast isolates were identified using the multiplex PCR and PCR-RFLP methods. The antifungal susceptibility of isolates to common antifungal agents and imidazole drugs was evaluated according to the M-27-A3 CLSI protocol. Among 101 yeast strains isolated from onychomycosis, Candida parapsilosis complex (50.49%) was the most common species, followed by C. albicans (20.79%) and C. tropicalis (10.89%). Rare species of yeasts such as C. guilliermondii and Saccharomyces cerevisiae were also identified by molecular methods. Results obtained from antifungal susceptibility testing showed significant differences in MIC values of isoconazole, fenticonazole, and sertaconazole among different species. Overall, a fluconazole-resistant rate of 3% was found among Candida species. Moreover, there was a statistically significant difference in MICs of fenticonazole and clotrimazole between the two most prevalent causative species, C. parapsilosis complex and C. albicans. Correct identification of the causative agents of onychomycosis and performing susceptibility testing could be helpful in choosing the most appropriate antifungal therapy.
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Affiliation(s)
- Somayeh Yazdanpanah
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Jabrodini
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Kamiar Zomorodian
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahboobeh Kharazi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shafigheh Shabanzadeh
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnia Ghasemi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sahar Shariat
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Rezaei Arab
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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6
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Lee SK, Kim HY, Lee JH, Lee UH, Kim MS. Real-world Effectiveness of a Fractional CO 2 Laser with Topical Antifungal Agents for the Treatment of Onychomycosis. Dermatol Ther 2022; 35:e15498. [PMID: 35388594 DOI: 10.1111/dth.15498] [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: 11/28/2021] [Revised: 02/14/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current therapeutic agents for onychomycosis have limited efficacy or cause side effects. Recently, successful treatment using fractional CO2 lasers has been reported; however, the results are inconsistent. OBJECTIVE We analyzed the real-world effectiveness of a Fractional CO2 laser for the treatment of Onychomycosis METHODS: A single-center retrospective chart review was conducted during January 2015-December 2018. Patients, diagnosed with onychomycosis through fungal culture and/or potassium hydroxide staining, underwent three or more fractional CO2 laser treatments and used topical antifungal agents. Treatment effects were assessed by using clinical images at 6 months, 12 months, and the last visit. RESULTS Ninety-six patients were included; they underwent an average of 7.7 laser treatment sessions. Finally, 15 patents (15.6%) showed complete response (CR, 100% clearing of all nails), 24 patients (25%) showed partial response, and 57 patients (59.4%) showed no response (no 100% clearing of nails among all treated toenails per patient including mild improvement or temporary cosmetic improvement). Multivariable logistic regression analysis revealed longer disease duration (P=0.006, OR=1.16(95% CI: 1.05-1.31)), patients with diabetes (P=0.021, OR=9.82(95% CI:1.75-94.01)) and fewer number of laser treatment sessions (P=0.001, OR=0.76(95% CI:0.64-0.89)) were significantly associated with non-response group. CONCLUSIONS In conclusion, fractional CO2 laser with topical antifungal could be a safe alternative treatment in patients with onychomycosis, who are difficult to take oral antifungals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Soo Kyung Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
| | - Ho Young Kim
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
| | - Jae Ho Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
| | - Un Ha Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
| | - Myoung Shin Kim
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul
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Pakshir K, Kamali M, Nouraei H, Zomorodian K, Motamedi M, Mahmoodi M. Molecular characterization and antifungal activity against non-dermatophyte molds causing onychomycosis. Sci Rep 2021; 11:20736. [PMID: 34671053 PMCID: PMC8528813 DOI: 10.1038/s41598-021-00104-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
Onychomycosis is a fungal disease that caused by different types of fungi. Non-dermatophyte molds are a large saprophytic fungi group that live in nature and could affect traumatic nails. The aim of this study was to identify non-dermatophyte molds causing onychomycosis and evaluation of several antifungal activities against the isolates. The samples consisted of 50 non-dermatophyte molds isolated from patients with onychomycosis confirmed by direct and culture examination fungal. DNA was extracted, amplified, and sequenced. Disk diffusion method was used to evaluate itraconazole, fluconazole, ketoconazole, terbinafine, posaconazole, and econazole activity against the isolates. The species identified as: Aspergillus flavus 22 (44%), A. niger 12 (24%), A. fumigates, 3 (6%), A. sydowii 3 (6%), A. terreus 1 (2%), Penicillium commune 2 (4%), P. glabrum 2 (4%), P. chrysogenum, 1 (2%), Fusarium solani 3 (6%) and F. thapsinum 1 (2%). Most of the samples were sensitive to terbinafine, itraconazole, and econazole and 94% of the isolates were resistant to fluconazole. This study showed that Aspergillus species were the most common cause of non-dermatophyte mold onychomycosis and fluconazole was the most resistant antifungals. Care must be taken to choose the appropriate antifungal drug for a better cure.
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Affiliation(s)
- Keyvan Pakshir
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. .,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mandana Kamali
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hasti Nouraei
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Mahmoodi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ferrusquia-Toriz D, Hernández-Díaz C, Amezcua-Guerra LM, Ventura-Ríos L, Higuera-Ortiz V, Lozada-Navarro AC, Silveira LH. Ultrasound characterization of the nail bed in patients with systemic lupus erythematosus. Lupus 2021; 30:608-614. [PMID: 33470159 DOI: 10.1177/0961203320988609] [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: 11/16/2022]
Abstract
OBJECTIVE To characterize the ultrasound findings of the nail plate and nail bed in systemic lupus erythematosus (SLE) and its association with nail dystrophy. METHODS Thirty-two SLE patients, 36 patients with osteoarthritis (OA) and 20 healthy individuals were studied. High-frequency linear ultrasound was performed in nails of the second to fifth fingers in all participants. Disease activity (SLEDAI-2K index), accrued organ damage (SLICC/ACR index), autoantibody profile, and Raynaud's phenomenon were also assessed in SLE patients. RESULTS Nail bed thickness in SLE patients was higher than in healthy individuals (1.25 ± 0.31 mm vs 1.17 ± 0.29 mm; P = 0.01) but lower than in OA (1.39 ± 0.37 mm; P < 0.001), while nail plate thickness was similar among groups. Nail dystrophy was found more frequently in SLE and OA than in healthy individuals. SLE patients with nail dystrophy were older than their counterparts with no dystrophy (39.4 ± 10.4 years vs 27.8 ± 5.6 years; P = 0.004), although nail dystrophy showed no association with SLICC/ACR, SLEDAI-2K, nail bed vascularity, or autoantibodies. CONCLUSIONS Nail bed in SLE patients is thicker than in healthy individuals but thinner than in OA patients. Nail dystrophy in SLE is associated with advanced age, but not with accrued organ damage, disease activity, Raynaud's phenomenon, or DIP synovitis assessed by ultrasound.
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Affiliation(s)
| | - Cristina Hernández-Díaz
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Lucio Ventura-Ríos
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Violeta Higuera-Ortiz
- Department of Rheumatology, The American British Cowdray Hospital, Mexico City, Mexico.,Department of Rheumatology, General Hospital No. 8, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ana C Lozada-Navarro
- Internal Medicine, Hospital Faro del Mayab/Christus Muguerza, Mérida Yucatán, Mexico
| | - Luis H Silveira
- Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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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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Shemer A, Daniel R, Kassem R, Geffen Y, Galili E. Cold sub-atmospheric and atmospheric pressure plasma for the treatment of Trichophyton rubrum onychomycosis: An in-vitro study. Dermatol Ther 2020; 33:e14084. [PMID: 32729232 DOI: 10.1111/dth.14084] [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: 07/11/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Previous studies have suggested the applicability of cold atmospheric pressure plasma for the treatment of onychomycosis. Whether delivering cold plasma in sub-atmospheric pressure would be beneficial for this purpose is yet to be established. The current study aimed to evaluate efficacy of cold sub-atmospheric and atmospheric pressure plasma in Trichophyton rubrum growth inhibition. Bovine nails infected with T. rubrum were treated by a cold air plasma device, which enables utilizing plasma in sub-atmospheric pressures (Low = 100 millibar; High = 300 millibar) or atmospheric pressure. The infected foci were exposed to the plasma source directly or indirectly. Treatment with high sub-atmospheric pressure setting achieved T. rubrum growth reduction of 94.0% and 73.0%, for direct and indirect exposure to the plasma source, respectively (P < .001). Low sub-atmospheric pressure setting achieved similar T. rubrum growth reduction of 86.2% for direct exposure to the plasma source (P < .001), but only marginally significant 58.8% reduction rate for indirect exposure to the plasma source (P = .056). None statistically significant fungal growth reduction was attained with the use of atmospheric pressure setting. Cold plasma was shown to effectively inhibit T. rubrum nail growth, with sub-atmospheric pressure setting achieving better outcome than atmospheric pressure.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA.,University of Alabama, Birmingham, Alabama, USA
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Geffen
- Department of Clinical Microbiology, Rambam Medical Center, Haifa, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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11
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Shemer A, Daniel R, Lyakhovitsky A, Aghion-Svirsky V, Kassem R, Rigopoulos D, Farhi R, Galili E. Clinical significance of Candida isolation from dystrophic fingernails. Mycoses 2020; 63:964-969. [PMID: 32563206 DOI: 10.1111/myc.13133] [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: 05/05/2020] [Revised: 06/06/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Candida onychomycosis mostly involves fingernails. Yet, in contrast to dermatophytes, Candida isolation from dystrophic fingernails does not prove casualty, as sample contamination and non-pathogenic Candida growth occur. Characterising treatment outcome of Candida-positive dystrophic nails is crucial to avoid unnecessary treatment. OBJECTIVE To investigate predicators associated with treatment outcome among Candida-positive dystrophic fingernails. PATIENTS AND METHODS A retrospective cohort study was carried out among 108 adults with Candida-positive dystrophic fingernails not cured with adequate systemic anti-fungal course. Diagnosis was based on a single mycological culture. Patients with treatment failure (n = 85; 78.7% of the cases) were compared to patients with partial response (mild to almost cure; n = 23; 21.3% of the cases) at 9 to 12 months following treatment initiation. RESULTS Treatment failure was significantly associated with primary onycholysis (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.1-7.4) and prolonged dystrophy (12.8 vs. 3.7 years in average), compared to partial treatment response. Non-responders had lower odds to present with distal lateral subungual onychomycosis, compared to partial responders (OR 0.3; 95% CI 0.1-0.7). Demographic and mycological characteristics, as well as number of nails affected, co-presence of paronychia, and treatment regime were not found to be associated with treatment response. CONCLUSION Candida-positive primary onycholysis was shown to be non-responsive to systemic anti-fungal treatment, suggesting that anti-fungal treatment is not indicated. For other clinical scenarios, high proportions of treatment non-response suggest that determining causality of Candida should not be based on a single positive mycological culture.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, MS, USA.,University of Alabama, Birmingham, AL, USA
| | - Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Aghion-Svirsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dimitris Rigopoulos
- National and Kapodistrian University of Athens, Medical School, 'A.Sygros' Hospital, Athens, Greece
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio De Janeiro, Brazil
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Different Numbers of Long-Pulse 1064-nm Nd-YAG Laser Treatments for Onychomycosis: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1216907. [PMID: 32051822 PMCID: PMC6995308 DOI: 10.1155/2020/1216907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 11/17/2022]
Abstract
Purpose To examine the benefits of different numbers of 1064-nm Nd-YAG laser treatments in patients with onychomycosis. Methods This was a pilot study of patients with onychomycosis who were divided into three groups: four treatment sessions (group A), eight sessions (group B), and 12 sessions (group C). Only infected nails of degrees II–III (Scoring Clinical Index for Onychomycosis) were included. Treatment was given once a week using a long-pulse Nd-YAG 1064-nm laser. Patients were followed at 8, 16, and 24 weeks after the first treatment. Side effects were recorded. Results Treatments were completed for 442 nails in 102 patients. The efficacy rates at 8, 16, and 24 weeks were 35.5%, 38.7%, and 37.4% for group A; 31.4%, 41.7%, and 44.0% for group B; and 27.7%, 50.0%, and 55.4% for group C, respectively. There was a significant difference in the efficacy rate at 24 weeks (P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all P = 0.016) between groups A and C, but not for groups A vs. B, or for groups B vs. C. No difference in the efficacy rate at 8 or 16 weeks was observed among the three groups. In all three groups, the efficacy was better for degree II nails than for degree III nails (all Conclusions The 1064-nm Nd-YAG laser had clinical benefits against onychomycosis. Higher numbers of treatments provided better long-term (24-week) benefits, but had no impact on the short-term outcomes. The efficacy of laser treatment on degree II onychomycosis was better than for degree III.
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Shemer A, Gupta AK, Kamshov S, Babaev M, Hermush V, Farhi R, Daniel CR, Foley KA. Continuous terbinafine and pulse itraconazole for the treatment of non-dermatophyte mold toenail onychomycosis. J DERMATOL TREAT 2019; 32:310-313. [PMID: 31415182 DOI: 10.1080/09546634.2019.1654598] [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
INTRODUCTION Although dermatophytes are considered the predominant causative organisms in onychomycosis, non-dermatophyte mold (NDM) infections may be more prevalent than originally thought and may be more difficult to treat. There are limited data of oral antifungal efficacy in treating NDM onychomycosis. METHOD A retrospective chart review (2009-2016) was conducted in patients receiving continuous oral terbinafine or pulse itraconazole for toenail onychomycosis due to NDMs. Mycology results and percent nail affected were recorded with patient characteristics including demographics and concurrent diseases. Complete, clinical, and mycological cure were tabulated. RESULTS Data from 176 patients were collected. Mycological and complete cure rates for terbinafine (69.8% and 17%) and itraconazole (67.5% and 22%) were not significantly different from each other. Regardless of oral treatment, age (p = .013), baseline severity (p = .016), and presence of atherosclerosis (p = .040) or hyperlipidemia (p = .033) decreased the likelihood of mycological cure, while age decreased the likelihood of complete cure (p = .001). CONCLUSION Continuous terbinafine and pulse itraconazole were similar in efficacy for curing NDM onychomycosis. Age was the most consistent prognostic factor affecting likelihood of cure, with factors that may influence drug reaching the site of infection also decreasing likelihood of mycological cure.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Canada.,Mediprobe Research Inc., London, Canada
| | - Shoni Kamshov
- Department of Dermatology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Babaev
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Vered Hermush
- Department of Geriatrics, Laniado Medical Center, Netanya, Israel
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio De Janeiro, Brazil
| | - C Ralph Daniel
- Department of Dermatology, University of Mississippi School of Medicine, Jackson, MS, USA.,Department of Dermatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Efficacy of Two-Stage Treatment of Onychomycosis Using a Long-Pulsed Nd:YAG 1064-nm Laser. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:3647519. [PMID: 31316570 PMCID: PMC6601484 DOI: 10.1155/2019/3647519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/10/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Onychomycosis is a fungal infection of the nail bed, nail matrix, and nail plate. Lasers have recently been studied as future clinical options for onychomycosis. We sought to evaluate the efficacy of the long-pulsed Nd:YAG 1064-nm laser on onychomycosis using a two-stage treatment. METHODS A total of 100 affected nails (88 toenails and 12 fingernails from 22 patients) were treated using a long-pulsed Nd:YAG 1064-nm laser. The self-controlled treatment schedule included the first stage (1 session per week for 8 weeks) and the second stage (1 session every 4 weeks for 16 weeks). Patients were followed up with for 12 weeks after the last laser treatment. Direct microscopy, cultures, and clinical assessments were performed at various time points. RESULTS Of the nails studied, 84% were infected by Trichophyton rubrum, while others were coinfected with T. rubrum and other fugal strains. The mycological clearance rate and the clinical efficacy rate of the nails were 29% and 21% after the first stage, 69% and 35% after the second stage, and 67% and 39% during follow-up, respectively. The second stage of laser treatment significantly improved the mycological clearance and clinical efficacy. CONCLUSION Long-pulsed Nd:YAG 1064-nm laser two-stage treatment was effective for onychomycosis, with significantly improved mycological clearance and clinical efficacy. This trial is registered with ChiCTR 1900021669.
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A Practical Guide to Curing Onychomycosis: How to Maximize Cure at the Patient, Organism, Treatment, and Environmental Level. Am J Clin Dermatol 2019; 20:123-133. [PMID: 30456537 DOI: 10.1007/s40257-018-0403-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophyte molds, and yeasts. Treatment of this infection can be difficult, with relapse likely to occur within 2.5 years of cure. The objective of this article is to review factors that can impact cure and to suggest practical techniques that physicians can use to maximize cure rates. Co-morbidities, as well as disease severity and duration, are among the many patient factors that could influence the efficacy of antifungal therapies. Furthermore, organism, treatment, and environmental factors that may hinder cure include point mutations, biofilms, affinity for non-target enzymes, and exposure to fungal reservoirs. To address patient-related factors, physicians are encouraged to conduct confirmatory testing and treat co-morbidities such as tinea pedis early and completely. To combat organism-focused factors, it is recommended that disruption of biofilms is considered, and drugs with multiple routes of delivery and unique mechanisms of action are prescribed when traditional agents are not effective. Extending follow-up periods, using combination treatments, and considering pulse regimens may also be of benefit. Through these practical techniques, physicians can maximize cure and limit the risk of relapse and re-infection.
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Weber GC, Firouzi P, Baran AM, Bölke E, Schrumpf H, Buhren BA, Homey B, Gerber PA. Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients. Eur J Med Res 2018; 23:53. [PMID: 30355363 PMCID: PMC6199788 DOI: 10.1186/s40001-018-0340-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Currently available treatment options for onychomycosis such as topical and systemic antifungals are often of limited efficacy, difficult to administer or associated with relevant side effects. Non-ablative laser therapy is proposed to represent a safe alternative without the disadvantages of drugs. Yet, to date, the efficacy of laser therapy for onychomycosis is discussed controversially. Against this background, we performed a systematic retrospective analysis of our clinical experience of 4 years of onychomycosis treatment applying a long-pulsed 1.064-nm diode laser. Methods We retrospectively evaluated the records of 56 patients with microscopic and culturally proven onychomycosis affecting a toenail of the hallux and other toes, who had been treated with a long-pulsed 1.064-nm diode laser (FOX, A.C.R. Laser GmbH, Nuremberg) during the time period of July 2013–December 2016 with or without concomitant topical antifungals. Thereof, 27 patients received laser treatment and 29 patients received laser treatment in combination with local antifungals. We conducted a mean of 3.9 laser treatments at 2–6-week intervals. The primary endpoint of our analysis was clinical improvement; secondary endpoints were complete remission of fungal pathogens in fungal culture and in microscopy. Results Clinical improvement was achieved in 56% of patients treated with laser only after a mean of 4.5 treatments and in 69% of patients treated with laser in combination with topical antifungals after a mean of 3.6 treatments. Cultural healing was detected in 63% of patients treated with laser only after a mean of 5.4 treatments, vs. 86% of patients treated with laser and concomitant topical antifungals after a mean of 4.8 treatments. Microscopic healing (complete healing) with the absence of fungal pathogens was achieved in 11% of patients after a mean of 4.7 treatments with laser only, vs. 21% of patients treated with laser and concomitant topical antifungals after a mean of 4 treatments. No relevant adverse effects were observed. Conclusions The 1.064-nm diode laser is an effective and safe option for the treatment of onychomycosis. Of note, the combination with topical antifungals will increase overall treatment efficacy and reduce the time to healing. Particularly, patients with contraindications against systemic antifungals may benefit from this multimodal therapeutic approach. Our data, moreover, suggest that treatment efficacy is positively correlated with the total number of laser treatments.
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Affiliation(s)
- G C Weber
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - P Firouzi
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - A M Baran
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - E Bölke
- Department of Radiation Oncology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - H Schrumpf
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - B A Buhren
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - B Homey
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - P A Gerber
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany.
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Ibrahim SA, Albalat W, Ebrahim HM. Evaluation of long pulsed Nd-YAG laser in the treatment of onychomycosis. J COSMET LASER THER 2018; 21:76-81. [PMID: 29768066 DOI: 10.1080/14764172.2018.1469765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Samia Ali Ibrahim
- a Dermatology , Venereology and Andrology Department, Zagazig University, Faculty of Medicine , Zagazig , Egypt
| | - Waleed Albalat
- a Dermatology , Venereology and Andrology Department, Zagazig University, Faculty of Medicine , Zagazig , Egypt
| | - Howyda Mohamed Ebrahim
- a Dermatology , Venereology and Andrology Department, Zagazig University, Faculty of Medicine , Zagazig , Egypt
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Shemer A, Daniel R, Rigopoulos D, Farhi R, Babaev M. Variability in Systemic Treatment Efficacy for Onychomycosis: Information That Clinical Studies Do Not Impart to the Office Dermatologist. Skin Appendage Disord 2017; 4:141-144. [PMID: 30197889 DOI: 10.1159/000481693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/06/2017] [Indexed: 01/21/2023] Open
Abstract
Wide differences in the cure rates of onychomycosis in various clinical studies can be avoided if we bear in mind some insights that will help us make study results more consistent. We suggest less rigid criteria in defining the cure rate, the inclusion of all toenails in studies, and the exclusion of nails with a history of trauma. Rather than address patients as a homogenous group, regardless of age, we suggest dividing them into age groups. Researchers should not forget inflammatory diseases that can imply changes on the nails and should take into account the duration of onychomycosis, nail changes caused by asymmetry, and the possibility of dermatophytoma.
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Affiliation(s)
- Avner Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Tel Aviv, Israel.,Department of Dermatology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center and University of Alabama, Birmingham, AL, USA
| | - Dimitris Rigopoulos
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, "Attikon" General University Hospital, Athens, Greece
| | - Renata Farhi
- Hospital Nossa Senhora da Saúde, University Fundação Tecnico Educacional Souza Marques, Rio de Janeiro, Brazil
| | - Meir Babaev
- Division of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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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.
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Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment. J Cutan Med Surg 2017. [PMID: 28639462 DOI: 10.1177/1203475417716362] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
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Affiliation(s)
- Aditya K Gupta
- 1 Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,2 Mediprobe Research, Inc, London, Ontario, Canada
| | | | - Neil H Shear
- 3 Department of Medicine (Dermatology, Clinical Pharmacology and Toxicology) and Department of Pharmacology, Sunnybrook and Women's College Health Science Centre and the University of Toronto, Toronto, Ontario, Canada
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Lavorato FG, Guimarães DA, Premazzi MG, Piñeiro-Maceira JM, Bernardes-Engemann AR, Orofino-Costa R. Performance of mycology and histopathology tests for the diagnosis of toenail onychomycosis due to filamentous fungi: Dermatophyte and non-dermatophyte moulds. Mycoses 2017; 60:587-593. [DOI: 10.1111/myc.12633] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/25/2017] [Accepted: 04/11/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Fernanda G. Lavorato
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
| | - Dávson A. Guimarães
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | - Mario G. Premazzi
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | | | - Andréa R. Bernardes-Engemann
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
| | - Rosane Orofino-Costa
- Dermatology Departament; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
- Medical Mycology Laboratory; Hospital Universitário Pedro Ernesto; UERJ; Rio de Janeiro Brazil
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Gupta A, Versteeg S. A critical review of improvement rates for laser therapy used to treat toenail onychomycosis. J Eur Acad Dermatol Venereol 2017; 31:1111-1118. [DOI: 10.1111/jdv.14212] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A.K. Gupta
- Department of Medicine; University of Toronto School of Medicine; Toronto ON Canada
- Mediprobe Research Inc.; London ON Canada
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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.
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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
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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.
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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
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Machado Vila TV, Sousa Quintanilha N, Rozental S. Miltefosine is effective against Candida albicans and Fusarium oxysporum nail biofilms in vitro. J Med Microbiol 2015; 64:1436-1449. [DOI: 10.1099/jmm.0.000175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Taissa Vieira Machado Vila
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Natália Sousa Quintanilha
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Kantarcıoğlu B, Türköz HK, Yılmaz G, Pepedil Tanrıkulu F, Kaygusuz Atagündüz I, Adıgüzel C, Fıratlı Tuğlular T. Aplastic anemia associated with oral terbinafine: a case report and review of the literature. Turk J Haematol 2015; 31:411-6. [PMID: 25541660 PMCID: PMC4454059 DOI: 10.4274/tjh.2013.0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Onychomycosis (OM) is a common fungal infection of the toenails and/or fingernails that is highly prevalent in the general population and also responsible for significant morbidity. OM is caused by dermatophytes, nondermatophytic molds, or yeast. Today systemic antifungal agents are considered as the gold standard for all types of OM. Here we report a case of aplastic anemia associated with oral terbinafine use and a review of the literature on hematological toxicities associated with terbinafine.
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Affiliation(s)
- Bülent Kantarcıoğlu
- Okmeydanı Training and Research Hospital, Clinic of Hematology, İstanbul, Turkey. E-ma-il:
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Abstract
Onychomycosis is a frequent cause of nail infections due to dermatophytes. Molds and yeast may also be responsible of these pathologies. Antifungal treatments are frequently given without a mycological diagnosis, partly because of the requisite time for obtaining the biological results. The mycological diagnosis requires a direct microscopic examination and a culture in order to accurately identify the fungal genus and species. Nevertheless, this conventional diagnosis is often time consuming due to the delay of fungal cultures and presents disadvantages that make it not sufficient enough to give a precise and confident response to the clinicians. Therefore additional tests have been developed to help distinguish onychomycosis from other nail disorders. Among them, molecular biology techniques offer modern and rapid tools to improve traditional microbiological diagnosis. In this review, we first present the conventional diagnosis methods for onychomycosis and then we describe the main molecular biology tools and the currently available commercial kits that allow a rapid detection of the pathology.
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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.
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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
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Gupta AK, Daigle D. Tavaborole (AN-2690) for the treatment of onychomycosis of the toenail in adults. Expert Rev Anti Infect Ther 2014; 12:735-42. [DOI: 10.1586/14787210.2014.915738] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aditya K Gupta
- Department of Medicine, University of Toronto,
Toronto, Ontario, Canada
- Mediprobe Research Inc.,
London, Ontario, Canada
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Abstract
INTRODUCTION Onychomycosis is a very common fungal infection of the nail apparatus; however, it is very hard to treat, even when the causative agent is identified, and usually requires prolonged systemic antifungal therapy. Until the 1990s, oral treatment options included only griseofulvin and ketoconazole, and the cure rate was very low. New generations of antimycotics, such as fluconazole, itraconazole and terbinafine have improved treatment success. METHODS Literature was identified by performing a PubMed Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) search. Prospective and randomized clinical trials were chosen to be included in this review. Forty-six trials were included. RESULTS Fluconazole, itraconazole and terbinafine are effective in the treatment of onychomycosis and have a good safety profile. When a dermatophyte is the pathogen, terbinafine produces the best results. For Candida and nondermatophyte infections, the azoles, mainly itraconazole, are the recommended therapy. CONCLUSION In the majority of the studies, terbinafine treatment showed a higher cure ratio than the other drugs for dermatophyte onychomycosis.
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Sigurgeirsson B, Baran R. The prevalence of onychomycosis in the global population: a literature study. J Eur Acad Dermatol Venereol 2013; 28:1480-91. [PMID: 24283696 DOI: 10.1111/jdv.12323] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 10/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature. OBJECTIVES Evaluate the prevalence of onychomycosis based on published studies. METHODS Relevant studies were identified in Medline by using specific search criteria. RESULTS Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3). LIMITATIONS We may not have been able to locate all studies. CONCLUSIONS Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.
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Affiliation(s)
- B Sigurgeirsson
- Faculty of Medicine, Department of Dermatology, University of Iceland, Reykjavík, Iceland
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