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Ahn JC, Mo SJ, Choi M, Kim B, Cho SB. In vivo Guinea Pig Model Study for Evaluating Antifungal Effect of a Dual-Diode Laser with Wavelengths of 405 Nm and 635 Nm on Dermatophytosis. Clin Cosmet Investig Dermatol 2023; 16:1559-1567. [PMID: 37351065 PMCID: PMC10284164 DOI: 10.2147/ccid.s415679] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
Background Various laser- and light-based devices have been introduced as complementary or alternative treatment modalities for dermatophytosis, particularly for finger or toenail onychomycosis. Objective This study aimed to comparatively evaluate the antifungal effects of 405-nm and 635-nm dual-band diode lasers using an in vivo guinea pig model of dermatophytosis. Materials and Methods A guinea pig model was developed by the repetitive application of fungal spore preparations to the back skin of guinea pigs. Dual-diode laser treatment was delivered to the guinea pig skin at a power of 24 mW at a wavelength of 405 nm and 18 mW at 635 nm for 12 min. The treatments were administered three times weekly for 2 weeks, and a mycological study was performed. Results Mycological studies using scraped samples obtained from treatment groups A (N = 8) and B (N = 8) after dual-diode laser treatment revealed that seven of eight (87.5%) samples in each group had negative results for direct potassium hydroxide microscopy and fungal culture studies. Skin specimens from each infected laser-untreated guinea pig exhibited spongiotic psoriasiform epidermis with parakeratosis. Meanwhile, skin specimens from infected laser-treated guinea pigs in groups A and B demonstrated thinner epidermal thickness than those from infected untreated controls but thicker than those from uninfected treated controls without noticeable inflammatory cell infiltration in the dermis. Conclusion The guinea pig dermatophytosis model can be used to comparatively evaluate the efficacy and safety of various treatment modalities, including dual-diode lasers, for superficial fungal skin infection.
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Affiliation(s)
- Jin-Chul Ahn
- Medical Laser Research Center, College of Medicine, Dankook University, Cheonan, Korea
| | - Sang Joon Mo
- Medical Laser Research Center, College of Medicine, Dankook University, Cheonan, Korea
| | - Min Choi
- R&D Center, Shenb Co., Ltd, Seoul, Korea
| | - Bora Kim
- R&D Center, Shenb Co., Ltd, Seoul, Korea
| | - Sung Bin Cho
- Yonsei Seran Dermatology and Laser Clinic, Seoul, Korea
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Szepietowska M, Bień B, Krajewski PK, Stefaniak AA, Matusiak Ł. Prevalence, Intensity and Psychosocial Burden of Acne Itch: Two Different Cohorts Study. J Clin Med 2023; 12:3997. [PMID: 37373690 DOI: 10.3390/jcm12123997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Chronic itch is a common symptom of inflammatory skin diseases. This study was undertaken to evaluate the presence and intensity of itching in two different cohorts of acne subjects. Additionally, the influence of itching on the psychosocial status of acne individuals was assessed. METHODS Consecutive acne patients seeking dermatological advice and university students diagnosed with acne during dermatological screening were considered. The clinical and psychological aspects of acne were assessed using a variety of instruments. RESULTS About 40% of acne subjects in both cohorts reported itching. The mean WI-NRS during the last 3 days in acne patients was 3.83 ± 2.31 points (mild itch) and was significantly more severe (p < 0.001) than in university students diagnosed with acne (2.09 ± 1.29 points). Itch intensity did not depend on the clinical severity of acne. In consecutive acne patients, itch intensity correlated with quality-of-life impairments (assessed using DLQI and CADI) and HADS scores. There was no correlation between itch intensity and stigmatization levels. CONCLUSIONS Itching seems to be a common phenomenon in acne sufferers. Acne itch significantly influences patients' well-being and should be considered in a holistic approach to acne patients.
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Affiliation(s)
- Marta Szepietowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Beata Bień
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Aleksandra A Stefaniak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Shukla P, Verma P, Suvirya S, Pathania S, Kapoor D. Cutaneous dermatophytosis: A problem deeper than we perceive – A cross sectional prospective study on quality of life in 385 patients. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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A Comparative Study on the Phenotypic Versus Molecular Identification of Clinical Dermatophytes. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dermatophytosis is the superficial infection of keratinized tissue like skin, hair, and nails, in humans and animals, by a group of closely related fungi known as dermatophytes. Phenotypic identification of dermatophytes, especially through classical methods can be difficult and uncertain at times, especially when differentiating species with overlapping characteristics. Alternative identification methods based on amplification and sequence analysis of the highly polymorphic internal transcribed spacer (ITS) sequences flanking the 5.8S ribosomal RNA gene has proven to be quite sensitive and reliable. The objective of our study was to compare the phenotypic and the ITS sequencing-based methods for the identification of clinically isolated dermatophyte specimens from Puducherry, India. A total of 13 clinical samples from 39 suspected cases were found positive for dermatophytes using KOH/DMSO preparations. Specimens were subsequently cultured in Sabouraud dextrose agar (SDA) supplemented with chloramphenicol, gentamicin, and cycloheximide. Dermatophytes were identified based on culture characteristics and microscopic examination in lactophenol cotton blue preparations. ITS sequencing was additionally performed after PCR amplification for species identification. Identification based on phenotype through microscopy and culture methods confirmed infections with Trichophyton mentagrophytes (n = 11), T. rubrum (n = 1), and Microsporum gypseum (n = 1). The strains were confirmed by ITS sequencing without any discrepancy with phenotypic identification. Identification of common dermatophytes based on phenotypic characteristics may be used as a reliable method of diagnosis where sophisticated methods like ITS sequencing and PCR are unavailable.
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Kang SY, Um JY, Chung BY, Kim JC, Park CW, Kim HO. Differential Diagnosis and Treatment of Itching in Children and Adolescents. Biomedicines 2021; 9:biomedicines9080919. [PMID: 34440123 PMCID: PMC8389554 DOI: 10.3390/biomedicines9080919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
Itching is prevalent in children with skin disorders and associated with effects on their mood, quality of life, and social functioning. Surprisingly, there are no data on childhood prevalence of pruritus in the general population. The aim of this article is to explore the epidemiology, clinical manifestation, and treatment for itch (pruritus) in the pediatric population (from infancy to adolescence), and to be helpful to primary care physicians who assess and diagnose pediatric patients with itching. In this study, we searched for specific keywords using PubMed and MEDLINE (Ovid) and, then, refined the retrieved searches for each cause and treatment. As a result of reviewing the literature, atopic dermatitis was shown to be the most common cause of itching, especially during infancy and through preschool. Not only skin disorders but also systemic diseases, drugs, and postburn states can predispose an individual to itching in childhood. There are traditional and newly developed treatment modalities for itching in pediatric patients. However, because the pharmacokinetics and pharmacodynamics of childhood are different from those of adults, the medications for itching have to be applied carefully for these age groups. There are many areas to be elucidated regarding the prevalence and objective assessment of pruritus in pediatric patients. Moreover, the safety profiles of medications in the pediatric population need to be better understood. Further studies to investigate itching in childhood are warranted.
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Saunte D, Pereiro‐Ferreirós M, Rodríguez‐Cerdeira C, Sergeev A, Arabatzis M, Prohić A, Piraccini B, Lecerf P, Nenoff P, Kotrekhova L, Bosshard P, Padovese V, Szepietowski J, Sigurgeirsson B, Nowicki R, Schmid‐Grendelmeier P, Hay R. Emerging antifungal treatment failure of dermatophytosis in Europe: take care or it may become endemic. J Eur Acad Dermatol Venereol 2021; 35:1582-1586. [DOI: 10.1111/jdv.17241] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Affiliation(s)
- D.M.L. Saunte
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - M. Pereiro‐Ferreirós
- European Academy of Dermatology and Venereology TASK force on Mycology
- Dermatología Faculty of Medicine University of Santiago de Compostela A Coruña Spain
| | - C. Rodríguez‐Cerdeira
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology Meixoeiro Hospital and University of Vigo Vigo Spain
| | - A.Y. Sergeev
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Clinical Immunology Sechenov University Moscow Russia
| | - M. Arabatzis
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology Medical School Aristotle University Thessaloniki Greece
| | - A. Prohić
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatovenereology University Sarajevo School of Science and TechnologySarajevo Medical School Sarajevo Bosnia and Herzegovina
| | - B.M. Piraccini
- European Academy of Dermatology and Venereology TASK force on Mycology
- Dermatology ‐IRCCS Policlinico di Sant’Orsola Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater Studiorum University of Bologna Bologna Italy
| | - P. Lecerf
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology University Hospital Brugmann & Saint‐PierreUniversité Libre de Bruxelles Brussels Belgium
| | - P. Nenoff
- European Academy of Dermatology and Venereology TASK force on Mycology
- Laboratory for Medical Microbiology Mölbis Germany
| | - L.P. Kotrekhova
- Department of Dermatovenereology North Western State Medical University Saint Petersburg Russia
| | - P.P. Bosshard
- Department of Dermatology University Hospital Zurich and Medical Faculty University of Zurich Zurich Switzerland
| | - V. Padovese
- Department of Dermatology and Venereology Genitourinary ClinicMater Dei Hospital Msida Malta
| | - J.C. Szepietowski
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology, Venereology and Allergology Wroclaw Medical University Wroclaw Poland
| | - B. Sigurgeirsson
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology Faculty of Medicine University of Iceland Reykjavik Iceland
| | - R.J. Nowicki
- European Academy of Dermatology and Venereology TASK force on Mycology
- Department of Dermatology, Venereology & Allergology Medical University of Gdansk Gdansk Poland
| | - P. Schmid‐Grendelmeier
- European Academy of Dermatology and Venereology TASK force on Mycology
- Allergy Unit Department of Dermatology University Hospital Zurich and Medical Faculty University of Zurich Zurich Switzerland
| | - R.J. Hay
- European Academy of Dermatology and Venereology TASK force on Mycology
- St John’s Institute of DermatologyKings College London London UK
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Verma SB, Panda S, Nenoff P, Singal A, Rudramuruthy SM, Uhrlass S, Das A, Bisherwal K, Shaw D, Vasani R. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol 2021; 87:154-175. [PMID: 33769736 DOI: 10.25259/ijdvl_301_20] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/01/2020] [Indexed: 12/21/2022]
Abstract
Dermatophytosis has attained unprecedented dimensions in recent years in India. Its clinical presentation is now multifarious, often with atypical morphology, severe forms and unusually extensive disease in all age groups. We hesitate to call it an epidemic owing to the lack of population-based prevalence surveys. In this part of the review, we discuss the epidemiology and clinical features of this contemporary problem. While the epidemiology is marked by a stark increase in the number of chronic, relapsing and recurrent cases, the clinical distribution is marked by a disproportionate rise in the number of cases with tinea corporis and cruris, cases presenting with the involvement of extensive areas, and tinea faciei.
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Affiliation(s)
| | - Saumya Panda
- Department of Dermatology, Belle Vue Clinic, Kolkata, West Bengal, India,
| | - Pietro Nenoff
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India,
| | - Shivprakash M. Rudramuruthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Silke Uhrlass
- Department of Dermatology and Laboratory Medicine, Laboratory of Medical Microbiology, Moelbis, Germany
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India,
| | - Kavita Bisherwal
- Department of Dermatology, Venereology and Leprosy, Lady Hardinge Medical College and SSK Hospital, Delhi, India,
| | - Dipika Shaw
- Department of Medical Microbiology, PGI, Chandigarh, India,
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Thakran P, Agrawal S, Singal A, Verma S, Madhu S. Iatrogenic Cushing's Syndrome in Patients with Superficial Dermatophytosis. Indian Dermatol Online J 2021; 12:237-243. [PMID: 33959519 PMCID: PMC8088179 DOI: 10.4103/idoj.idoj_432_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/07/2020] [Accepted: 09/24/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The epidemic-like scenario of superficial fungal infections in India has been complicated by the prescription of systemic and topical potent steroids. As a result, alarming number of patients are presenting with exogenous Cushing's syndrome. METHODS This cross-sectional study involved 23 patients of superficial dermatophytosis on steroids who presented with clinical features like that of Cushing's syndrome. Their clinical details and laboratory investigations including fungal culture and serum cortisol, were recorded on a pre-designed proforma. RESULTS There were 23 patients (14 males and 9 females) with mean age of 29.47 ± 15.5 years, majority with extensive tinea cruris and corporis. All of them received oral (Betamethasone) or parenteral corticosteroids along with potent topical steroids (clobetasol propionate and betamethasone valerate) for at least two months. In majority (56.5%), treatment was prescribed by unqualified medical practitioners and in the rest by alternative medical practitioners. Striae, buffalo hump, hirsutism were observed in 16 (69.5%), 15 (65.2%), 13 (56.5%) patients, respectively. Serum cortisol estimation revealed low levels and ranged from 0.66 to 6 μg/ml with a mean of 1.53 ± 1.27 μg/ml (normal 7-25 μg/ml). CONCLUSIONS Corticosteroids are life saving for many dermatological diseases; their injudicious use (topical, oral, and parenteral) for prolonged periods in the treatment of superficial dermatophytosis can lead to Cushing's syndrome.
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Affiliation(s)
- Priyesh Thakran
- Department of Endocrinology and Metabolism University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | - Sonia Agrawal
- Department of Endocrinology and Metabolism University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | - Archana Singal
- Department of Endocrinology and Metabolism University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | - Shyam Verma
- Department of Endocrinology and Metabolism University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
| | - S.V. Madhu
- Department of Endocrinology and Metabolism University College of Medical Sciences and GTB Hospital (University of Delhi), Delhi, India
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Spread of Terbinafine-Resistant Trichophyton mentagrophytes Type VIII (India) in Germany-"The Tip of the Iceberg?". J Fungi (Basel) 2020; 6:jof6040207. [PMID: 33027904 PMCID: PMC7712673 DOI: 10.3390/jof6040207] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic recalcitrant dermatophytoses, due to Trichophyton (T.) mentagrophytes Type VIII are on the rise in India and are noteworthy for their predominance. It would not be wrong to assume that travel and migration would be responsible for the spread of T. mentagrophytes Type VIII from India, with many strains resistant to terbinafine, to other parts of the world. From September 2016 until March 2020, a total of 29 strains of T. mentagrophytes Type VIII (India) were isolated. All patients were residents of Germany: 12 females, 15 males and the gender of the remaining two was not assignable. Patients originated from India (11), Pakistan (two), Bangladesh (one), Iraq (two), Bahrain (one), Libya (one) and other unspecified countries (10). At least two patients were German-born residents. Most samples (21) were collected in 2019 and 2020. All 29 T. mentagrophytes isolates were sequenced (internal transcribed spacer (ITS) and translation elongation factor 1-α gene (TEF1-α)). All were identified as genotype VIII (India) of T. mentagrophytes. In vitro resistance testing revealed 13/29 strains (45%) to be terbinafine-resistant with minimum inhibitory concentration (MIC) breakpoints ≥0.2 µg/mL. The remaining 16 strains (55%) were terbinafine-sensitive. Point mutation analysis revealed that 10/13 resistant strains exhibited Phe397Leu amino acid substitution of squalene epoxidase (SQLE), indicative for in vitro resistance to terbinafine. Two resistant strains showed combined Phe397Leu and Ala448Thr amino acid substitutions, and one strain a single Leu393Phe amino acid substitution. Out of 16 terbinafine-sensitive strains, in eight Ala448Thr, and in one Ala448Thr +, new Val444 Ile amino acid substitutions were detected. Resistance to both itraconazole and voriconazole was observed in three out of 13 analyzed strains. Treatment included topical ciclopirox olamine plus topical miconazole or sertaconazole. Oral itraconazole 200 mg twice daily for four to eight weeks was found to be adequate. Terbinafine-resistant T. mentagrophytes Type VIII are being increasingly isolated. In Germany, transmission of T. mentagrophytes Type VIII from the Indian subcontinent to Europe should be viewed as a significant public health issue.
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Ebert A, Monod M, Salamin K, Burmester A, Uhrlaß S, Wiegand C, Hipler UC, Krüger C, Koch D, Wittig F, Verma SB, Singal A, Gupta S, Vasani R, Saraswat A, Madhu R, Panda S, Das A, Kura MM, Kumar A, Poojary S, Schirm S, Gräser Y, Paasch U, Nenoff P. Alarming India-wide phenomenon of antifungal resistance in dermatophytes: A multicentre study. Mycoses 2020; 63:717-728. [PMID: 32301159 DOI: 10.1111/myc.13091] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. OBJECTIVES The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. PATIENTS/METHODS We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. RESULTS Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine-sensitive and terbinafine-resistant isolates but was associated with increased MICs of itraconazole and voriconazole. CONCLUSIONS The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future.
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Affiliation(s)
- Andreas Ebert
- Medizinische Fakultät, Universität Leipzig, Leipzig, Germany.,Labor für medizinische Mikrobiologie, Rötha, Germany
| | - Michel Monod
- Service de Dermatologie et Vénéréologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Karine Salamin
- Service de Dermatologie et Vénéréologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anke Burmester
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | - Silke Uhrlaß
- Labor für medizinische Mikrobiologie, Rötha, Germany
| | - Cornelia Wiegand
- Klinik für Hautkrankheiten, Universitätsklinikum Jena, Jena, Germany
| | | | | | - Daniela Koch
- Labor für medizinische Mikrobiologie, Rötha, Germany
| | | | | | - Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Sanjeev Gupta
- M M Institute of Medical Sciences and Research, MM Deemed to be University, Ambala, India
| | - Resham Vasani
- Department of Dermatology, Bhojani Clinic, Mumbai, India
| | - Abir Saraswat
- Department of Dermatology, Indushree Skin Clinic, Lucknow, India
| | - Rengarajan Madhu
- Department of Dermatology (Mycology), Madras Medical College, Chennai, India
| | - Saumya Panda
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College, Kolkata, India
| | - Mahendra M Kura
- Department of Dermatology, Grant Medical College & Sir J J Group of Hospitals, Mumbai, India
| | - Akshy Kumar
- Department of Dermatology, Government Medical College, Kota, India
| | - Shital Poojary
- Department of Dermatology, K J Somaiya Medical College, Mumbai, India
| | - Sibylle Schirm
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig, Germany
| | - Yvonne Gräser
- Institut für Mikrobiologie und Hygiene, Nationales Konsiliarlabor für Dermatophyten, Universitätsmedizin Berlin Charité, Berlin, Germany
| | - Uwe Paasch
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Pietro Nenoff
- Labor für medizinische Mikrobiologie, Rötha, Germany
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