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Albucker SJ, Conway J, Lipner SR. Nails in older adults. Ann Med 2024; 56:2336989. [PMID: 38738374 PMCID: PMC11095289 DOI: 10.1080/07853890.2024.2336989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 03/25/2024] [Indexed: 05/14/2024] Open
Abstract
As the world's population of adults greater than 60 years old continues to increase, it is important to manage nail disorders that may impact their daily lives. Nail disorders may have significant impact on quality of life due to decreased functionality, extreme pain, or social embarrassment. In this review, we discuss nail disorders affecting older patients, including physiologic, traumatic, drug-induced, infectious, environmental, inflammatory, and neoplastic conditions. Diagnosis of these conditions involves a detailed history, physical examination of all 20 nails, and depending on the condition, a nail clipping or biopsy and/or diagnostic imaging. Nails grow even more slowly in older adults compared to younger individuals, and therefore it is important for accurate diagnosis, and avoidance of inappropriate management and delay of treatment. Increased awareness of nail pathologies may help recognition and management of nail conditions in older adults.
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Affiliation(s)
- Samantha Jo Albucker
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jade Conway
- Department of Dermatology, NY Medical College, Valhalla, NY, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Tamimi P, Fattahi M, Ghaderi A, Firooz A, Shirvani F, Alkhen A, Zamani S. Terbinafine-resistant T. indotineae due to F397L/L393S or F397L/L393F mutation among corticoid-related tinea incognita patients. J Dtsch Dermatol Ges 2024; 22:922-934. [PMID: 38924688 DOI: 10.1111/ddg.15440] [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: 09/23/2023] [Accepted: 03/26/2024] [Indexed: 06/28/2024]
Abstract
Tinea incognita (TI) can mimic other dermatoses, presenting a diagnostic challenge for dermatologists. In some uncertain cases, it is crucial to accurately identify the causative agent using internal transcribed spacer (ITS) sequencing. The global issue of drug-resistant dermatophytosis is increasing, with Trichophyton (T.) indotineae being the main cause. This study presents four cases of TI (diagnosed as eczema) by terbinafine-resistant T. indotineae strains and reviews the current global TI epidemiology based on geographical continent and related conditions. Furthermore, squalene epoxidase (SQLE)-associated resistance mechanisms are evaluated. Lesions caused by terbinafine-resistant T. indotineae strains do not respond to allylamine antifungals, thus allowing the infection to spread. Among T. indotineae isolates, the SQLE F397L substitution is the most prevalent mutation contributing to azole resistance. F397L and L393F replacements in SQLE were detected in all isolates that exhibited high-level resistance. L393S was seen in isolates with low-resistant strains. Interestingly, and for the first time, an L393F amino acid substitution in the SQLE gene product was detected in the Iranian clinical T. indotineae strain. Also, a genomics-based update on terbinafine resistance that focuses on T. indotineae is discussed in this study.
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Affiliation(s)
- Pegah Tamimi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Fattahi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliasghar Ghaderi
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Firooz
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Shirvani
- Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Shayan Zamani
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Nail conditions are not only aesthetic concerns, and nail changes may be a clue to an underlying systemic diseases or infection. Without timely treatment, nail diseases can continue to worsen and significantly impair performance of daily activities and reduce quality of life. Examination of the nails is essential at every medical visit, and may uncover important findings. Brittle nail syndrome, onychomycosis, paronychia, nail psoriasis, longitudinal melanonychia, Beau's lines, onychomadesis and retronychia are common nail disorders seen in clinical practice. These conditions stem from infectious, inflammatory, neoplastic and traumatic aetiologies. Though each nail condition presents with its own distinct characteristics, the clinical findings may overlap between different conditions, resulting in misdiagnosis and treatment delays. Patients can present with nail plate changes (e.g. hyperkeratosis, onycholysis, pitting), discolouration, pain and inflammation. The diagnostic work-up of nail disease should include a detailed history and clinical examination of all 20 nail units. Dermoscopy, diagnostic imaging and histopathologic and mycological analyses may be necessary for diagnosis. Nail findings concerning for malignancy should be promptly referred to a dermatologist for evaluation and biopsy. Nail disease management requires a targeted treatment approach. Treatments include topical and/or systemic medications, discontinuation of offending drugs or surgical intervention, depending on the condition. Patient education on proper nail care and techniques to minimize further damage to the affected nails is also important. This article serves to enhance familiarity of the most common nail disorders seen in clinical practice. It will highlight the key clinical manifestations, systematic approaches to diagnosis and treatment options for each nail condition to improve diagnosis and management of nail diseases, as well as patient outcomes.Key messagesNail disease is not only a cosmetic issue, as nail changes can indicate the presence of a serious underlying systemic disease, infection or malignancy.Nail pain and changes associated with NP are physically and emotionally distressing and may contribute to functional impairment and diminished quality of life.LM is a hallmark sign of subungual melanoma and this finding warrants further investigation to rule out malignancy.
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Affiliation(s)
- Debra K Lee
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine New York, NY, USA
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Falotico JM, Lipner SR. Updated Perspectives on the Diagnosis and Management of Onychomycosis. Clin Cosmet Investig Dermatol 2022; 15:1933-1957. [PMID: 36133401 PMCID: PMC9484770 DOI: 10.2147/ccid.s362635] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/02/2022]
Abstract
Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.
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Affiliation(s)
- Julianne M Falotico
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Pearce B, Bishop SC, Jones CE, Kennedy JP. Fungal Nails? DNA Facts Challenge Dystrophic Etiology. J Am Podiatr Med Assoc 2022; 112:18-042. [PMID: 34951866 DOI: 10.7547/18-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Historically recalcitrant to treatment, infection of the nail unit is a pervasive clinical condition affecting approximately 10% to 20% of the US population; patients present with both cosmetic symptomatology and pain, with subsequent dystrophic morphology. To date, the presumptive infectious etiologies include classically reported fungal dermatophytes, nondermatophyte molds, and yeasts. Until now, the prevalence and potential contribution of bacteria to the clinical course of dystrophic nails had been relatively overlooked, if not dismissed. Previously, diagnosis had largely been made by means of clinical presentation, although microscopic examinations (potassium hydroxide) of nail scrapings to identify fungal agents and, more recently, panel-specific polymerase chain reaction assays have been used to elucidate causative infectious agents. Each of these tools suffers from test-specific limitations. METHODS Molecular-age medicine now includes DNA-based tools to universally assess any microbe or pathogen with a known DNA sequence. This affords clinicians with rapid DNA sequencing technologies at their disposal. These sequencing-based diagnostic tools confer the accuracy of DNA-level certainty, and concurrently obviate cultivation or microbial phenotypical biases. RESULTS Using DNA sequencing-based diagnostics, the results in this article document the first identification and quantification of significant bacterial, rather than mycotic, pathogens to the clinical manifestation of dystrophic nails. CONCLUSIONS In direct opposition to the prevailing and presumptive mycotic-based causes, the results in this article invoke questions about the very basis for our current standards of care, including effective treatment regimens.
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Affiliation(s)
- Beth Pearce
- *Orthopaedic Associates of St. Augustine, St. Augustine, FL. Dr. Pearce is now with Upperline Health Florida, Ponte Vedra Beach, FL
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Gupta AK, Venkataraman M, Talukder M. Onychomycosis in Older Adults: Prevalence, Diagnosis, and Management. Drugs Aging 2022; 39:191-198. [PMID: 35102533 DOI: 10.1007/s40266-021-00917-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/03/2022]
Abstract
The risk of having onychomycosis increases with age. Data suggest that the prevalence of onychomycosis may be ≥ 20% in subjects aged ≥ 60 years and ≥ 50% in those aged ≥ 70 years. Older males are 2.1 times more prone to onychomycosis than are females. Although most nail dystrophies (approximately 50%) are caused by onychomycosis, proper clinical assessment followed by mycological examination is recommended to exclude other conditions such as nail trauma, lichen planus, and psoriasis. The US FDA-approved onychomycosis treatments are systemic antifungals (terbinafine and itraconazole) for severe onychomycosis and topical antifungals (ciclopirox 8%, efinaconazole 10%, and tavaborole 5%) for mild-to-moderate onychomycosis. Oral fluconazole is used off-label, and itraconazole may be considered for non-dermatophyte onychomycosis. Recently, fosravuconazole was approved in Japan for onychomycosis treatment. Although the treatment options and durations are the same for older patients as for other age groups, a clinical decision should take into account various age-related factors such as comorbidities, polypharmacy, hepatic and renal insufficiency, and noncompliance. Clinicians should also consider possible drug interactions and side effects when choosing a particular antifungal. Since the recurrence rate of onychomycosis is high, older patients should practice sanitization techniques, consider lifestyle changes, and perhaps consider using a topical antifungal as long-term maintenance therapy one to three times per week to prevent the recurrence of onychomycosis or to treat early disease.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada. .,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Mesbah Talukder
- Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X 2P1, Canada
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Bunyaratavej S, Srinonprasert V, Kiratiwongwan R, Wongdama S, Leeyaphan C. Onychomycosis in older adults: The age and associated factors affecting the complete cure rate. Australas J Dermatol 2021; 63:74-80. [PMID: 34398469 DOI: 10.1111/ajd.13686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/22/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Limited studies exist on the factors associated with a complete cure of onychomycosis in older adults. OBJECTIVES To determine the age and factors associated with a complete cure among older adults diagnosed with toenail onychomycosis. METHODS A retrospective cohort study was conducted of 95 older adult patients (aged ≥ 60 years) diagnosed with toenail onychomycosis between January 2016 and December 2017. Demographic data, mycological findings, treatments and durations to a complete cure were reviewed. RESULTS The complete cure rates of the patients aged < 70 years and ≥70 years were 67.4% and 44.9%, respectively (P = 0.027). Patients aged ≥ 70 years were significantly higher in male gender, had higher history of smoking, peripheral arterial disease, impaired renal function, antihypertensive drug and amorolfine nail lacquer usage, and polypharmacy. A multivariate analysis revealed that being aged ≥70 years and having a nail thickness >2 mm were associated with failure to achieve a complete cure. The median times to a complete cure for older adults aged <70 years and ≥70 years were 20 months and 47 months, respectively (P = 0.007). CONCLUSIONS An age ≥ 70 years was related to a lower cure rate and delays in achieving a complete cure. A nail thickness > 2 mm was a poor prognostic factor for a complete cure. Moreover, very old adults were more likely to suffer side effects arising from the use of systemic antifungal medications.
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Affiliation(s)
- Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Kiratiwongwan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supisara Wongdama
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Marcos-Tejedor F, Mota M, Iglesias-Sánchez MJ, Mayordomo R, Gonçalves T. Identification of Fungi Involved in Onychomycosis in Patients of a Spanish Rural Area. J Fungi (Basel) 2021; 7:jof7080623. [PMID: 34436162 PMCID: PMC8398180 DOI: 10.3390/jof7080623] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Onychomycosis is one of the most frequent reasons for visiting podiatrist clinics. Complementary tests and the accurate identification of the infectious agents are key issues for a successful treatment of onychomycosis. This is particularly important when lifestyle, age and immunodepressed patients increase the prevalence of non-dermatophyte fungal infection. In this paper, we describe issues related to onychomycosis prevalence in a population of patients, mostly with rural lifestyles, visiting a podiatry clinic in a rural area of Spain. A total of 51 cases were studied with an average age of 65.96 ± 21.28 years (the youngest being 16 years and the oldest being 95 years). Fungal agents were isolated using conventional sampling and microbiological culture techniques. The results obtained with these techniques were compared with the results obtained with a direct methodology using molecular biology, by PCR and nucleotide sequencing of the ITS-5.8S rDNA fragment. The classical culture methodology confirmed the infection in 76.5% of the samples (n = 39), while the PCR confirmed the infection in 84.3% (n = 51) of the nails, although the difference between these results did not show statistical significance (p = 0.388). We found a high variability in agents, with more yeasts than dermatophytes as etiological agents of onychomycosis. However, only among individuals older than 65 years, was the difference between yeasts (82%) and dermatophytes (18%) was statistically significant (p = 0.004). Among the agents of non-dermatophyte onychomycosis, we found predominantly fungi (yeasts) of the Candida genus, interestingly with no isolates of Candida albicans, and moulds of the Aspergillus genus.
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Affiliation(s)
- Felix Marcos-Tejedor
- Department of Medical Sciences, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain
- Correspondence:
| | - Marta Mota
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; (M.M.); (T.G.)
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - María José Iglesias-Sánchez
- Department of Medical and Surgical Therapy, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain;
| | - Raquel Mayordomo
- Department of Anatomy and Human Embryology, University Center of Plasencia, University of Extremadura, 10600 Plasencia, Spain;
| | - Teresa Gonçalves
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal; (M.M.); (T.G.)
- CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
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Treatment Outcome with Fosravuconazole for Onychomycosis. Mycopathologia 2021; 186:259-267. [PMID: 33754205 DOI: 10.1007/s11046-021-00540-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/02/2021] [Indexed: 10/20/2022]
Abstract
Fosravuconazole L-lysine ethanolate (F-RVCZ), a ravuconazole prodrug, is a newly available agent with high expectations for efficacy in the treatment of onychomycosis. However, clinical data regarding the efficacy of F-RVCZ are limited because the drug was launched only in Japan in 2018. Therefore, we analyzed the outcome of F-RVCZ therapy in the treatment of onychomycosis at outpatient dermatology clinics in Japan. We examined data for 109 patients (68 male, 41 female) with varying clinical type, including total dystrophic onychomycosis and dermatophytoma, and a wide range of age groups, including the elderly. The complete cure rate at 12 weeks was 6.4% (7/109) and 67.9% (74/109) at the last visit (mean time to last visit: 32 ± 14.2 weeks). Mean rate of improvement in the affected nail area was 49.1 ± 23.3% at 12 weeks and 86.8 ± 22.4% at the last visit. Efficacy at 12 weeks and the last visit, respectively, was as follows: none, 4 cases and 1 case; slight, 35 cases and 4 cases; moderate, 51 cases and 21 cases; significant, 12 cases and 9 cases; complete cure, 7 cases and 74 cases. There were no serious adverse events. This retrospective survey was the first large-scale analysis of actual clinical practice outcomes and had minimal exclusions. Compared to previous reports, our results demonstrated excellent efficacy of F-RVCZ therapy in a variety of patients. Considering our results and the ease of oral administration (1 capsule/day for 12 weeks) and few adverse events, F-RVCZ therapy appears to be a useful option for the treatment of onychomycosis.
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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: 49] [Impact Index Per Article: 12.3] [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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Gill P, Kaur S, Gupta A. Arbitrarily primed polymerase chain reaction-based identification of dystrophic onychomycosis. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2020. [DOI: 10.4103/amhs.amhs_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Introduction: Onychomycosis is a widespread nail disease, often occurring on the feet. It is a chronic and often recurring disease, which makes it difficult to eradicate. The infection may be caused by dermatophytes, non-dermatophyte molds, and yeasts. Traditionally, systemic antifungal medications have been used to treat this infection, but in recent years topical formulations have been the focus of research.Areas covered: This review outlines the current antifungal market and novel treatments currently in development or in experimental phases. It highlights a shift from systemic treatments to topical options as well as penetration enhancers. There are also several novel systemic options in development.Expert opinion: Although there have been significant developments in treatment options for onychomycosis, it remains a challenging chronic condition with less than desirable cure rates. This may be attributed to the formation of fungal biofilms and limited understanding of the fungal lifecycle. However, when patients adhere to treatment protocols and employ preventative measures, outcomes are generally favorable.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc, London, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Stec
- Mediprobe Research Inc, London, Ontario, Canada
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Abdallah NA, Said M, Mahmoud MT, Omar MA. Onychomycosis: Correlation between the dermoscopic patterns and fungal culture. J Cosmet Dermatol 2019; 19:1196-1204. [DOI: 10.1111/jocd.13144] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Naglaa A. Abdallah
- Dermatology Department Faculty of Medicine (For Girls) Al‐Azhar University Cairo Egypt
| | - Marwa Said
- Dermatology Department Faculty of Medicine (For Girls) Al‐Azhar University Cairo Egypt
| | | | - Maha A. Omar
- Dermatology Department Faculty of Medicine (For Girls) Al‐Azhar University Cairo Egypt
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Efficacy of laser treatment for onychomycotic nails: a systematic review and meta-analysis of prospective clinical trials. Lasers Med Sci 2019; 34:1513-1525. [DOI: 10.1007/s10103-019-02802-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/03/2019] [Indexed: 11/26/2022]
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Bitew A, Wolde S. Prevalence, Risk Factors, and Spectrum of Fungi in Patients with Onychomycosis in Addis Ababa, Ethiopia: A Prospective Study. J Trop Med 2019; 2019:3652634. [PMID: 31275400 PMCID: PMC6582801 DOI: 10.1155/2019/3652634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Onychomycosis is a common refractory infection deleteriously affecting quality of life via social stigma and upsetting day-to-day activities. OBJECTIVE To study the prevalence of onychomycosis, spectrum of fungal etiological agents, and associated risk factors. METHODS A prospective nonrandomized study on the prevalence of onychomycosis was carried out from September 2017 to April 2018 at a dermatology center in Addis Ababa. Nail scrapings were collected from 303 patients clinically identified with nail disorders of fungal origin by dermatologists. Fungal etiological agents were identified microscopically and by culture method following standard procedures. RESULTS The prevalence of onychomycosis was 60.4%. Fungi neither were detected nor showed visible fungal growth in 39.6% of the cases. Females were more likely to present dystrophic nails than men. Patients in the middle age group were more affected. The isolation rates of dermatophytes, yeasts, and nondermatophyte molds were 44.7%, 33.3%, and 32.3%, respectively. Trichophyton rubrum, Scytalidium dimidiatum, and Candida albicans were the dominant species of dermatophytes, nondermatophyte molds, and yeasts, respectively. There was no statistically significant association between onychomycosis and risk factors. CONCLUSIONS The prevalence rate of onychomycosis in the present study was high. The isolation rate of nondermatophyte molds was comparable with that of dermatophytes. Further studies on the prevalence of onychomycosis, fungal etiological agents, and changes in species distribution of the etiological agents of nail infection in Ethiopia are important.
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Affiliation(s)
- Adane Bitew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sinknesh Wolde
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Real-time PCR: A rapid and sensitive method for diagnosis of dermatophyte induced onychomycosis, a comparative study. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bajuk V, Leskovec NK, Ručigaj TP, Suhodolčan AB, Dolenc-Voljč M. Toenail alterations in chronic venous disease patients are not always of mycotic origin. Phlebology 2018; 34:421-426. [PMID: 30541415 DOI: 10.1177/0268355518818619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The prevalence of toenail alterations in chronic venous disease has only rarely been studied. We aimed to establish the frequency and clinical characteristics of toenail onychomycosis in chronic venous disease. Methods We included 80 adult patients, in all stages of chronic venous disease. Onychomycosis was confirmed by mycological examination. The clinical type of onychomycosis and the onychomycosis severity index were determined. Clinical characteristics of non-fungal nail changes were also analyzed. Results We included 58 women and 22 men, with a mean age of 67.0 years. Pathological toenail changes were observed in 83.8% of patients. Onychomycosis was confirmed in 33.8% of all patients and was more frequent in higher clinical stages of chronic venous disease (p = 0.009). Trichophyton rubrum was the leading causative pathogen. Disto-lateral onychomycosis was most commonly present. Average onychomycosis severity index was 23.1. Conclusion Onychomycosis accounted for 40% of all toenail alterations. Patients with chronic venous disease often have severe and difficult to treat toenail onychomycosis.
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Affiliation(s)
- Vid Bajuk
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Nada Kecelj Leskovec
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tanja Planinšek Ručigaj
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Mateja Dolenc-Voljč
- 1 Department of Dermatovenereology, University Medical Centre Ljubljana, Ljubljana, Slovenia.,2 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Murdan S. Nail disorders in older people, and aspects of their pharmaceutical treatment. Int J Pharm 2016; 512:405-411. [DOI: 10.1016/j.ijpharm.2016.05.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 12/14/2022]
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Maraki S, Mavromanolaki VE. Epidemiology of onychomycosis in Crete, Greece: a 12-year study. Mycoses 2016; 59:798-802. [DOI: 10.1111/myc.12533] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/25/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine; University Hospital of Heraklion; Heraklion Greece
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Abstract
Background: Onychomycosis is a persistent fungal nail infection that is notoriously hard to treat. Approximately 20% to 25% of patients with onychomycosis do not respond to treatment, and 10% to 53% of patients relapse. As such, successful treatment is imperative for long-term disease management. Objective: To identify ways to improve cure rates for onychomycosis. Method: The literature on onychomycosis treatment and recurrence was reviewed to summarize treatment approaches and suggest strategies to increase cure rates. Results and Conclusion: To improve treatment success in onychomycosis, we suggest the following measures be followed: (1) onychomycosis must be correctly diagnosed, (2) the treatment regimen should be tailored to the individual patient, (3) the efficacy of antifungals must be maximized, and (4) recurrence must be prevented.
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Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Mediprobe Research, Inc, London, ON, Canada
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21
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Castilla-Guerra L, Coronel-Pérez IM, Rodríguez-Rey EM. [Onychomadesis: An unusual sign of alarm in the elderly]. Rev Esp Geriatr Gerontol 2016; 51:183-184. [PMID: 26548847 DOI: 10.1016/j.regg.2015.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
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Opportunistic fungi in lake water and fungal infections in associated human population in Dal Lake, Kashmir. Microb Pathog 2016; 93:105-10. [DOI: 10.1016/j.micpath.2016.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/26/2016] [Indexed: 11/23/2022]
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Robres P, Aspiroz C, Rezusta A, Gilaberte Y. Utilidad de la terapia fotodinámica en el manejo de la onicomicosis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:795-805. [DOI: 10.1016/j.ad.2015.08.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 11/28/2022] Open
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Efinaconazole Topical Solution, 10%: Factors Contributing to Onychomycosis Success. J Fungi (Basel) 2015; 1:107-114. [PMID: 29376902 PMCID: PMC5753103 DOI: 10.3390/jof1020107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/16/2022] Open
Abstract
To provide an adequate therapeutic effect against onychomycosis, it has been suggested that topical drugs should have two properties: drug permeability through the nail plate and into the nail bed, and retention of their antifungal activity in the disease-affected areas. Only recently has the importance of other delivery routes (such as subungual) been discussed. Efinaconazole has been shown to have a more potent antifungal activity in vitro than the most commonly used onychomycosis treatments. The low keratin affinity of efinaconazole contributes to its effective delivery through the nail plate and retention of its antifungal activity. Its unique low surface tension formulation provides good wetting properties affording drug delivery both through and under the nail. High antifungal drug concentrations have been demonstrated in the nail of onychomycosis patients, and effectiveness of efinaconazole topical solution, 10% confirmed in two large well-controlled multicenter Phase 3 clinical studies in patients with mild-to-moderate disease.
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26
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LaSenna CE, Tosti A. Patient considerations in the management of toe onychomycosis - role of efinaconazole. Patient Prefer Adherence 2015; 9:887-91. [PMID: 26170638 PMCID: PMC4494615 DOI: 10.2147/ppa.s72701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Onychomycosis is a difficult diagnosis to manage and treatment is sometimes avoided, as this diagnosis is often wrongly perceived as a cosmetic problem. However, onychomycosis has a negative impact on patients' quality of life, affecting social interaction, psychological well-being, and physical activities. Onychomycosis is also a risk factor for patients with diabetes, with proven increased rates of cellulitis, gangrene, and foot ulcers. Treatments are only mild to moderately effective, and rates of relapse and reinfection are high. Oral treatments require laboratory monitoring due to risk of hepatotoxicity and may be contraindicated in some patients due to risk of drug-drug interactions. Topical treatments require prolonged application and are not very effective. Efinaconazole 10% solution is a new topical triazole treatment for mild to moderate distal subungual onychomycosis, with good efficacy and without the need for debridement of nails. In onychomycosis of the toenails, efinaconazole 10% solution is documented to have a statistically significant, positive impact on patient satisfaction and quality of life.
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Affiliation(s)
- Charlotte E LaSenna
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
- Correspondence: Charlotte LaSenna, Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 Northwest, 10th Avenue, RMSB Building, Room 2023C, Miami, FL 33136, USA, Tel +1 305 243 5523, Fax +1 305 243 5810, Email
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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Gupta AK, Daigle D, Foley KA. The prevalence of culture-confirmed toenail onychomycosis in at-risk patient populations. J Eur Acad Dermatol Venereol 2014; 29:1039-44. [PMID: 25413984 DOI: 10.1111/jdv.12873] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.
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Affiliation(s)
- A K Gupta
- University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc., London, ON, Canada
| | - D Daigle
- Mediprobe Research Inc., London, ON, Canada
| | - K A Foley
- Mediprobe Research Inc., London, ON, Canada
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Pollak RA. Efinaconazole topical solution, 10%: the development of a new topical treatment for toenail onychomycosis. J Am Podiatr Med Assoc 2014; 104:568-73. [PMID: 25514267 DOI: 10.7547/8750-7315-104.6.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Toenail onychomycosis is a common disease with limited treatment options; treatment failure and relapse are frequently encountered. Many patients experience long-standing disease affecting multiple toenails, with substantial discomfort and pain. Although some patients might prefer a topical therapy, efficacy with ciclopirox nail lacquer has been disappointing. METHODS Efinaconazole topical solution, 10% is the first topical triazole antifungal agent specifically developed for the treatment of onychomycosis. This paper reviews the preclinical and clinical data on efinaconazole topical solution, 10%. RESULTS Efinaconazole has a broad spectrum of antifungal activity in vitro and is more potent than ciclopirox against common onychomycosis pathogens. It has a more optimal keratin affinity than ciclopirox, and it exhibits significantly greater in vivo activity owing to its superior nail penetration. Mycologic cure rates at week 52 were 55.2% (study 1) and 53.4% (study 2) with efinaconazole topical solution, 10% compared with 16.8% and 16.9%, respectively, with vehicle (P<.001 for both). In addition, efinaconazole is well tolerated. CONCLUSIONS Efinaconazole topical solution, 10% may likely become a preferred topical agent for the management of mild-to-moderate onychomycosis.
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Miura Y, Takehara K, Nakagami G, Amemiya A, Kanazawa T, Kimura N, Kishi C, Koyano Y, Tamai N, Nakamura T, Kawashima M, Tsunemi Y, Sanada H. Screening for tinea unguium by thermography in older adults with subungual hyperkeratosis. Geriatr Gerontol Int 2014; 15:991-6. [DOI: 10.1111/ggi.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Yuka Miura
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Japan Society for the Promotion of Science; The University of Tokyo; Tokyo Japan
| | - Kimie Takehara
- Department of Nursing Administration; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Ayumi Amemiya
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
- Japan Society for the Promotion of Science; The University of Tokyo; Tokyo Japan
| | - Toshiki Kanazawa
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Nao Kimura
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Yuiko Koyano
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Nao Tamai
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | | | - Makoto Kawashima
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - Yuichiro Tsunemi
- Department of Dermatology; Tokyo Women's Medical University; Tokyo Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Rezaei-Matehkolaei A, Mirhendi H, Makimura K, de Hoog GS, Satoh K, Najafzadeh MJ, Shidfar MR. Nucleotide sequence analysis of beta tubulin gene in a wide range of dermatophytes. Med Mycol 2014; 52:674-88. [PMID: 25079222 DOI: 10.1093/mmy/myu033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We investigated the resolving power of the beta tubulin protein-coding gene (BT2) for systematic study of dermatophyte fungi. Initially, 144 standard and clinical strains belonging to 26 species in the genera Trichophyton, Microsporum, and Epidermophyton were identified by internal transcribe spacer (ITS) sequencing. Subsequently, BT2 was partially amplified in all strains, and sequence analysis performed after construction of a BT2 database that showed length ranged from approximately 723 (T. ajelloi) to 808 nucleotides (M. persicolor) in different species. Intraspecific sequence variation was found in some species, but T. tonsurans, T. equinum, T. concentricum, T. verrucosum, T. rubrum, T. violaceum, T. eriotrephon, E. floccosum, M. canis, M. ferrugineum, and M. audouinii were invariant. The sequences were found to be relatively conserved among different strains of the same species. The species with the closest resemblance were Arthroderma benhamiae and T. concentricum and T. tonsurans and T. equinum with 100% and 99.8% identity, respectively; the most distant species were M. persicolor and M. amazonicum. The dendrogram obtained from BT2 topology was almost compatible with the species concept based on ITS sequencing, and similar clades and species were distinguished in the BT2 tree. Here, beta tubulin was characterized in a wide range of dermatophytes in order to assess intra- and interspecies variation and resolution and was found to be a taxonomically valuable gene.
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Affiliation(s)
- Ali Rezaei-Matehkolaei
- Departments of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Mirhendi
- Departments of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Koichi Makimura
- Teikyo University Institute of Medical Mycology, Tokyo, Japan
| | - G Sybren de Hoog
- Fungal Biodiversity Center, Institute of the Royal Netherlands, Academy of Arts and Sciences, Centraalbureau voor Schimmelcultures-KNAW, Utrecht, The Netherlands
| | - Kazuo Satoh
- Teikyo University Institute of Medical Mycology, Tokyo, Japan
| | - Mohammad Javad Najafzadeh
- Department of Parasitology and Mycology, Ghaem Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Shidfar
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Tietz HJ, Hay R, Querner S, Delcker A, Kurka P, Merk HF. Efficacy of 4 weeks topical bifonazole treatment for onychomycosis after nail ablation with 40% urea: a double-blind, randomized, placebo-controlled multicenter study. Mycoses 2013; 56:414-21. [DOI: 10.1111/myc.12037] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kozhichkina NV. Etiology of foot mycosis and onychomycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents data from Russian and foreign sources related to the etiology of foot mycosis and onychomycosis. In spite of the substantial spread of data by countries and regions of the world, dermatophytes play a leading part in the etiology of foot mycosis and onychomycosis, and Trichophyton rubrum is found in most studies in more than one half of all cases. Yeast-like fungi of the Candida genus as well as mold fungi belong to less frequent pathogens of foot mycosis. However, they play a greater role in countries with hot and humid climate such as Brazil, Indonesia, Columbia and India. These data are important for the determination of organizational measures aimed at the early diagnostics of patients, timely treatment and implementation of anti-epidemic and disinfectant measures.
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Succi IB, Bernardes-Engemann AR, Orofino-Costa R. Intermittent therapy with terbinafine and nail abrasion for dermatophyte toe onychomycosis: a pilot study. Mycoses 2013; 56:327-32. [DOI: 10.1111/myc.12032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomas J, Jacobson GA, Narkowicz CK, Peterson GM, Burnet H, Sharpe C. REVIEW ARTICLE: Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 2010; 35:497-519. [DOI: 10.1111/j.1365-2710.2009.01107.x] [Citation(s) in RCA: 204] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Carrillo-Muñoz AJ, Tur-Tur C, Hernández-Molina JM, Santos P, Cárdenes D, Giusiano G. [Antifungal agents for onychomycoses]. Rev Iberoam Micol 2010; 27:49-56. [PMID: 20346303 DOI: 10.1016/j.riam.2010.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 01/17/2010] [Accepted: 01/21/2010] [Indexed: 11/29/2022] Open
Abstract
Nail fungal infections are considered one of the major dermatological problems due to their high rate of therapeutic failure, management and treatment difficulties. Long-term treatments, inadequate therapies, mycological misdiagnosis and follow-up, secondary alterations of the nail, and resistant microorganisms, are some of the causes of these complications. Although the discovery of new antifungal agents has provided some effective molecules, none of the current available drugs are totally effective. It is important to continue researching in this field to provide new antifungal agents and combined therapies.
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Mycoses in the elderly. Eur J Clin Microbiol Infect Dis 2009; 29:5-13. [DOI: 10.1007/s10096-009-0822-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 09/24/2009] [Indexed: 12/19/2022]
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Abstract
Onychomycosis is a common fungal infection affecting nails. The primary cause for onychomycosis is dermatophytes, while Candida species have emerged as second-line pathogens. Onychomycosis due to Candida (candidal onychomycosis) is increasingly found in individuals having defective immunity consequential to aging, diabetes mellitus, vascular diseases, HIV infection and drug therapies such as immunosuppressives and broad-spectrum antibiotics. Breached local immunity at the nail complex due to trauma, chronic exposure to moisture and chemicals including smoke, detergents, soap, etc., also contribute to candidal onychomycosis. Adhesion, filamentation, secretion of extracellular enzymes and the development of antifungal resistance are some of the virulence mechanisms of Candida species associated with onychomycosis. Diagnosis of onychomycosis depends on history and clinical examination, direct microscopic investigation, mycological culture and histopathology. Restoration of immune defenses, elimination of fungi using appropriate drug therapy and improvement of nail hygiene with the removal of predisposing factors are key aspects in the management of candidal onychomycosis.
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Yamaguchi MU, Barbosa da Silva AP, Ueda-Nakamura T, Dias Filho BP, Conceição da Silva C, Nakamura CV. Effects of a thiosemicarbazide camphene derivative on Trichophyton mentagrophytes. Molecules 2009; 14:1796-807. [PMID: 19471200 PMCID: PMC6254219 DOI: 10.3390/molecules14051796] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 12/02/2022] Open
Abstract
Thiosemicarbazides are compounds known for their biological activity, particularly their antimicrobial properties, which include activity against fungi. The difficulty of treating fungal diseases induced us to assess the antifungal properties of some novel thiosemicarbazide compounds. We selected the natural products limonene and camphene as sources for the preparation of these new thiosemicarbazide derivatives. The compound N(4)-[2,2-dimethyl-3-methylnorbornane]-thiosemicarbazide (TIO C) showed an antifungal effect on Trichophyton mentagrophytes, with values of MIC = 55 μmol L-1 and MFC = 110 μmol L-1. Scanning-electron microscopy showed a decrease in mycelium development and morphological alterations of T. mentagrophytes cultured on nail fragments and treated with TIO C. In an attempt to discover its mode of action, we noted that ergosterol is apparently not a target of TIO C activity. An effect of TIO C on T. mentagrophytes cell walls and dividing cross-walls was shown by observed impairment of the fluorescence of tissues stained with calcofluor white, a specific marker for fungal chitin, suggesting that the compound can affect and damage the cell-wall structure or may interfere with its formation, during cell division, growth, and morphogenesis. This approach to the synthesis of new derivatives might provide interesting compounds with greater biological activity in pharmacological research.
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Affiliation(s)
- Mirian Ueda Yamaguchi
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, PR, Brazil; E-mails: (M-U.Y.), (T-U.N.), (B-D.F.), (C-V.N.)
- Author to whom correspondence should be addressed; E-mail: ; Tel: +55 44 3261 1397; Fax: +55 44 3261 4860
| | | | - Tânia Ueda-Nakamura
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, PR, Brazil; E-mails: (M-U.Y.), (T-U.N.), (B-D.F.), (C-V.N.)
| | - Benedito Prado Dias Filho
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, PR, Brazil; E-mails: (M-U.Y.), (T-U.N.), (B-D.F.), (C-V.N.)
| | | | - Celso Vataru Nakamura
- Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Estadual de Maringá, PR, Brazil; E-mails: (M-U.Y.), (T-U.N.), (B-D.F.), (C-V.N.)
- Author to whom correspondence should be addressed; E-mail: ; Tel: +55 44 3261 1397; Fax: +55 44 3261 4860
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CD4+CD25+ Treg cells in patients with toenail onychomycosis. Arch Dermatol Res 2009; 301:725-9. [DOI: 10.1007/s00403-009-0941-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 02/13/2009] [Accepted: 03/02/2009] [Indexed: 01/05/2023]
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Arroll B, Oakley A. Preventing long term relapsing tinea unguium with topical anti-fungal cream: a case report. CASES JOURNAL 2009; 2:70. [PMID: 19154619 PMCID: PMC2647914 DOI: 10.1186/1757-1626-2-70] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/21/2009] [Indexed: 11/18/2022]
Abstract
Background The patient was aged 34 when he consulted a dermatologist in Vancouver BC with onychomycosis affecting the right great toenail. Case presentation Trichophyton rubrum was cultured from nail clippings. Griseofulvin was taken for 6 months, resulting in clinical and mycological cure. Over the next 27 years there were multiple relapses. Each course of treatment with oral terbinafine (for up to 18 months) or itraconazole resulted in clinical and mycological cure. A dermatological colleague suggested the reason for relapse was likely to be self re-infection. Conclusion No clinical relapse has occurred with once-weekly miconazole cream applied to the toenail and webspaces of the right foot over the last four years.
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Affiliation(s)
- Bruce Arroll
- University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Abstract
Onychomycosis is the most common single cause of nail dystrophy and has a marked impact on quality of life. The availability of newer topical and systemic antifungal agents has improved our ability to effectively treat this condition. This article will review the most commonly used therapies and discuss the relative advantages and disadvantages of different treatment strategies.
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