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Antifungal Nail Lacquer for Enhanced Transungual Delivery of Econazole Nitrate. Pharmaceutics 2022; 14:pharmaceutics14102204. [PMID: 36297639 PMCID: PMC9607990 DOI: 10.3390/pharmaceutics14102204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
The fungal disease of the nail, onychomycosis, which is also the most prevalent nail disturbance, demands effective topical treatment options considering the possible adverse effects of systemic antifungal therapy. The current work is focused on development of an adhesive and resistant, drug-delivering and permeation-enhancing polymeric film containing econazole nitrate (ECN) for topical antifungal treatment. The development of the lacquer formulation was guided by the Quality by Design approach to achieve the critical quality attributes needed to obtain the product of desired quality. Eudragit RSPO at 10% w/w was found to be the ideal adhesive polymer for the application and an optimal permeation-enhancing lacquer formulation was achieved by the optimization of other formulation excipients, such as plasticizer and the solvent system. Additionally, novel experimental enhancements introduced to the research included refined D50 drying time and drying rate tests for lacquer characterization as well as a multi-mechanism permeation-enhancing pre-treatment. Moreover, a practical implication was provided by a handwashing simulation designed to test the performance of the lacquer during actual use. In vitro drug release testing and ex vivo nail permeation testing demonstrated that the optimized nail lacquer performed better than control lacquer lacking the permeation enhancer by achieving a faster and sustained delivery of ECN. It can be concluded that this is a promising drug delivery system for topical antifungal treatment of onychomycotic nails, and the novel characterization techniques may be adapted for similar formulations in the future.
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Uemura EVG, Barbosa MDS, Simionatto S, Al-Harrasi A, Al-Hatmi AMS, Rossato L. Onychomycosis Caused by Fusarium Species. J Fungi (Basel) 2022; 8:jof8040360. [PMID: 35448591 PMCID: PMC9027400 DOI: 10.3390/jof8040360] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
Onychomycosis is a nail fungal infection that produces nail discolouration, thickness, and separation from the nail bed. The species of the Fusarium genus that cause onychomycosis are emerging and the number of cases has increased throughout the years. Microscopic examination, as well as cultures, are required for the accurate diagnosis of onychomycosis. The goal of treatment is to eliminate the organism that causes the disease and restore the nail’s normal appearance. Here, we provide an overview of the onychomycosis cases that have been reported in literature over the last 24 years, which have been caused by the Fusarium species. We performed a review on the onychomycosis cases caused by the Fusarium species from January 1997 to January 2021. Patients aged between 40 and 49 years made up 30.23% of the cases. The most common aetiologic species was Fusarium solani species complex (FSSC), which accounted for 44.11% of the cases, followed by F. fujikuroi species complex (FFSC), which accounted for 17.64%; 14.70% of the cases were due to F. dimerum species complex (FDSC) and 14.70% of the cases were due F. oxysporum species complex (FOSC). Europe accounted for 29.06% of the cases caused by FOSC, whereas Africa accounted for 46.67% of the cases due to FSSC. The clinical presentation of onychomycosis due to Fusarium spp. is commonly the distal–lateral pattern of onychomycosis. Identification of the infectious agent in onychomycosis cases due to Fusarium is crucial in deciding the proper treatment. Although antifungal susceptibility tests have only been performed in a few cases, susceptibility testing can help with patient management.
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Affiliation(s)
- Eduardo Vinicius Grego Uemura
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados 79862-000, MS, Brazil; (E.V.G.U.); (M.d.S.B.); (S.S.)
| | - Marcelo dos Santos Barbosa
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados 79862-000, MS, Brazil; (E.V.G.U.); (M.d.S.B.); (S.S.)
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados 79862-000, MS, Brazil
| | - Simone Simionatto
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados 79862-000, MS, Brazil; (E.V.G.U.); (M.d.S.B.); (S.S.)
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa 616, Oman; (A.A.-H.); (A.M.S.A.-H.)
| | - Abdullah M. S. Al-Hatmi
- Natural & Medical Sciences Research Center, University of Nizwa, Nizwa 616, Oman; (A.A.-H.); (A.M.S.A.-H.)
- Centre of Expertise in Mycology, Radboud University Medical Centre/Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
| | - Luana Rossato
- Faculdade de Ciências da Saúde, Universidade Federal da Grande Dourados, Dourados 79862-000, MS, Brazil; (E.V.G.U.); (M.d.S.B.); (S.S.)
- Correspondence: ; Tel.: +55-11-971224947
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3
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Gupta AK, Venkataraman M, Renaud HJ, Summerbell R, Shear NH, Piguet V. A Paradigm Shift in the Treatment and Management of Onychomycosis. Skin Appendage Disord 2021; 7:351-358. [PMID: 34604322 DOI: 10.1159/000516112] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022] Open
Abstract
There is an increase in the incidence of onychomycosis, especially in at-risk populations. Onychomycosis is difficult to treat, as the efficacy of most antifungal agents is relatively low. Nondermatophyte molds (NDMs) and mixed infection (dermatophyte plus NDM) onychomycosis are contributing to growing antifungal resistance, as they are often underestimated and ignored due to incorrect diagnosis. There is a need for a paradigm shift in the management of onychomycosis to a patient-centered, holistic approach with an emphasis on laboratory diagnosis prior to initiating treatment, which enables the rational choice of the antifungal agent. Additionally, in the case of resistant infections, antifungal susceptibility testing is recommended. Strategies for effective management of onychomycosis include disinfection of fungal reservoirs in shoes and socks and prophylaxis posttreatment using topical antifungal agents. These measures may reduce the recurrence of onychomycosis and improve long-term clinical success.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | | | | | - Richard Summerbell
- Sporometrics, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada
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4
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Gupta AK, Summerbell RC, Venkataraman M, Quinlan EM. Nondermatophyte mould onychomycosis. J Eur Acad Dermatol Venereol 2021; 35:1628-1641. [PMID: 33763903 DOI: 10.1111/jdv.17240] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 01/21/2023]
Abstract
Nondermatophyte moulds (NDMs) onychomycosis is often difficult to diagnose as NDMs have been considered contaminants of nails. There are several diagnostic methods used to identify NDMs, however, repeated laboratory isolation is recommended to validate pathogenicity. With NDM and mixed infection (dermatophytes plus NDM) onychomycosis on the rise, accurate clinical diagnosis along with mycological tests is recommended. Systemic antifungal agents such as itraconazole and terbinafine (e.g. pulse regimen: 1 pulse = every day for one week, followed by no treatment for three weeks) have shown efficacy in treating onychomycosis caused by various NDMs such as Aspergillus spp., Fusarium spp., Scopulariopsis brevicaulis, and Onychocola canadensis. Studies investigating topical therapy and devices for NDM onychomycosis are limited. The emergence of antifungal resistance necessitates the incorporation of antifungal susceptibility testing into diagnosis when possible, for the management of recalcitrant infections. Case studies documented in the literature show newer azoles such as posaconazole and voriconazole as sometimes effective in treating resistant NDM onychomycosis. Treatment with broad-spectrum antifungal agents (e.g. itraconazole and efinaconazole) and other combination therapy (oral + oral and/or oral + topical) may be considerations in the management of NDM onychomycosis.
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Affiliation(s)
- A K Gupta
- Mediprobe Research Inc., London, ON, Canada.,Department of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - R C Summerbell
- Sporometrics, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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5
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Guo J, Ding A, Zhang J. Combination of toenail thinning and photodynamic therapy in distal and lateral subungual onychomycosis treatment: A case report. Photodiagnosis Photodyn Ther 2020; 30:101692. [DOI: 10.1016/j.pdpdt.2020.101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/16/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
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6
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Iozumi K, Abe M, Ito Y, Uesugi T, Onoduka T, Kato I, Kato F, Kodama K, Takahashi H, Takeda O, Tomizawa K, Nomiyama T, Fujii M, Mayama J, Muramoto F, Yasuda H, Yamanaka K, Sato T, Oh-I T, Kasai H, Tsuboi R, Hattori N, Maruyama R, Omi T, Shimoyama H, Sei Y, Nakasu I, Nishimoto S, Hata Y, Mochizuki T, Fukuzawa M, Seishima M, Sugiura K, Katayama I, Yamamoto O, Shindo M, Kiryu H, Kusuhara M, Takenaka M, Watanabe S. Efficacy of long-term treatment with efinaconazole 10% solution in patients with onychomycosis, including severe cases: A multicenter, single-arm study. J Dermatol 2019; 46:641-651. [PMID: 31206779 PMCID: PMC6771904 DOI: 10.1111/1346-8138.14935] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/01/2019] [Indexed: 11/28/2022]
Abstract
We evaluated the efficacy of efinaconazole 10% topical solution in long‐term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE‐t, suggested that efinaconazole treatment improved the patients’ quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long‐term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.
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Affiliation(s)
- Ken Iozumi
- Department of Dermatology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | | | | | | | | | - Ichiro Kato
- Eniwa Station Dermatology Clinic, Hokkaido, Japan
| | | | | | | | - Osamu Takeda
- Takeda Dermatological Skin Care Clinic, Hokkaido, Japan
| | | | | | - Mizue Fujii
- Department of Dermatology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Jun Mayama
- Chitose Dermatology and Plastic Surgery Clinic, Hokkaido, Japan
| | | | | | | | - Tomotaka Sato
- Department of Dermatology, Teikyo University Chiba Medical Center, Chiba, Japan.,Department of Dermatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | | | - Hiroko Kasai
- Department of Dermatology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Ryoji Tsuboi
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | | | | | - Tokuya Omi
- Queen's Square Medical Center, Kanagawa, Japan
| | - Harunari Shimoyama
- Department of Dermatology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Yoshihiro Sei
- Department of Dermatology, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | | | - Shuhei Nishimoto
- Department of Dermatology, Saiseikai Kanagawa Hospital, Kanagawa, Japan
| | - Yasuki Hata
- Department of Dermatology, Saiseikai Kanagawa Hospital, Kanagawa, Japan.,Kanagawa Hata Dermatology Clinic, Kanagawa, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Ishikawa, Japan
| | - Masao Fukuzawa
- Department of Dermatology, Ina Central Hospital, Nagano, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Osamu Yamamoto
- Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Tottori University Faculty of Medicine, Tottori, Japan
| | - Masahisa Shindo
- Department of Dermatology, National Hospital Organization Hamada Medical Center, Shimane, Japan
| | | | | | - Motoi Takenaka
- Department of Dermatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Shinichi Watanabe
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
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7
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Brown SJ. Pharmacy Technicians and Improving Onychomycosis Treatment Outcomes. J Pharm Technol 2019; 35:82-87. [PMID: 34860989 DOI: 10.1177/8755122518815057] [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] Open
Abstract
Objective: To provide an overview of onychomycosis and current treatments and to identify opportunities for pharmacy technicians to improve treatment outcomes. Data Sources: A MEDLINE/PubMed search (1966 to October 2018) was performed using search terms designed to identify English-language articles on onychomycosis diagnosis, treatment, and prevention, as well as articles on the impact of pharmacy technicians on onychomycosis outcomes and the use of pharmacy technicians to improve treatment adherence. Study Selection and Data Extraction: Review articles and clinical studies describing onychomycosis, risk factors, treatment efficacy, and prevention of recurrent infections were included. Data Synthesis: Although no articles on the impact of pharmacy technicians in the treatment of onychomycosis were found, the importance of treatment adherence on positive outcomes highlights a potential role of pharmacy technicians. Pharmacy technicians can identify patients with potential onychomycosis based on questions about over-the-counter products and refer patients to the pharmacist for counseling on treatment. Pharmacy technicians can also reinforce treatment adherence at refill visits. Conclusions: Pharmacy technicians can have a positive impact on onychomycosis treatment outcomes by addressing barriers to successful treatment and promoting treatment adherence.
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8
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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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9
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Gupta AK, Mays RR, Versteeg SG, Piraccini BM, Takwale A, Shemer A, Babaev M, Grover C, Di Chiacchio NG, Taborda PRO, Taborda VBA, Shear NH, Piguet V, Tosti A. Global perspectives for the management of onychomycosis. Int J Dermatol 2018; 58:1118-1129. [PMID: 30585300 DOI: 10.1111/ijd.14346] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/24/2018] [Accepted: 11/24/2018] [Indexed: 12/18/2022]
Abstract
Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating onychomycosis were similar between countries, slight differences in onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of onychomycosis provides a framework of success for the committed clinician with appreciation of how onychomycosis is managed worldwide.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Incorporated, London, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Bianca Maria Piraccini
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Anita Takwale
- Gloucestershire Royal Hospital, Gloucester, United Kingdom
| | - Avner Shemer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Babaev
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Chander Grover
- Division of Dermatology and STD, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Nilton G Di Chiacchio
- Dermatology Clinic, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Paulo R O Taborda
- Division of Dermatology, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, Women's College Hospital, Toronto, Canada.,Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology, University of Miami, Miami, FL, USA
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Gupta AK, Versteeg SG, Shear NH. Common drug-drug interactions in antifungal treatments for superficial fungal infections. Expert Opin Drug Metab Toxicol 2018; 14:387-398. [DOI: 10.1080/17425255.2018.1461834] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto School of Medicine, Toronto, Canada
- Mediprobe Research Inc., London, Canada
| | | | - Neil H. Shear
- 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, Canada
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11
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Gupta AK, Vlahovic TC, Foley KA, Lowe NG, Turner R, Brown M, Hall S. In vitro efficacy of tavaborole topical solution, 5% after penetration through nail polish on ex vivo human fingernails. J DERMATOL TREAT 2018; 29:633-636. [DOI: 10.1080/09546634.2017.1422078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto, Toronto, Canada
- Mediprobe Research Inc, London, Canada
| | | | | | | | | | - Marc Brown
- MedPharm Ltd, Guildford, UK
- TDDT, School of Health and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Steve Hall
- Medical Affairs, Sandoz Pharmaceuticals Inc, Princeton, NJ, USA
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12
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Xiao Y, Xu YK, Pattengale P, O'Gorman MR, Fu X. A Rapid High-Performance LC-MS/MS Method for Therapeutic Drug Monitoring of Voriconazole, Posaconazole, Fluconazole, and Itraconazole in Human Serum. ACTA ACUST UNITED AC 2017; 1:626-636. [DOI: 10.1373/jalm.2016.022756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
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13
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Li Y, Xu J, Zhao JY, Zhuo FL. Self-controlled Study of Onychomycosis Treated with Long-pulsed Nd:YAG 1064-nm Laser Combined with Itraconazole. Chin Med J (Engl) 2017; 129:1929-34. [PMID: 27503017 PMCID: PMC4989423 DOI: 10.4103/0366-6999.187858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Onychomycosis is a fungal infection of the nail plate and subungual area. In this study, we examined the efficacy of laser treatment using self-controlled study programs involving a long-pulsed Nd:YAG 1064-nm laser combined with oral medication. Methods: Self-controlled strategies were followed in this study. The patients received treatment with oral itraconazole in conjunction with long-pulsed Nd:YAG 1064-nm laser treatment at the nails of the unilateral limb once a week for a total of four times. A total of 84 affected nails were divided into Group A (mild to moderate) and Group B (severe) according to disease severity. Affected nails with the same Scoring Clinical Index for Onychomycosis scores were selected to compare the therapeutic effects of the pure medication treatment group and the combination treatment group with a 24-week follow-up period. Results: In Group A, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 81.0%, 81.0%, and 90.5%, respectively, while those in the combination treatment group were 100%, 95.2%, and 90.5%, respectively. The differences between groups were not significant (8th week: χ2 = 4.421, P > 0.05; 16th week: χ2 = 2.043, P > 0.05; 24th week: χ2 = 0.00, P > 0.05). In Group B, at the 8th, 16th, and 24th weeks of follow-up, the efficacies in the pure medication treatment group were 61.9%, 66.7%, and 52.4%, respectively, while those in the combination treatment group were 95.2%, 90.5%, and 100%, respectively. The differences between groups at the 8th and 24th weeks of follow-up were statistically significant (8th week: χ2 = 6.929, P < 0.05; 24th week: χ2 = 13.125, P < 0.05). Conclusions: For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. For those patients with severe onychomycosis, we recommended a combination of medication and laser therapy.
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Affiliation(s)
- Yan Li
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jing Xu
- Department of Dermatology, Capital Institute of Pediatrics, Beijing 100020, China
| | - Jun-Ying Zhao
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Feng-Lin Zhuo
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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14
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Okan G, Tarikci N, Gokdemir G. The Effect of Long-Pulsed Nd:YAG Laser for the Treatment of Onychomycosis. J Am Podiatr Med Assoc 2017; 107:54-59. [PMID: 28271946 DOI: 10.7547/15-137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Topical onychomycosis therapies are usually inadequate, and patient compliance to systemic therapies is poor. Recently, interest in laser therapy for the treatment of onychomycosis has increased. We sought to investigate the efficacy of long-pulsed Nd:YAG laser therapy for onychomycosis. METHODS Thirty patients with mycologically confirmed onychomycosis received long-pulsed 1064-nm Nd:YAG laser therapy, moving the beam in a spiral pattern over the whole nail plate two times, with a 1-minute pause between passes. Laser therapy was performed with a spot diameter of 4 mm at a speed of 25 mm/sec once weekly for 4 weeks using fluencies ranging from 40 to 60 J/cm2, depending on the thickness of the nail plate. Patients were evaluated in terms of clinical improvement and mycologic cure. RESULTS Thirty patients started and 15 completed the study. Mycologic cure was achieved in nine patients (60%), of whom eight (89%) were infected with Trichophyton sp. Complete clinical improvement was achieved in seven patients (47%), all of whom were infected with Trichophyton sp. Mycologic cure was not achieved in one of two patients infected with Epidermophyton or in either patient in whom the agent was Candida or Aspergillus; complete clinical improvement did not occur in any of these patients. No serious adverse events were observed. CONCLUSIONS Based on these results, long-pulsed Nd:YAG laser can be used as an effective treatment for onychomycosis, but further studies are needed to draw firmer conclusions.
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Affiliation(s)
- Gökhan Okan
- Department of Dermatology, Kemerburgaz University, Kemerburgaz Tip Fakültesi Mahmutbey Dilmenler Caddesi, Istanbul, Turkey
| | - Nagehan Tarikci
- Department of Dermatology, Simav State Hospital, Kutahya, Turkey
| | - Gonca Gokdemir
- Department of Dermatology, Bahçeşehir Tip Fakültesi Beşiktaş Kampüsü, Bahcesehir University, Istanbul, Turkey
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Mushi MF, Buname G, Bader O, Groß U, Mshana SE. Aspergillus fumigatus carrying TR34/L98H resistance allele causing complicated suppurative otitis media in Tanzania: Call for improved diagnosis of fungi in sub-Saharan Africa. BMC Infect Dis 2016; 16:464. [PMID: 27589956 PMCID: PMC5009654 DOI: 10.1186/s12879-016-1796-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 08/23/2016] [Indexed: 12/03/2022] Open
Abstract
Background Suppurative otitis media (SOM) is a major public health concern worldwide and is associated with increased morbidity. Cases of fungal suppurative otitis media were studied to establish the effect of fungi in otitis media. Methods Ear swabs from 410 patients were collected aseptically using sterile cotton swabs from discharging ear through perforated tympanic membrane. Swabs were subjected to microscopic and culture investigations. The species of fungal growing on Sabouraud’s agar were identified using MALDI-TOF MS. For moulds broth micro dilution method following EUCAST guidelines was employed to determine susceptibility patterns against itraconazole, voriconazole and posaconazole. Results A total of 44 (10.74 %) cases with positive fungal culture growth were studied. The median age of patients with fungal infection was 29.5 (IQR 16–43) years. Of 44 patients; 35 (79.6 %) had pure growth of one type of fungal. Candida albicans was the most common fungus isolated (n = 13; 29.6 %) followed by Aspergillus versicolor (n = 8; 18.2 %). A total of 7 (15.9 %) patients had disease complication at time of enrollment; of them 6 (13.6 %) had hearing loss. On follow up 7 (15.9 %) had poor treatment outcome. All five Aspergillus fumigatus strains resistant itraconazole with reduced susceptibility to voriconazole and posaconazole carried carrying TR34/L98H resistance allele. In addition, all Penicillium citrinum isolates were resistant to voriconazole while all Penicillium sumatrense were resistant to both itraconazole and voriconazole. There were non-significant association of poor treatment outcome and female gender, being HIV positive and being infected with moulds. Conclusion Fungal infections play a significant role in SOM pathology in our setting. Diagnosis of fungal infections in developing countries should be improved so that appropriate management can be initiated on time to prevent associated complications.
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Affiliation(s)
- Martha F Mushi
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences (CUHAS), P.O. BOX 1464, Mwanza, Tanzania.
| | - Gustave Buname
- Department of Surgery, Bugando Medical Center, Mwanza, Tanzania
| | - Oliver Bader
- Institute of Medical Microbiology, University Medical Center Goettingen, Göttingen, Germany
| | - Uwe Groß
- Institute of Medical Microbiology, University Medical Center Goettingen, Göttingen, Germany
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Heath and Allied Sciences (CUHAS), P.O. BOX 1464, Mwanza, Tanzania
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Tsunemi Y. A questionnaire survey on drug selection by subtype and severity of onychomycosis and drug evaluation. ACTA ACUST UNITED AC 2016. [DOI: 10.3812/jocd.33.630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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