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Shah VK, Desai AD, Lipner SR. Retrospective Analysis of Onychomycosis Risk Factors Using the 2003-2014 National Inpatient Sample. Dermatol Pract Concept 2024; 14:dpc.1402a74. [PMID: 38810060 PMCID: PMC11135940 DOI: 10.5826/dpc.1402a74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors may inform onychomycosis screening guidelines. OBJECTIVES This retrospective study investigated common demographic and comorbidity risk factors among hospitalized patients using the National Inpatient Sample. METHODS The 2003-2014 National Inpatient Sample (NIS) database was used to identify onychomycosis cases and age and sex matched controls in a 1:2 ratio. Chi-square tests and T-tests for independent samples were utilized to compare categorical and continuous patient factors. Demographic and comorbidity variables significant (P < 0.05) on univariate analysis were analyzed via a multivariate regression model with Bonferroni correction (P < 0.0029). RESULTS 119,662 onychomycosis cases and 239,324 controls were identified. Compared to controls, onychomycosis patients frequently were White (69.0% versus 68.0%; P < 0.001), Black (17.9% versus 5.8%; P < 0.0001), and insured by Medicare or Medicaid (80.1% versus 71.1%; P < 0.0001). Patients had greater hospital stays (9.69 versus 5.39 days; P < 0.0001) and costs ($39,925 versus $36,720; P < 0.001) compared to controls. On multivariate analysis, onychomycosis was commonly associated with tinea pedis (odds ratio [OR]: 111.993; P < 0.0001), human immunodeficiency virus (OR: 4.372; P < 0.001), venous insufficiency (OR: 6.916; P < 0.0001), and psoriasis (OR: 3.668; P < 0.001). CONCLUSIONS Onychomycosis patients had longer hospital stays and greater costs compared to controls. Black patients were disproportionately represented among cases compared to controls. Onychomycosis was associated with tinea pedis, venous insufficiency, human immunodeficiency virus, psoriasis, obesity (body mass index [BMI] ≥ 30 kg/m2), peripheral vascular disease, and diabetes with chronic complications, suggesting that inpatients with onychomycosis should be screened for these conditions.
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Affiliation(s)
- Vrusha K. Shah
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Shari R. Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Yousefian F, Smythe C, Han H, Elewski BE, Nestor M. Treatment Options for Onychomycosis: Efficacy, Side Effects, Adherence, Financial Considerations, and Ethics. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:24-33. [PMID: 38495549 PMCID: PMC10941855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Onychomycosis is a fungal infection of the nail unit that affects a large patient population globally. Onychomycosis, or tinea unguium, has a benign chronic clinical course; however, it can cause complications in certain patient populations suffering from diabetes and peripheral vascular disease. As nails grow slowly, onychomycosis requires a lengthy treatment plan, and choosing appropriate treatments can be challenging. There are a variety of treatment modalities available for patients including topical, oral, laser, light therapy, procedures such as avulsion and matrixectomy, supplements, over-the-counter medication, and plasma therapy that can be used as monotherapy or in combination for patient satisfaction. Objective We sought to review treatment options for onychomycosis, taking into consideration the efficacy, side effect profiles, practicality of treatment (adherence), and costs to help healthcare providers offer ethically appropriate treatment regimens to their patients. Methods A literature search was conducted using electronic databases (PubMed, Embase, Medline, CINAHL, EBSCO) and textbooks, in addition to the clinical experiences of the authors and other practitioners in treating onychomycosis, and a summary of the findings are presented here. Results Although topical (efinaconazole, tavaborole, ciclopirox), oral (terbinafine, itraconazole), and laser (1064nm Nd:YAG lasers, both short-pulsed and Q-switched lasers, carbon dioxide lasers, and the diode 870, 930nm) are the current Food and Drug Administration (FDA)-approved treatments for onychomycosis, they are just a fraction of available treatment options. New and emerging therapies including new topical and oral medications, combination therapy, photodynamic light therapy, procedural, supplements, over-the-counter medication, and plasma therapy are discussed in our review. Discussion Onychomycosis has high reinfection and recurrence rates, and the treatment remains challenging as treatment selection involves ethical, evidence-based decision-making and consideration of each individual patient's needs, adherence, budget, the extent of quality of life discomfort, and aesthetic goals, independent of potential financial benefits to the clinicians.
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Affiliation(s)
- Faraz Yousefian
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Ciaran Smythe
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Haowei Han
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Boni E. Elewski
- Dr. Elewski is with the Department of Dermatology at the University of Alabama at Birmingham School of Medicine in Birmingham, Alabama
| | - Mark Nestor
- Drs. Yousefian, Smythe, Han and Nestor are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Additionally, Dr. Nestor is with the University of Miami's Miller School of Medicine in Miami, Florida
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Mickle AT, Lozano-Ortega G, Gaudet V, Popoff E, Barbeau M, Mathieu S. Toenail Onychomycosis with or without Diabetes in Canada: Patient Treatment Preferences and Health State Utilities. Patient Prefer Adherence 2024; 18:475-486. [PMID: 38410773 PMCID: PMC10896105 DOI: 10.2147/ppa.s450215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
Background Toenail onychomycosis affects approximately 6.7% of Canadians. Symptoms include nail discolouration/disfiguration and pain; psychosocial impacts contribute to reduced health-related quality-of-life. Comorbid diabetes increases the risk of complications and exacerbates burden. Treatment may include topical therapy and/or oral agents. Purpose To understand toenail onychomycosis treatment preferences, and to quantify the impact of toenail onychomycosis, with or without diabetes, on patient well-being. Methods Adults living in Canada with self-reported, physician-diagnosed, toenail onychomycosis were recruited online. A discrete choice experiment was used to quantify treatment preferences. Scenarios were randomized; data were analyzed using conditional logit regression. Health state utilities were estimated using the Health Utilities Index Mark 3®. Results were stratified by diabetes status and toenail onychomycosis severity; the Wilcoxon Rank Sum test was used to assess between-group utility differences. Results Three-hundred thirteen participants with toenail onychomycosis were included (161 had comorbid diabetes; 61.3%, severe onychomycosis). The mean age was 57.7 years; 55.9% were male. Treatment attributes with statistically significant impacts on patient preferences were efficacy (odds ratio [OR],1.04; 95% confidence interval [CI], 1.02-1.05 per 1% increased treatment success), administration method (one pill versus topical nail lacquer reference, 1.14; 1.04-1.26; topical solution applicator versus reference: 1.15; 1.03-1.29), severe adverse events (0.85; 0.80-0.90 per 1% increased risk), and risk of potential pharmacodynamic (0.80; 0.76-0.85) and alcohol (0.93; 0.88-0.98) interactions; preferences were more pronounced for efficacy and avoiding severe adverse events among toenail onychomycosis patients with comorbid diabetes. The mean (95% CI) utility value was 0.73 (0.70-0.75) overall, and statistically significantly lower (p=0.02) for toenail onychomycosis patients with diabetes (0.70; CI, 0.66-0.73) than those without (0.76; CI, 0.72-0.79). Conclusion Among patients with toenail onychomycosis, the presence of diabetes was associated with differing treatment-related preferences. Utility values for patients with toenail onychomycosis represent a significant decline from full health that is exacerbated by comorbid diabetes.
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Affiliation(s)
- Alexis T Mickle
- Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - Greta Lozano-Ortega
- Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - Veronique Gaudet
- Market Access and Government Affairs, Bausch Health, Canada Inc., Laval, Québec, Canada
| | - Evan Popoff
- Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada
| | - Martin Barbeau
- Market Access and Government Affairs, Bausch Health, Canada Inc., Laval, Québec, Canada
| | - Steve Mathieu
- Service de Dermatologie, Centre hospitalier de l'Université de Québec-Université Laval, Québec, Québec, Canada
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Fernandes FAV, Arruda DC, Santana GNP, Longo LVG, Cesar MCM, da Matta DA, Borba OSM, Monteiro RC, de Moura Bello M, de Moura LHB, Neto DJ, Yarak S, de Camargo ZP, Gompertz OF, Ogawa MM. Morphological and ultrastructural changes in fungal agents after LASER application. Int J Dermatol 2024; 63:217-223. [PMID: 38044478 DOI: 10.1111/ijd.16919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Onychomycosis is a fungal nail infection of difficult treatment due to the fungal survival capacity and reduced number of effective therapies. The present study aimed to isolate fungal agents that cause onychomycosis in immunocompetent patients and evaluate how LASER treatments affect the growth and ultrastructure of isolates. METHODS In total, 21 patients with positive direct microscopic examination (DME) for onychomycosis had nail samples collected for cultivation and phenotypic identification of microorganisms. From these patients, 12 underwent LASER treatment, divided in Group 1 (n = 5) treated with Nd: YAG 1,064 nm, and Group 2 (n = 7) treated with Nd: YAG 1,064 nm + Er: YAG 2,940 nm + topical isoconazole. Transmission Electron Microscopy (TEM) was performed to evaluate ultrastructural changes after treatment. RESULTS DME, cultivation, and phenotypic identification showed that the most identified fungus was Trichophyton rubrum spp. After LASER therapy, sample cultivation showed alterations in the fungal morphology with reduction of hyphae, conidia, and reproductive structures. Alterations in fungal cell wall structure, cytoplasm density, and organelles were observed by TEM. CONCLUSION LASER irradiation causes changes in the fungal cells, especially in the number of hyphae and the presence of conidia. In addition, it affects fungal growth and reproduction capacity, which interferes with their infection ability and virulence.
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Affiliation(s)
- Fernanda A V Fernandes
- Departamento de Infectologia, ESCOLA PAULISTA DE MEDICINA, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Denise C Arruda
- Núcleo Integrado de Biotecnologia, Universidade de Mogi das Cruzes, UMC, Mogi das Cruzes, Brazil
| | - Gilglécia N P Santana
- Departamento de Infectologia, ESCOLA PAULISTA DE MEDICINA, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Larissa V G Longo
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina-Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Maria C M Cesar
- Núcleo Integrado de Biotecnologia, Universidade de Mogi das Cruzes, UMC, Mogi das Cruzes, Brazil
| | - Daniel A da Matta
- Departamento de Infectologia, ESCOLA PAULISTA DE MEDICINA, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Orion S M Borba
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina-Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Ruan C Monteiro
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina-Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Marina de Moura Bello
- Departamento de Infectologia, ESCOLA PAULISTA DE MEDICINA, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Luís H B de Moura
- Departamento de Dermatologia, Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Domingos J Neto
- Departamento de Dermatologia, Hospital Heliópolis do Estado de São Paulo SP, São Paulo, Brazil
| | - Samira Yarak
- Departamento de Dermatologia, Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Zoilo P de Camargo
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina-Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Olga F Gompertz
- Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina-Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
| | - Marília M Ogawa
- Departamento de Dermatologia, Universidade Federal de São Paulo, EPM-UNIFESP, São Paulo, Brazil
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Kishishita J, de Almeida Perez Pimenta C, Cerqueira Macedo DP, Delgado-Charro MB, Bastos Leal L. New Formulation-Microporation Combination Approaches to Delivering Ciclopirox across Human Nails. Pharmaceutics 2024; 16:72. [PMID: 38258083 PMCID: PMC10819317 DOI: 10.3390/pharmaceutics16010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/31/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Topical treatments for onychomycosis are of interest to those seeking to avoid systemic drug interactions and to improve systemic safety. This work aimed to develop aqueous-based, simple, and cost-effective vehicles that provide high solubility for ciclopirox and enable the delivery of an active through channels created by nail microporation. Following solubility tests, aqueous gels and thermogels based on hydroxypropylmethylcellulose and poloxamer 407, respectively, were loaded with 8% and 16% ciclopirox. Their performance was then compared to the marketed lacquer Micolamina® in in vitro release tests with artificial membranes and in in vitro permeation tests with human nail clippings with and without poration. Finally, a microbiological assay compared the best gel formulations and the reference product. Little correlation was observed between the in vitro release and the permeation data, and the drug release was highly membrane-dependent. Ciclopirox nail retention in single-dose, porated nails tests was larger than in daily-dosing, non-porated nail conditions. The series of new gel and thermogel vehicles delivered ciclopirox more effectively than Micolamina® in single-dose, porated nail experiments. The inhibition of Trichophyton rubrum activity was significantly increased with microporated nails when the gel formulations were applied but not with Micolamina®. Overall, the results suggest that the new vehicles could be successfully combined with nail microporation to improve the drug delivery and efficacy of topical antifungal medication while reducing the dosing frequency, facilitating patients' adherence.
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Affiliation(s)
- Juliana Kishishita
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
| | - Camila de Almeida Perez Pimenta
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
| | - Danielle Patricia Cerqueira Macedo
- Departamento de Ciências Farmacêuticas, Laboratório de Análises Microbiológicas (LAM), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil;
| | | | - Leila Bastos Leal
- Departamento de Ciências Farmacêuticas, Núcleo de Desenvolvimento Farmacêutico e Cosmético (NUDFAC), Universidade Federal de Pernambuco (UFPE), Recife 50740-521, PE, Brazil; (J.K.); (C.d.A.P.P.); (L.B.L.)
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Roy M, Karhana S, Shamsuzzaman M, Khan MA. Recent drug development and treatments for fungal infections. Braz J Microbiol 2023; 54:1695-1716. [PMID: 37219748 PMCID: PMC10484882 DOI: 10.1007/s42770-023-00999-z] [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: 11/25/2022] [Accepted: 04/27/2023] [Indexed: 05/24/2023] Open
Abstract
Fungal infections are now becoming a hazard to individuals which has paved the way for research to expand the therapeutic options available. Recent advances in drug design and compound screening have also increased the pace of the development of antifungal drugs. Although several novel potential molecules are reported, those discoveries have yet to be translated from bench to bedside. Polyenes, azoles, echinocandins, and flucytosine are among the few antifungal agents that are available for the treatment of fungal infections, but such conventional therapies show certain limitations like toxicity, drug interactions, and the development of resistance which limits the utility of existing antifungals, contributing to significant mortality and morbidity. This review article focuses on the existing therapies, the challenges associated with them, and the development of new therapies, including the ongoing and recent clinical trials, for the treatment of fungal infections. Advancements in antifungal treatment: a graphical overview of drug development, adverse effects, and future prospects.
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Affiliation(s)
- Madhura Roy
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Sonali Karhana
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India
| | - Md Shamsuzzaman
- Department of Pharmaceutical Sciences, College of Pharmacy, Shaqra University, Sahqra, Kingdom of Saudi Arabia
| | - Mohd Ashif Khan
- Centre for Translational & Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India.
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Abd-Elsalam WH, Abouelatta SM. Contemporary Techniques and Potential Transungual Drug Delivery Nanosystems for The Treatment of Onychomycosis. AAPS PharmSciTech 2023; 24:150. [PMID: 37421509 DOI: 10.1208/s12249-023-02603-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/04/2023] [Indexed: 07/10/2023] Open
Abstract
The humanoid nail is considered an exceptional protective barrier that is formed mainly from keratin. Onychomycosis is the cause of 50% of nail infections that is generally caused by dermatophytes. Firstly, the infection was regarded as a cosmetic problem but because of the tenacious nature of onychomycosis and its relapses, these infections have attracted medical attention. The first line of therapy was the oral antifungal agents which were proven to be effective; nevertheless, they exhibited hepato-toxic side effects, alongside drug interactions. Following, the opportunity was shifted to the topical remedies, as onychomycosis is rather superficial, yet this route is hindered by the keratinized layers in the nail plate. A potential alternative to overcome the obstacle was applying different mechanical, physical, and chemical methods to boost the penetration of drugs through the nail plate. Unfortunately, these methods might be expensive, require an expert to be completed, or even be followed by pain or more serious side effects. Furthermore, topical formulations such as nail lacquers and patches do not provide enough sustaining effects. Recently, newer therapies such as nanovesicles, nanoparticles, and nanoemulsions have emerged for the treatment of onychomycosis that provided effective treatment with possibly no side effects. This review states the treatment strategies such as mechanical, physical, and chemical methods, and highlights various innovative dosage forms and nanosystems developed in the last 10 years with a focus on advanced findings regarding formulation systems. Furthermore, it demonstrates the natural bioactives and their formulation as nanosystems, and the most relevant clinical outcomes.
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Affiliation(s)
- Wessam H Abd-Elsalam
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Samar M Abouelatta
- Department of Pharmaceutics, Faculty of Pharmacy, Ahram Candian University, 6 October, Cairo, Egypt
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Gouveia RG, Oliveira NR, Andrade-Júnior FP, Ferreira RC, Amorim GMW, Silva DKF, Duarte SS, Medeiros CIS, Oliveira-Filho AA, Lima EO. Antifungal effect of (R) and (S)-citronellal enantiomers and their predictive mechanism of action on Candida albicans from voriconazole-resistant onychomycoses. BRAZ J BIOL 2023; 83:e271530. [PMID: 37222371 DOI: 10.1590/1519-6984.271530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Onychomycosis is the most common disease affecting the nail unit and accounts for at least 50% of all nail diseases. In addition, Candida albicans is responsible for approximately 70% of onychomycoses caused by yeasts. This study investigated the antifungal effect of (R) and (S)-citronellal enantiomers, as well as its predictive mechanism of action on C. albicans from voriconazole-resistant onychomycoses. For this purpose, in vitro broth microdilution and molecular docking techniques were applied in a predictive and complementary manner to the mechanisms of action. The main results of this study indicate that C. albicans was resistant to voriconazole and sensitive to the enantiomers (R) and (S)-citronellal at a dose of 256 and 32 µg/mL respectively. In addition, there was an increase in the minimum inhibitory concentration (MIC) of the enantiomers in the presence of sorbitol and ergosterol, indicating that these molecules possibly affect the integrity of the cell wall and cell membrane of C. albicans. Molecular docking with key biosynthesis proteins and maintenance of the fungal cell wall and plasma membrane demonstrated the possibility of (R) and (S)-citronellal interacting with two important enzymes: 1,3-β-glucan synthase and lanosterol 14α-demethylase. Therefore, the findings of this study indicate that the (R) and (S)-citronellal enantiomers are fungicidal on C. albicans from onychomycoses and probably these substances cause damage to the cell wall and cell membrane of these micro-organisms possibly by interacting with enzymes in the biosynthesis of these fungal structures.
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Affiliation(s)
- R G Gouveia
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - N R Oliveira
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - F P Andrade-Júnior
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - R C Ferreira
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - G M W Amorim
- Universidade Federal da Paraíba - UFPB, Departamento de Ciências Farmacêuticas - DCF, João Pessoa, Paraíba, Brasil
| | - D K F Silva
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - S S Duarte
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - C I S Medeiros
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
| | - A A Oliveira-Filho
- Universidade Federal de Campina Grande - UFCG, Centro de Saúde e Tecnologia Rural - CTSR, Patos, Paraíba, Brasil
| | - E O Lima
- Universidade Federal da Paraíba - UFPB, Programa de Pós-Graduação em Produtos Naturais e Sintéticos Bioativos, João Pessoa, Paraíba, Brasil
- Universidade Federal da Paraíba - UFPB, Departamento de Ciências Farmacêuticas - DCF, João Pessoa, Paraíba, Brasil
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Khan SS, Hay RJ, Saunte DML. A Review of Antifungal Susceptibility Testing for Dermatophyte Fungi and It's Correlation with Previous Exposure and Clinical Responses. J Fungi (Basel) 2022; 8:jof8121290. [PMID: 36547624 PMCID: PMC9785514 DOI: 10.3390/jof8121290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: An increase in the number of recurrent and recalcitrant dermatophytoses calls for a tool to guide the clinician to correlate in vitro minimum inhibitory concentration (MIC) data, antifungal treatment with clinical outcomes. This systematic review aims to explore a possible correlation between one aspect of this, previous antifungal exposure, and clinical outcomes. Methods: A systematic literature search for articles on previous antifungal treatment, treatment outcome, susceptibility methods used, organism (genus/species), and MIC values was conducted. Results: A total of 720 records were identified of which 19 articles met the inclusion criteria. Forty percent of the cases had contact with or travel to India, 28% originated from or had traveled to other countries where treatment unresponsive tinea infections had been reported. Tinea corporis was the most common clinical presentation and the species involved were Trichophyton (T.) indotineae and T. rubrum, followed by T. mentagrophyte/interdigitale complex and T. tonsurans. Nearly all patients had previously been exposed to one or more antifungals. The studies were too heterogeneous to perform a statistical analysis to test if previous antifungal exposure was related to resistance. Conclusions: Only a few studies were identified, which had both sufficient and robust data on in vitro susceptibility testing and clinical treatment failure. Further research on the value of susceptibility testing to improve clinical practice in the management of dermatophyte infections is needed.
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Affiliation(s)
- Sidra Saleem Khan
- The Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Roderick James Hay
- St. John’s Institute of Dermatology, King’s College London, London SE1 9RT, UK
| | - Ditte Marie Lindhardt Saunte
- Department of Dermatology, Zealand University Hospital, DK-4000 Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health Science, University of Copenhagen, DK-1350 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-47322600; Fax: +45-47322698
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Sobhy N, Talla Eweed H, Omar SS. Fractional CO2 laser - assisted methylene blue photodynamic therapy is a potential alternative therapy for onychomycosis in the era of antifungal resistance. Photodiagnosis Photodyn Ther 2022; 40:103149. [PMID: 36228978 DOI: 10.1016/j.pdpdt.2022.103149] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Treatment of onychomycosis is challenging by virtue of the impact of nail disfigurement, the location of the fungi within the nail and reported antifungal resistance worldwide. Light-based technologies are promising primary or adjunctive therapeutic modalities. We aimed to compare the efficacy of photodynamic therapy and fractional CO2 laser monotherapy either alone or in combination for onychomycosis. PATIENTS AND METHODS This prospective randomized comparative study was conducted on 51 onychomycosis patients divided into three groups. In group A, patients were treated using 6 photodynamic therapy sessions using methylene blue and IPL (560 to 700 nm, fluence 12 J/cm2). Group B patients were treated using 6 bimonthly fractional CO2 laser sessions (10,600 nm, 1.600 mj energy and 0.6 mm density) and group C patients were treated using 6 combined fractional CO2 laser and photodynamic therapy sessions. Patients were evaluated mycologically, dermoscopically and clinically by calculation of proximal nail diameter percentage at baseline, monthly, at the end of treatment and after a 6-month follow-up period post-treatment. RESULTS Candida was the most commonly isolated organismin in 64.7%, 70.6% and 70.6% of the pateints in groups A, B and C, respectively. The dermoscopic findings in the total dystrophic onychomycosis was subungual hyperkeratosis in 6 patients (100%), longitudinal streaks and striae in 1 patient (16.7%). In dorsolateral subungual onychomycosis, jagged proximal edge in 31 patients (70.5%), and pigmentation in 30 patients (68.2%) were noted. In proximal subungual onychomycosis irregular matt patches were seen in 1 patient (100%). Proximal nail diameter percentage showed statistically significant improvement after treatment and 6 months follow up in the 3 studied groups. Mean increase of proximal nail diameter after treatment was highest in group C (52.94 ± 20.24), followed by group B (43.82 ± 21.03) and least in group A (35.29 ± 17.0). This difference was statistically significant (p = 0.044). Reported side effects were mild-moderate pain, discoloration and paronychia. CONCLUSION We conclude that fractional CO2 laser and photodynamic monotherapy, and their combination achieve high success rates, good patient satisfaction and safety profile. Fractional CO2-assisted photodynamic therapy is associated with the highest improvement over either fractional CO2 or photodynamic therapy alone.
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Affiliation(s)
- Nagat Sobhy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Elkhartoum Square 21521, Egypt
| | - Heba Talla Eweed
- Bakkous Dermatology Clinic, Ministry of Health, Alexandria, Egypt
| | - Salma Samir Omar
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Alexandria University, Elkhartoum Square 21521, Egypt.
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11
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Current methodologies for the assessment of deep eutectic systems toxicology: Challenges and perspectives. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2022.119675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Piraccini BM, Starace M, Rubin AI, Di Chiacchio NG, Iorizzo M, Rigopoulos D. Onychomycosis: Recommendations for Diagnosis, Assessment of Treatment Efficacy, and Specialist Referral. The CONSONANCE Consensus Project. Dermatol Ther (Heidelb) 2022; 12:885-898. [PMID: 35262878 PMCID: PMC9021334 DOI: 10.1007/s13555-022-00698-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/14/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Onychomycosis is the most common nail disorder in adults, with high recurrence and relapse rates. Its diagnosis may be difficult by non-experts because the clinical signs may overlap with other dermatoses. The treatment may be challenging, as it should be patient-tailored. Methods An online survey was conducted among European Nail Society (ENS) members to provide recommendations on the diagnosis and assessment of distal lateral subungual onychomycosis (DLSO) in non-specialized clinical environments, as well as recommendations for patient referral. Results DLSO diagnosis is predominantly based on clinical aspects, and microscopy and fungal culture are commonly employed to establish the diagnosis. Assessment of clinical features is the main method for DLSO follow-up, and the main criterion to define cure is a combination of mycologic cure and clinical cure. The most commonly selected treatments for onychomycosis include oral antifungals, topical antifungals, and nail debridement. According to the nail experts, predisposing factors of DLSO to be evaluated include concurrent tinea pedis diagnosis, immunocompromised status, and diabetes. The minimum clinical aspects to be evaluated for DLSO diagnosis should include subungual hyperkeratosis, white-yellow-orange subungual scales, and absence of salmon-pink coloration. Recommendations for clinical signs that should be evaluated to confirm treatment effectiveness include normal appearance and color of the nail, reduction or absence of scales under the nail, and absence of onycholysis. Recommendations for specialist referral include lack of treatment effectiveness, need of additional therapies, concurrent presence of other diseases or comorbidities, severe DLSO, and presence of a dermatophytoma or involvement of the nail matrix. Conclusions According to the surveyed nail experts, after evaluating clinical signs and predisposing factors for DLSO, the diagnosis should include subungual hyperkeratosis, nail color (yellow-orange), and onycholysis and thickening. In cases of severe DLSO, when there is treatment failure, concomitant diseases/comorbidities, presence of a dermatophytoma or involvement of the nail matrix, or involvement of several/all nails, referral should be considered. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00698-x.
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Affiliation(s)
- Bianca Maria Piraccini
- Dermatology-IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Michela Starace
- Dermatology-IRCCS, Policlinico Sant'Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Adam I Rubin
- Children's Hospital of Philadelphia, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nilton Gioia Di Chiacchio
- Faculdade de Medicina do ABC, Santo André, Brazil.,Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
| | - Dimitris Rigopoulos
- Department of Dermatology-Venereology, Faculty of Medicine, National and Kapodistrian University of Athens-Andreas Sygros Hospital, Athens, Greece
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13
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A Clinical Study for the Treatment of Onychomycosis Patients Using a Novel ROS Producing Onychomycosis Treatment When Compared Against 5% Amorolfine Topical Lacquer to Reduce the Visible Size of Infected Toenails. J Mycol Med 2022; 32:101256. [DOI: 10.1016/j.mycmed.2022.101256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/19/2022]
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14
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Al-Khairallah HA, Al-Yasiri MH. MOLECULAR DETECTION OF THE TWO VIRULENCE GENES HWP1 AND ALS1 IN CANDIDA SPECIES ISOLATED FROM ONYCHOMYCOSIS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1295-1298. [PMID: 35758446 DOI: 10.36740/wlek202205211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: This article was aimed to assess the prevalence of Candida species causing nail infections and to investigate the most important virulence genes that cause adhesion. PATIENTS AND METHODS Materials and methods: Samples were collected from General Hospital and the outpatient's clinics in Thi-Qar Province, southern Iraq, during the period from January 2021 to May 2021. Samples were inoculated on Sabouraud Dextrose Agar plates containing 0.5 mg chloramphenicol, then Petri dishes were incubated at 30°C under aerobic conditions and observed for Candida species growth for 24-72 hrs. All isolates were identified by morphologic and chromatic properties on CHROMagar and by Api Candida. RESULTS Results: Twenty five isolates were obtained from hundred samples, which belong to five species of the genus Candida, distributed in percentage 9(36%), 4(16%), 4(16%), 4(16%) and 3(12%) of C. glabrata, C. krusei, C. albicans, C. famata and C. tropicalis consecutively and one isolate was not identified. Monoplex PCR technique was used to detect virulence genes (hwp1 and als1) of Candida species. Four Candida albicans isolates (16%) were carried of both hwp1 and als1 genes. CONCLUSION Conclusions: The virulence gene (hwp1) can be relied upon in molecular detection as a special diagnostic tool of Candida albicans species except other types causing Candidal onychomycosis.
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15
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In Silico Drug Screening Based Development of Novel Formulations for Onychomycosis Management. Gels 2021; 7:gels7040221. [PMID: 34842710 PMCID: PMC8628710 DOI: 10.3390/gels7040221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/13/2021] [Accepted: 11/14/2021] [Indexed: 12/13/2022] Open
Abstract
Onychomycosis is a prominent fungal infection that causes discoloration, thickening, and mutilation leading to the separation of the nail from the nail bed. Treatment modalities for onychomycosis may include oral, topical, or combination therapy with antifungals and at times may require chemical or surgical intervention. The burden of side effects of antifungals is enormous, and therefore using molecular docking-based drug selection in context with the target keratin protein would ensure better disease management. Ciclopirox, Amorolfine HCl, Efinaconazole, Tioconazole, and Tavaborole were submitted for assessment, revealing that Amorolfine HCl is the best fit. Consequently, two formulations (Nail lacquer and nanoemulgel) were developed from Amorolfine HCl to validate the in silico screening outcomes. The formulations were further fortified with over-the-counter ingredients vis-a-vis with vitamin E in nail lacquer and undecylenic acid in nanoemulgel for their prominent roles in improving nail health. Both the formulations were systematically designed, optimized, and characterized. Amorolfine HCl containing nanoemulgel (NEG) was developed using undecylenic acid as an oil phase and thioglycolic acid as a penetration enhancer. The quality parameters evaluated were particle size, the zeta potential for nanoemulsion (NE) (78.04 ± 4.724 nm and −0.7mV, respectively), in vitro cumulative drug release (96.74% for NE and 88.54% for NEG), and transungual permeation (about 73.49% for NEG and 54.81% for NE). Nail lacquer was evaluated for the drying time, non-volatile content, and blush test. In vitro cumulative drug release of the developed nail lacquer and comparator marketed formulations were around 81.5% and 75%, respectively. Similarly, the transungual drug permeation was 6.32 μg/cm2 and 5.89 μg/cm2, respectively, in 24 h. The in silico guided preparation of both formulations containing Amorolfine HCl and over the counter ingredients is amenable for therapeutic use against onychomycosis and will be evaluated in the in vivo model.
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16
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Trifan A, Luca SV, Bostănaru AC, Brebu M, Jităreanu A, Cristina RT, Skalicka-Woźniak K, Granica S, Czerwińska ME, Kruk A, Greige-Gerges H, Sieniawska E, Mareș M. Apiaceae Essential Oils: Boosters of Terbinafine Activity against Dermatophytes and Potent Anti-Inflammatory Effectors. PLANTS (BASEL, SWITZERLAND) 2021; 10:plants10112378. [PMID: 34834740 PMCID: PMC8623916 DOI: 10.3390/plants10112378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 05/03/2023]
Abstract
Dermatophyte infections represent an important public health concern, affecting up to 25% of the world's population. Trichophyton rubrum and T. mentagrophytes are the predominant dermatophytes in cutaneous infections, with a prevalence accounting for 70% of dermatophytoses. Although terbinafine represents the preferred treatment, its clinical use is hampered by side effects, drug-drug interactions, and the emergence of resistant clinical isolates. Combination therapy, associating terbinafine and essential oils (EOs), represents a promising strategy in the treatment of dermatophytosis. In this study, we screened the potential of selected Apiaceae EOs (ajowan, coriander, caraway, and anise) to improve the antifungal activity of terbinafine against T. rubrum ATCC 28188 and T. mentagrophytes ATCC 9533. The chemical profile of EOs was analyzed by gas chromatography. The minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) of EOs/main compounds were determined according to EUCAST-AFST guidelines, with minor modifications. The checkerboard microtiter method was used to identify putative synergistic combinations of EOs/main constituents with terbinafine. The influence of EOs on the viability and pro-inflammatory cytokine production (IL-1β, IL-8 and TNF-α) was determined using an ex vivo human neutrophils model. The binary associations of tested EOs with terbinafine were found to be synergistic against T. rubrum, with FICI values of 0.26-0.31. At the tested concentrations (6.25-25 mg/L), EOs did not exert cytotoxic effects towards human neutrophils. Anise EO was the most potent inhibitor of IL-1β release (46.49% inhibition at 25 mg/L), while coriander EO displayed the highest inhibition towards IL-8 and TNF-α production (54.15% and 54.91%, respectively). In conclusion, the synergistic combinations of terbinafine and investigated Apiaceae EOs could be a starting point in the development of novel topical therapies against T. rubrum-related dermatophytosis.
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Affiliation(s)
- Adriana Trifan
- Department of Pharmacognosy, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Correspondence: (A.T.); (A.-C.B.)
| | - Simon Vlad Luca
- Department of Pharmacognosy, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- Biothermodynamics, TUM School of Life and Food Sciences, Technical University of Munich, 85354 Freising, Germany;
| | - Andra-Cristina Bostănaru
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Sciences, 700489 Iasi, Romania;
- Correspondence: (A.T.); (A.-C.B.)
| | - Mihai Brebu
- Physical Chemistry of Polymers Laboratory, Petru Poni Institute of Macromolecular Chemistry, 700481 Iasi, Romania;
| | - Alexandra Jităreanu
- Department of Toxicology, Faculty of Pharmacy, Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania;
| | - Romeo-Teodor Cristina
- Department of Pharmacology, The Banat University of Agricultural Sciences and Veterinary Medicine, 300645 Timisoara, Romania;
| | - Krystyna Skalicka-Woźniak
- Department of Natural Products Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (K.S.-W.); (E.S.)
| | - Sebastian Granica
- Microbiota Lab, Centre for Preclinical Studies, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.G.); (A.K.)
| | - Monika E. Czerwińska
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland;
- Centre for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Aleksandra Kruk
- Microbiota Lab, Centre for Preclinical Studies, Department of Pharmacognosy and Molecular Basis of Phytotherapy, Medical University of Warsaw, 02-097 Warsaw, Poland; (S.G.); (A.K.)
| | - Hélène Greige-Gerges
- Bioactive Molecules Research Laboratory, Department of Chemistry and Biochemistry, Faculty of Sciences, Section II, Lebanese University, Jdaidet el-Matn B.P. 90656, Lebanon;
| | - Elwira Sieniawska
- Department of Natural Products Chemistry, Medical University of Lublin, 20-093 Lublin, Poland; (K.S.-W.); (E.S.)
| | - Mihai Mareș
- Laboratory of Antimicrobial Chemotherapy, Faculty of Veterinary Medicine, “Ion Ionescu de la Brad” Iasi University of Life Sciences, 700489 Iasi, Romania;
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17
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Pakshir K, Kamali M, Nouraei H, Zomorodian K, Motamedi M, Mahmoodi M. Molecular characterization and antifungal activity against non-dermatophyte molds causing onychomycosis. Sci Rep 2021; 11:20736. [PMID: 34671053 PMCID: PMC8528813 DOI: 10.1038/s41598-021-00104-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
Onychomycosis is a fungal disease that caused by different types of fungi. Non-dermatophyte molds are a large saprophytic fungi group that live in nature and could affect traumatic nails. The aim of this study was to identify non-dermatophyte molds causing onychomycosis and evaluation of several antifungal activities against the isolates. The samples consisted of 50 non-dermatophyte molds isolated from patients with onychomycosis confirmed by direct and culture examination fungal. DNA was extracted, amplified, and sequenced. Disk diffusion method was used to evaluate itraconazole, fluconazole, ketoconazole, terbinafine, posaconazole, and econazole activity against the isolates. The species identified as: Aspergillus flavus 22 (44%), A. niger 12 (24%), A. fumigates, 3 (6%), A. sydowii 3 (6%), A. terreus 1 (2%), Penicillium commune 2 (4%), P. glabrum 2 (4%), P. chrysogenum, 1 (2%), Fusarium solani 3 (6%) and F. thapsinum 1 (2%). Most of the samples were sensitive to terbinafine, itraconazole, and econazole and 94% of the isolates were resistant to fluconazole. This study showed that Aspergillus species were the most common cause of non-dermatophyte mold onychomycosis and fluconazole was the most resistant antifungals. Care must be taken to choose the appropriate antifungal drug for a better cure.
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Affiliation(s)
- Keyvan Pakshir
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. .,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mandana Kamali
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hasti Nouraei
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamiar Zomorodian
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Motamedi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Mahmoodi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Nair AB, Al-Dhubiab BE, Shah J, Gorain B, Jacob S, Attimarad M, Sreeharsha N, Venugopala KN, Morsy MA. Constant Voltage Iontophoresis Technique to Deliver Terbinafine via Transungual Delivery System: Formulation Optimization Using Box-Behnken Design and In Vitro Evaluation. Pharmaceutics 2021; 13:pharmaceutics13101692. [PMID: 34683985 PMCID: PMC8538220 DOI: 10.3390/pharmaceutics13101692] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Topical therapy of antifungals is primarily restricted due to the low innate transport of drugs through the thick multi-layered keratinized nail plate. The objective of this investigation was to develop a gel formulation, and to optimize and evaluate the transungual delivery of terbinafine using the constant voltage iontophoresis technique. Statistical analysis was performed using Box–Behnken design to optimize the transungual delivery of terbinafine by examining crucial variables namely concentration of polyethylene glycol, voltage, and duration of application (2–6 h). Optimization data in batches (F1–F17) demonstrated that chemical enhancer, applied voltage, and application time have influenced terbinafine nail delivery. Higher ex vivo permeation and drug accumulation into the nail tissue were noticed in the optimized batch (F8) when compared with other batches (F1–F17). A greater amount of terbinafine was released across the nails when the drug was accumulated by iontophoresis than the passive counterpart. A remarkably higher zone of inhibition was observed in nails with greater drug accumulation due to iontophoresis, as compared to the passive process. The results here demonstrate that the optimized formulation with low voltage iontophoresis could be a viable and alternative tool in the transungual delivery of terbinafine, which in turn could improve the success rate of topical nail therapy in onychomycosis.
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Affiliation(s)
- Anroop B. Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Correspondence: ; Tel.: +966-536-219-868
| | - Bandar E. Al-Dhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
| | - Jigar Shah
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India;
| | - Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia;
- Centre for Drug Delivery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya 47500, Malaysia
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates;
| | - Mahesh Attimarad
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
| | - Nagaraja Sreeharsha
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Pharmaceutics, Vidya Siri College of Pharmacy, Off Sarjapura Road, Bangalore 560035, India
| | - Katharigatta N. Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Biotechnology and Food Technology, Durban University of Technology, Durban 4000, South Africa
| | - Mohamed A. Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia; (B.E.A.-D.); (M.A.); (N.S.); (K.N.V.); (M.A.M.)
- Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
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Merad Y, Derrar H, Tabouri S, Berexi-Reguig F. Candida guilliermondii Onychomycosis Involving Fingernails in a Breast Cancer Patient under Docetaxel Chemotherapy. Case Rep Oncol 2021; 14:1530-1535. [PMID: 34899247 PMCID: PMC8613606 DOI: 10.1159/000519695] [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: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/19/2022] Open
Abstract
Onychomycosis has been shown to have a higher incidence in cancer patients. Nail toxicity is a quite common side effect of anticancer agents. Taxotere© is a chemotherapeutic known to cause great incidence of nail change and has a role in subungual suppuration. We report on a 52-year-old woman with breast cancer admitted in our institution for onycholysis. Because of the stage and histology of breast cancer, neoadjuvant chemotherapy was initiated. The patient received 8 cycles of Taxotere and Adriamycin (AT), and she underwent a modified radical mastectomy. Three months later, the patient developed evidence of onycholysis, involving all the fingernails. We observed the following changes in nails of all the digits in both hands: onycholysis, dystrophy, oedema, and exudate. Nail scraping and purulent discharge were collected and cultured on Sabouraud medium. Physical features of the colonies and biochemical tests (Auxacolor©) revealed Candida guilliermondii as the sole etiologic agent of onychomycosis. This case details an onycholysis in a breast cancer case successfully managed solely with amorolfine lacquer. This clinical and mycological presentation should alert the clinician to the possibility of onychomycosis induced by docetaxel chemotherapy.
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Affiliation(s)
- Yassine Merad
- Department of Parasitology-Mycology, Central Laboratory, Hassani “Abdelkader University Hospital,”, Sidi Bel Abbès, Algeria
- Laboratoire de Synthèse de l'Information Environnementale, Université de Lille, Lille, France
| | - Hichem Derrar
- Department of Pulmonary and Lung Diseases, Sidi Bel Abbès, Algeria
| | - Sarah Tabouri
- Departement of Oncology, Centre Anti Cancer, Sidi Bel Abbès, Algeria
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Gupta AK, Venkataraman M, Anbalagan N, Guenin EP. One size does not fit all: the need for individualized treatment based on factors that may affect the therapeutic outcome of efinaconazole 10% solution for the treatment of toenail onychomycosis. Int J Dermatol 2021; 60:1296-1302. [PMID: 34216026 DOI: 10.1111/ijd.15739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/28/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
Successful management of onychomycosis is a challenge because cure rates with most antifungals are relatively low and recurrence rates are high. A drug-based approach by treating the nail alone may not suffice. There are several host-related factors (age, sex, body mass index [BMI], and patient's quality of life), disease-related factors (disease severity, duration, and the number of toenails affected), and comorbidities (tinea pedis and diabetes) that may affect treatment efficacy. Here, we review the post hoc analyses of the phase III trials of efinaconazole 10% solution that have investigated the impact of these factors on topical therapy for toenail onychomycosis. The significant clinical variables that may affect the efficacy of efinaconazole include sex, BMI, disease severity, disease duration, and tinea pedis. As older patients may have slower toenail growth and more severe, longstanding disease compared with younger patients, they may require longer treatment duration, beyond the 48-week standard regimen. Treatment compliance may need to be discussed for an improved health outcome. Therefore, these prognostic factors need to be carefully evaluated, which may aid in formulating individualized therapy to maximize treatment success.
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Affiliation(s)
- Aditya K Gupta
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Mediprobe Research Inc, London, ON, Canada
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Rahman A, Aqil M, Ahad A, Imam SS, Qadir A, Ali A. Application of central composite design for the optimization of itraconazole loaded nail lacquer formulation. 3 Biotech 2021; 11:324. [PMID: 34194908 DOI: 10.1007/s13205-021-02862-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Onychomycosis is a common fungal infection of the nails that mostly affects the elderly and athletes. Antifungal drug-like itraconazole is one of the therapeutic agents of choice for the topical treatment of onychomycosis. The current work aimed for the preparation and optimization of itraconazole-loaded nail lacquer formulation. Central composite design was employed; independent variables were polymer concentration (X1) and thioglycolic acid (TGA) concentration (X2). While the dependent variables were cumulative amount of drug permeated per unit area (CADP/A, Y1), drying time (Y2) and nonvolatile content (Y3). The optimized formulation was characterized for various parameters including ex-vivo permeation study, confocal laser scanning microscopy (CLSM) and antifungal study. The optimized nail lacquer formulation (F7) exhibited CADP/A of 198.23 µg/cm2, drying time of 185 s and nonvolatile content of 97.23%. The scanning electron microscopy of goat hoof treated with optimized nail lacquer formulation demonstrated loosening of the structure and marked increase in surface roughness. The CLSM micrograph of goat hoof treated with optimized nail lacquer formulation demonstrated that the probe dye was eventually distributed and penetrated through the hoof. Bio-adhesiveness analysis showed that the prepared nail lacquer film has ample adhesiveness to be maintained on the nail plate surface for a sufficient time. In antifungal study, the optimized nail lacquer, and marketed gel exhibited a zone inhibition of 21 mm, and 10 mm against Candida albicans, respectively. The stability study showed that the optimized nail lacquer is stable at storage condition. The prepared nail lacquers have been shown to serve as a useful dosage form for the delivery of itraconazole across nail plate for controlling the problems associated with 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: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
Abstract
Background: Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results: Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use.Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Shatin, Hong Kong
| | | | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
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Piraccini BM, Iorizzo M, Lencastre A, Nenoff P, Rigopoulos D. Ciclopirox Hydroxypropyl Chitosan (HPCH) Nail Lacquer: A Review of Its Use in Onychomycosis. Dermatol Ther (Heidelb) 2020; 10:917-929. [PMID: 32705532 PMCID: PMC7477053 DOI: 10.1007/s13555-020-00420-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/07/2023] Open
Abstract
Ciclopirox 8% hydroxypropyl chitosan (HPCH) [Marketed in different countries as the following registered (®) brands: Ciclopoli, Fulcare, Kitonail, Myconail, Niogermos, Niogermox, Onytec, Ony-Tec, Polinail, Privex, Rejuvenail] is the first topical nail lacquer developed using innovative drug formulation technology. It is indicated for the treatment of mild-to-moderate fungal infections of the nails that are caused by dermatophytes and/or other ciclopirox-sensitive fungi, without nail matrix involvement. HPCH is a patented drug formulation technology for the delivery of active principles into the nails based on a hydrosoluble semisynthetic amino-polysaccharide biopolymer derivative of chitosan. The lacquer acts as a protective barrier against microbiological attack, physical damage and/or aggressive chemicals. Results from in vitro studies suggest that the application of ciclopirox 8% HPCH nail lacquer improves drug permeation into and/or drug penetration through the nail, relative to the water-insoluble ciclopirox 8%, amorolfine 5% and efinaconazole 10% reference lacquers. In addition, in vitro and clinical studies in healthy subjects found that the concentration of ciclopirox reached in subungual fluids after application of ciclopirox 8% HPCH was sufficient for inhibiting fungal growth. In clinical studies in patients with mild-to-moderate onychomycosis, ciclopirox 8% HPCH was found to be more effective than the commercial water-insoluble ciclopirox 8% and amorolfine 5% lacquers, as indicated by higher complete cure, response and mycological cure rates at 48 weeks after treatment initiation. Ciclopirox 8% HPCH has been found to be generally well tolerated, with no treatment-related adverse events reported in patients using this nail lacquer. Thus, current evidence indicates that ciclopirox 8% HPCH represents a valuable treatment option for the treatment of patients with onychomycosis.
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Affiliation(s)
- Bianca Maria Piraccini
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | | | - André Lencastre
- Serviço de Dermatologia, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Pietro Nenoff
- Allergology, Andrology, Tropical and Travel Dermatology (DDA), Laboratory for Medical Microbiology, Partnership Prof. Dr. med. Pietro Nenoff & Dr. med. Constanze Krüger, Rötha OT Mölbis, Germany
| | - Dimitris Rigopoulos
- Dermatology-Venereology, Department of Medicine, School of Health Sciences, National and Kapodistrian University of Athens-A. Sygros Hospital, Athens, Greece
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Šveikauskaitė I, Briedis V. Potential of Naftifine Application for Transungual Delivery. Molecules 2020; 25:E3043. [PMID: 32635240 PMCID: PMC7411873 DOI: 10.3390/molecules25133043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/03/2022] Open
Abstract
Naftifine is used to treat fungal skin infections as it inhibits dermatophytes, which are the cause of onychomycosis. However, naftifine's ability to permeate the human nail barrier has not been investigated, thus, the antimycotic potential is not clearly established. This work aims to evaluate the effect of penetration enhancing factors on the accumulation of naftifine hydrochloride through human nail clippings. Naftifine polymeric nail lacquers with Eudragit RL100 were developed as a suitable delivery system. Low penetration of naftifine into nail has been determined as less than 10% of applied drug dose accumulated in the nail layers. Incorporation of thioglycolic acid into formulations resulted in increased accumulation of antifungal agent in the nail layers by 100% compared with a control group. Salicylic acid did not effect naftifine accumulation in the human nail. The permeation of naftifine through the nail increased by threefold when the thioglycolic acid-containing formulation was applied and the nail was pretreated with a fractional CO2 laser. Structural changes of the nail barrier, induced by fractional CO2 laser, were visualized by microscopy. The results suggest, that naftifine nail penetration could be significantly increased when physical and chemical enhancing factors are applied.
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Affiliation(s)
- Indrė Šveikauskaitė
- Department of Clinical Pharmacy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, Kaunas 50161, Lithuania;
- Institute of Pharmaceutical Technologies, Lithuanian University of Health Sciences, Sukilėlių pr. 13, Kaunas 50161, Lithuania
| | - Vitalis Briedis
- Department of Clinical Pharmacy, Lithuanian University of Health Sciences, Sukilėlių pr. 13, Kaunas 50161, Lithuania;
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Maggioni D, Cimicata A, Praticò A, Villa R, Bianchi F, Badiale SB, Piana U, Angelinetta C. Clinical Evaluation of a Topical Formulation for the Management of Onychomycosis. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2020; 13:53-57. [PMID: 32983339 PMCID: PMC7492023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND: Onychomycosis is a diffused fungal-associated disease affecting the nails. It induces discoloration, dystrophy, and, in the most severe cases, nail detachment. No completely effective pharmacological cures are available for onychomycosis. Available treatment options usually require a long-term treatment period and might raise safety concerns. OBJECTIVE: The aim of this preliminary clinical study is to evaluate the efficacy of Myco Clear® (MC) in improving the structural integrity and appearance of nails affected by mild onychomycosis. MC is a topical product to be applied on the nails either for onychomycosis treatment or for the prevention of fungal nail infections. Its main action is the formation of a mechanic protective barrier on the nail surface, which protects the damaged nail structure from additional external aggressions and prevents further pathogen penetration. METHODS: This monocentric, single-arm investigation enrolled 30 subjects with damaged nails on the feet. Patients were asked to apply the product once a day for 56 consecutive days; the instrumental analysis of nail roughness was obtained after seven, 14, 28, and 56 days of product application. In addition, the clinical evaluation of nail integrity and hardness were performed at baseline and after seven, 14, 28 and 56 days. RESULTS: The obtained data were statistically evaluated in comparison to baseline. MC treatment significantly promoted a restoration of the nail structure and an improvement in its appearance; furthermore, no adverse events were reported, thus demonstrating that MC is optimally tolerated. CONCLUSION: The results of this pilot study suggest that MC is effective in improving the overall appearance and structural integrity of damaged nails affected by possible mild onychomycosis.
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Affiliation(s)
| | | | | | - Roberta Villa
- All authors are with Bio Basic Europe in Milan, Italy
| | | | | | - Umberto Piana
- All authors are with Bio Basic Europe in Milan, Italy
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Pereira LD, Vila T, Borba-Santos LP, de Souza W, Navarro M, Rozental S. Activity of Metal-Azole Complexes Against Biofilms of Candida albicans and Candida glabrata. Curr Pharm Des 2020; 26:1524-1531. [DOI: 10.2174/1381612826666200217120321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/21/2020] [Indexed: 02/06/2023]
Abstract
Background:
Onychomycosis is a chronic nail infection caused by fungi frequently resistant to antifungal
treatments. Recalcitrance in nail infections is a result of reduced antifungal penetration due to biofilm
formation, combined with poor patient compliance with the treatment, which can be as long as 18 months.
Objective:
Metal-drug complexation is a widely used strategy to increase drug efficacy. Therefore, the aim of this
work was to evaluate the antifungal and anti-biofilm activity of several metal-azole complexes against Candida
albicans and Candida glabrata.
Methods:
Susceptibility assays and scanning electron microscopy were performed to determine the anti-biofilm
activity of eight metal-azole complexes in vitro and ex-vivo, using human nail fragments.
Results:
In vitro susceptibility assays showed that complexation of both Au(I) and Zn(II) to clotrimazole and
ketoconazole improved the anti-biofilm activity compared to the azole alone. Using an ex-vivo model of biofilm
formation on fragments of human nails, we also demonstrate the improved efficacy of metal-azole complexes
against biofilms of C. albicans and C. glabrata that resembles the onychomycosis structure. Noteworthy, biofilms
of C. glabrata were more susceptible to the optimized complexes than those of C. albicans.
Conclusion:
In conclusion, metal-azole complexes used in this work show promising anti-biofilm activity and
further clinical studies should confirm its potential for the treatment of Candida-associated onychomycosis.
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Affiliation(s)
- Livia D. Pereira
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taissa Vila
- Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland, Baltimore, United States
| | - Luana P. Borba-Santos
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wanderley de Souza
- Laboratório de Ultraestrutura Celular Hertha Meyer, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maribel Navarro
- Laboratório de Química Bioinorgânica e Catalise, Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Sonia Rozental
- Laboratório de Biologia Celular de Fungos; Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Retrospective study of factors affecting medication adherence in patients prescribed efinaconazole 10% solution for onychomycosis. J Am Acad Dermatol 2020; 84:208-210. [PMID: 32360855 DOI: 10.1016/j.jaad.2020.04.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/10/2020] [Accepted: 04/23/2020] [Indexed: 12/28/2022]
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Arora S, Lal S, Janney M, Ranjan E, Donaparthi N, Dabas R. Fractional CO2 laser in the management of onychomycosis. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_53_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sprenger AB, Purim KSM, Sprenger F, Queiroz-Telles F. A Week of Oral Terbinafine Pulse Regimen Every Three Months to Treat all Dermatophyte Onychomycosis. J Fungi (Basel) 2019; 5:E82. [PMID: 31487828 PMCID: PMC6787629 DOI: 10.3390/jof5030082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/30/2022] Open
Abstract
Terbinafine has proved to treat numerous fungal infections, including onychomycosis, successfully. Due to its liver metabolization and dependency on the cytochrome P450 enzyme complex, undesirable drug interaction are highly probable. Additionally to drug interactions, the treatment is long, rising the chances of the appearance of side effects and abandonment. Pharmacokinetic data suggest that terbinafine maintains a fungicidal effect within the nail up to 30 weeks after its last administration, which has aroused the possibility of a pulse therapy to reduce the side effects while treating onychomycosis. This study's goal was to evaluate the effectiveness of three different oral terbinafine regimens in treating onychomycosis due to dermatophytes. Sixty-three patients with onychomycosis were sorted by convenience in three different groups. Patients from group 1 received the conventional terbinafine dose (250 mg per day for 3 months). Group 2 received a monthly week-long pulse-therapy dose (500 mg per day for 7 days a month, for 4 months) and group 3 received a 500 mg/day dose for 7 days every 3 months, totaling four treatments. There were no statistical differences regarding the effectiveness or side effects between the groups. Conclusion: A quarterly terbinafine pulse regimen can be a possible alternative for treating onychomycosis caused by dermatophytes.
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Affiliation(s)
- Anarosa B Sprenger
- Santa Casa de Curitiba Hospital, Clinic of Diseases and Surgery of the Nail Apparatus, Department of Dermatology, Praça Rui Barbosa, 694, 80.010-030 Curitiba, Brazil.
| | - Katia Sheylla Malta Purim
- Hospital de Clínicas de Curitiba-Universidade Federal do Paraná (UFPR), Clinic of Dermatology, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
| | - Flávia Sprenger
- Univerdidade Federal do Paraná (UFPR), Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
| | - Flávio Queiroz-Telles
- Hospital de Clínicas de Curitiba-Paraná Federal University (UFPR), Department of Public Health, Rua General Carneiro, 181, 80.060-900 Curitiba, Brazil
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30
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Take a multifaceted approach when treating onychomycosis. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00640-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pinto SML, Rivera Y, Herrera Sandoval LV, Lizarazo JC, Rincón JJ, Vargas Méndez LY. Semisynthetic eugenol derivatives as antifungal agents against dermatophytes of the genus Trichophyton. J Med Microbiol 2019; 68:1109-1117. [PMID: 31199226 DOI: 10.1099/jmm.0.001019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Eugenol, the main component of clove bud essential oil (Eugenia caryophyllus), has been linked to antimicrobial, anti-inflammatory, insecticidal and immunomodulatory properties. The purpose of this study was to evaluate the antifungal and cytotoxic activity of eugenol, the essential oil of Eugenia caryophyllus, and some semisynthetic derivatives of eugenol against dermatophytes of the genus Trichophyton. METHODOLOGY We evaluated the antifungal effect of the compounds, determining the minimum inhibitory concentrations (MICs) by the microdilution method and the minimum fungicidal concentrations by cultures from the inhibitions. Additionally, the inhibition of the radial growth of the mycelium of the dermatophyte fungi was tested by poisoned substrate. Cytotoxicity was measured by the colorimetric method on Vero cells. RESULTS All of the eugenol compounds tested exhibited antifungal properties, showing MICs of 62.5-500 µg ml-1 , determined within three dermatophyte species: Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. Among these derivatives, methyl isoeugenol, at concentrations of 300 and 100 µg ml-1, was found to completely inhibit (100 %) radial growth of the mycelium of all three species after 20 days of treatment. Additionally, phenotypic variations related to the decrease in pigment production of T. rubrum were observed after treatment with O-ethyl and O-butyl isoeugenol derivatives. Meanwhile, all of the tested (iso)eugenol molecules exhibited moderate toxicity in Vero cells [50 % cytotoxic concentration (the concentration required for a 50 % reduction in cell viability; CC50): 54.06-265.18 µg ml-1 ). CONCLUSION The results suggest that the semisynthetic eugenol derivatives (SEDs) show promising antifungal activity and selectivity against dermatophyte fungi.
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Affiliation(s)
- Sandra Milena Leal Pinto
- Universidad de Santander, Facultad de Ciencias de la Salud, Grupo de Investigación en Manejo Clínico, Bucaramanga, Colombia
| | - Yohana Rivera
- Universidad de Santander, Facultad de Ciencias de la Salud, Grupo de Investigación en Biotecnología Agroambiental, Bucaramanga, Colombia
| | - Laura Viviana Herrera Sandoval
- Departamento de Ciencias Básicas, Grupo de Investigación Sistema Estomatognático y Morfofisiología, Universidad Santo Tomás, Bucaramanga, Colombia
| | - Juan Camilo Lizarazo
- Facultad de Química Ambiental, Grupo de Investigación Ambiental para el Desarrollo Sostenible, Universidad Santo Tomas, Bucaramanga, Colombia
| | - John Jairo Rincón
- Facultad de Química Ambiental, Grupo de Investigación Ambiental para el Desarrollo Sostenible, Universidad Santo Tomas, Bucaramanga, Colombia
| | - Leonor Yamile Vargas Méndez
- Facultad de Química Ambiental, Grupo de Investigación Ambiental para el Desarrollo Sostenible, Universidad Santo Tomas, Bucaramanga, Colombia
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