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Miller RC, Curtis KL, Magro CM, Lipner SR. Difficulties in diagnosing dermatophytomas: Analysis of clinical and dermoscopic findings. J Eur Acad Dermatol Venereol 2024; 38:e967-e970. [PMID: 38644750 DOI: 10.1111/jdv.20020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Rhiannon C Miller
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Kaya L Curtis
- Weill Cornell Medical College, New York, New York, USA
| | - Cynthia M Magro
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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2
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Gupta AK, Mann A, Polla Ravi S, Wang T, Cooper EA. Efinaconazole 10% solution: a comprehensive review of its use in the treatment of onychomycosis. Expert Opin Pharmacother 2024. [PMID: 39394930 DOI: 10.1080/14656566.2024.2416924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 10/07/2024] [Accepted: 10/11/2024] [Indexed: 10/14/2024]
Abstract
INTRODUCTION Onychomycosis is an infection of the nail bed and the nail plate. While oral antifungals are first-line for moderate to severe onychomycosis, topical efinaconazole 10% solution (JUBLIA®; Clenafin®) is effective and safe for mild to moderate severity onychomycosis. It is FDA-approved for patients aged 6 years and above. AREAS COVERED This literature review includes pharmacokinetics, microbiology, efficacy, safety, and post-marketing surveillance. It demonstrates consistent safety and efficacy across diverse patient demographics and comorbidities, including pediatric, diabetic and the elderly populations, without systemic side effects or drug interactions. EXPERT OPINION Efinaconazole 10% solution is an important addition to the armamentarium of therapies available to treat onychomycosis. Certain subgroups respond particularly well: females versus males, children versus adults, early onset onychomycosis (<1-year disease), those with mild onychomycosis (≤25% nail involvement), absence of tinea pedis, and thin nail plates at baseline (<1 mm thickness). Efinaconazole 10% solution is effective in diabetics and has demonstrated efficacy against dermatophytomas. Efinaconazole may be a consideration when terbinafine resistance is a concern, due to its different target of action.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Mediprobe Research Inc, London, ON, Canada
| | | | | | - Tong Wang
- Mediprobe Research Inc, London, ON, Canada
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Dubljanin E, Zunic J, Vujcic I, Colovic Calovski I, Sipetic Grujicic S, Mijatovic S, Dzamic A. Host-Pathogen Interaction and Resistance Mechanisms in Dermatophytes. Pathogens 2024; 13:657. [PMID: 39204257 PMCID: PMC11357293 DOI: 10.3390/pathogens13080657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/14/2024] Open
Abstract
Dermatophytes are widely distributed in the environment, with an estimated prevalence of 20-25% of the the global population yearly. These fungi are keratinophilic and keratinolytic and cause the infection of keratin-rich structures such as skin, hair, and nails. The pattern of this infectious disease covers a wide spectrum from exposed individuals without symptoms to those with acutely inflammatory or non-inflammatory, chronic to invasive, and even life-threatening symptoms. This review summarizes current information on the pathogenicity, virulence factors, and drug resistance mechanisms associated with dermatophytes. A greater number of virulence factors of these fungi are important for the occurrence of infection and the changes that occur, including those regarding adhesins, the sulfite efflux pump, and proteolytic enzymes. Other virulence factors include mechanisms of evading the host defense, while the development of resistance to antifungal drugs is increasing, resulting in treatment failure. The investigation of host-pathogen interactions is essential for developing a more complete understanding of the mechanisms underlying dermatophyte pathogenesis and host response to inform the use of diagnostics methods and antifungal therapeutics to minimize the high fungal burden caused by dermatophytes and to control the spread of resistance.
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Affiliation(s)
- Eleonora Dubljanin
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Zunic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Isidora Vujcic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Colovic Calovski
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Sandra Sipetic Grujicic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, 11000 Belgrade, Serbia
| | - Stefan Mijatovic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Dzamic
- Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade, 11000 Belgrade, Serbia
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Gupta AK, Elewski B, Joseph WS, Lipner SR, Daniel CR, Tosti A, Guenin E, Ghannoum M. Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents. Mycoses 2024; 67:e13683. [PMID: 38214375 DOI: 10.1111/myc.13683] [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: 08/03/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
A growing body of literature has marked the emergence and spread of antifungal resistance among species of Trichophyton, the most prevalent cause of toenail and fingernail onychomycosis in the United States and Europe. We review published data on rates of oral antifungal resistance among Trichophyton species; causes of antifungal resistance and methods to counteract it; and in vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of Trichophyton against terbinafine and itraconazole-the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes-has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug-drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in vitro against susceptible and/or resistant isolates of Trichophyton species, with low potential for development of antifungal resistance. Additional real-world long-term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.
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Affiliation(s)
- Aditya K Gupta
- Mediprobe Research Inc., London, Ontario, Canada
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Boni Elewski
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Warren S Joseph
- Arizona College of Podiatric Medicine, Midwestern University, Glendale, Arizona, USA
| | | | - C Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Eric Guenin
- Ortho Dermatologics (a division of Bausch Health US, LLC), Bridgewater, New Jersey, USA
| | - Mahmoud Ghannoum
- Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Opaigbeogu OC, Lawrence R, Ragland H, Han B, Murina A. Melanonychia and subungual papule in a middle-aged man. JAAD Case Rep 2023; 37:131-133. [PMID: 37409012 PMCID: PMC10319164 DOI: 10.1016/j.jdcr.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Affiliation(s)
| | - Ryan Lawrence
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Howard Ragland
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Bing Han
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
| | - Andrea Murina
- Department of Dermatology, Tulane University School of Medicine, New Orleans, Louisiana
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Hwang JK, Bakotic WL, Gold JAW, Magro CM, Lipner SR. Isolation of Terbinafine-Resistant Trichophyton rubrum from Onychomycosis Patients Who Failed Treatment at an Academic Center in New York, United States. J Fungi (Basel) 2023; 9:710. [PMID: 37504699 PMCID: PMC10381657 DOI: 10.3390/jof9070710] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Onychomycosis is a common nail infection. Terbinafine-resistant dermatophyte infections pose an emerging global public health concern, but few cases have been described in the United States. We retrospectively reviewed and characterized clinical, histopathological, and mycological features of patients with mycologically confirmed onychomycosis who failed oral terbinafine treatment for onychomycosis at a U.S. academic nail referral center and ascertained for terbinafine-resistant isolates. During 1 June 2022-31 January 2023 at Weill Cornell Medicine in New York City, USA, 96 patients with mycologically confirmed onychomycosis were treated with oral terbinafine. Among 64 patients with adequate follow-up, 36 had clinical or complete cure. Of 28 patients who failed treatment, 17 underwent terbinafine resistance testing. Trichophyton rubrum with terbinafine resistance-conferring mutations was isolated from two patients. Overall, terbinafine failures for onychomycosis were relatively common, with some cases associated with terbinafine-resistant T. rubrum infections. These findings underscore the need for a clinical awareness of this emerging problem and public health efforts to monitor and prevent spread. We highlight the importance of diagnostic testing and species identification for onychomycosis patients and the increasingly important role of fungal identification and susceptibility testing to guide therapy.
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Affiliation(s)
| | | | - Jeremy A W Gold
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Costa-Orlandi CB, Bila NM, Bonatti JLC, Vaso CO, Santos MB, Polaquini CR, Santoni Biasioli MM, Herculano RD, Regasini LO, Fusco-Almeida AM, Mendes-Giannini MJS. Membranolytic Activity Profile of Nonyl 3,4-Dihydroxybenzoate: A New Anti-Biofilm Compound for the Treatment of Dermatophytosis. Pharmaceutics 2023; 15:pharmaceutics15051402. [PMID: 37242644 DOI: 10.3390/pharmaceutics15051402] [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: 11/25/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 05/28/2023] Open
Abstract
The ability of dermatophytes to live in communities and resist antifungal drugs may explain treatment recurrence, especially in onychomycosis. Therefore, new molecules with reduced toxicity that target dermatophyte biofilms should be investigated. This study evaluated nonyl 3,4-dihydroxybenzoate (nonyl) susceptibility and mechanism of action on planktonic cells and biofilms of T. rubrum and T. mentagrophytes. Metabolic activities, ergosterol, and reactive oxygen species (ROS) were quantified, and the expression of genes encoding ergosterol was determined by real-time PCR. The effects on the biofilm structure were visualized using confocal electron microscopy, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). T. rubrum and T. mentagrophytes biofilms were susceptible to nonyl and resistant to fluconazole, griseofulvin (all strains), and terbinafine (two strains). The SEM results revealed that nonyl groups seriously damaged the biofilms, whereas synthetic drugs caused little or no damage and, in some cases, stimulated the development of resistance structures. Confocal microscopy showed a drastic reduction in biofilm thickness, and transmission electron microscopy results indicated that the compound promoted the derangement and formation of pores in the plasma membrane. Biochemical and molecular assays indicated that fungal membrane ergosterol is a nonyl target. These findings show that nonyl 3,4-dihydroxybenzoate is a promising antifungal compound.
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Affiliation(s)
- Caroline B Costa-Orlandi
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Níura M Bila
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
- Department of Para-Clinic, School of Veterinary, Eduardo Modlane University (UEM), Maputo 257, Mozambique
| | - Jean Lucas C Bonatti
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Carolina O Vaso
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Mariana B Santos
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Carlos R Polaquini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Mariana M Santoni Biasioli
- Department of Biological Sciences, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Rondinelli D Herculano
- Department of Bioprocesses and Biotechnology, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Luis O Regasini
- Department of Chemistry and Environmental Sciences, Institute of Biosciences, Humanities and Exact Sciences, São Paulo State University (U.N.E.S.P.), Sao Jose do Rio Preto 15054-000, SP, Brazil
| | - Ana Marisa Fusco-Almeida
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
| | - Maria José S Mendes-Giannini
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (U.N.E.S.P.), Araraquara 14800-903, SP, Brazil
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Ishida H, Noriki S, Mochizuki T. Diagnostic clue for dermatophytoma using the dermatophyte test strip. J Dermatol 2023; 50:e87-e88. [PMID: 36282900 DOI: 10.1111/1346-8138.16619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/25/2022] [Accepted: 10/11/2022] [Indexed: 02/04/2023]
Affiliation(s)
| | - Sakon Noriki
- Department of Nursing and Welfare Sciences, Fukui Prefectural University, Fukui, Japan
| | - Takashi Mochizuki
- Department of Dermatology, Kanazawa Medical University, Kahoku, Japan
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