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Zhu T, Chen X, Li C, Tu J, Liu N, Xu D, Sheng C. Lanosterol 14α-demethylase (CYP51)/histone deacetylase (HDAC) dual inhibitors for treatment of Candida tropicalis and Cryptococcus neoformans infections. Eur J Med Chem 2021; 221:113524. [PMID: 33992927 DOI: 10.1016/j.ejmech.2021.113524] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022]
Abstract
Invasive fungal infections remain a challenge due to lack of effective antifungal agents and serious drug resistance. Discovery of antifungal agents with novel antifungal mechanism is important and urgent. Previously, we designed the first CYP51/HDAC dual inhibitors with potent activity against resistant Candida albicans infections. To better understand the antifungal spectrum and synergistic mechanism, herein new CYP51/HDAC dual inhibitors were designed which showed potent in vitro and in vivo antifungal activity against C. neoformans and C. tropicalis infections. Antifungal mechanism studies revealed that the CYP51/HDAC dual inhibitors acted by inhibiting various virulence factors of C. tropicalis and C. neoformans and down-regulating resistance-associated genes. This study highlights the potential of CYP51/HDAC dual inhibitors as a promising strategy for the discovery of novel broad-spectrum antifungal agents.
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Affiliation(s)
- Tianbao Zhu
- National & Local Joint Engineering Research Center for High-efficiency Refining and High-quality Utilization of Biomass, School of Pharmacy, 1 Gehu Road, Changzhou University, Changzhou, 213164, China; School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai, 200433, China
| | - Xi Chen
- Key Laboratory of Synthetic and Natural Functional Molecule of the Ministry of Education, College of Chemistry and Materials Science, Northwest University, 1 Xuefu Avenue, Xi'an, 710127, China
| | - Chenglan Li
- School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai, 200433, China
| | - Jie Tu
- School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai, 200433, China
| | - Na Liu
- School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai, 200433, China.
| | - Defeng Xu
- National & Local Joint Engineering Research Center for High-efficiency Refining and High-quality Utilization of Biomass, School of Pharmacy, 1 Gehu Road, Changzhou University, Changzhou, 213164, China.
| | - Chunquan Sheng
- School of Pharmacy, Second Military Medical University, 325 Guohe Road, Shanghai, 200433, China.
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Schlager E, Ashack K, Khachemoune A. Erosio interdigitalis blastomycetica: A review of interdigital candidiasis. Dermatol Online J 2018; 24:13030/qt8tm443f6. [PMID: 30677843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023] Open
Abstract
Erosio interdigitalis blastomycetica (EIB) is a Candida infection affecting the third web space, between the third and fourth fingers. In 1915, Gougerot and Goncea first described saccharomycetic organisms isolated from the hands and feet. Johannes Fabry later named it in 1917, well before the genus Candida was introduced in 1923. EIB is most common among those who work with their hands frequently in water, such as dishwashers, launderers, bartenders, and homemakers. Clinical presentation most commonly consists of a central erythematous erosion surrounded by a rim of white macerated skin involving at least one interdigital web space. The differential diagnosis is narrow, consisting of irritant contact dermatitis (ICD), erythrasma, inverse psoriasis, and bacterial infection (i.e. impetigo). The diagnosis is made by clinical examination in addition to fungal culture and KOH testing. The prognosis is good and treatment options include avoidance of frequent water immersion and topical or oral antifungal agents. Suspicion for secondary infections such as erysipelas and cellulitis should remain high until lesions have resolved. This review aims to address the history, epidemiology, pathophysiology, histopathology, clinical presentation, differential diagnoses, diagnosis, prognosis, and management of EIB. It also suggests an alternative name in place of the current misnomer.
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Affiliation(s)
| | | | - Amor Khachemoune
- Veterans Affairs Medical Center Brooklyn, New York SUNY Downstate, Department of Dermatology, Brooklyn, New York.
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Tumietto F, Giacomelli L. Fenticonazole: an effective topical treatment for superficial mycoses as the first-step of antifungal stewardship program. Eur Rev Med Pharmacol Sci 2017; 21:2749-2756. [PMID: 28678309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The resistance of microorganisms to antimicrobial drugs is a major issue for public health, with important consequences in terms of morbidity, mortality and resource use. The phenomenon is so serious that in some areas of the world resistant strains to all available drugs have been selected. Many conditions may result in the development of resistance: they include the indiscriminate or inappropriate (e.g., for viral infection or colonization) use of antibiotics, the excessive duration of the prescribed treatment regimens, as well as inadequate dosing or administration routes. Resistance is well-known, but less studied, also for infections caused by fungi. In the last decade, an impressive outbreak of candidiasis due to non-albicans strains (with variable patterns of resistance to azoles) was observed. This outbreak was likely associated with inappropriate use of oral azoles for the treatment of non-complicated candidiasis, such as vulvovaginal candidiasis or Candida dermatitis. In this setting, fenticonazole may represent an effective topical drug for the treatment of mycotic infections of skin and mucosa. Topical treatment of superficial mycoses still holds a major importance as it helps reduce the exposure to oral systemic azoles - mainly fluconazole and itraconazole - of intestinal microbiota, which represents the main human reservoir of yeasts. This strategy can contribute to reduce the selection of resistant strains of Candida, within the context of a really-effective antifungal stewardship program.
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Affiliation(s)
- F Tumietto
- Infectious Diseases Unit Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Desomchoke R, Bunyaratavej S, Leeyaphan C, Prasertworonun N, Rujitharanawong C, Matthapan L, Pattanaprichakul P. Efficacy and Safety in 1% Clotrimazole Powder, Adjuvant Therapy in Patients with Superficial Fungal Cutaneous Infection in Intertriginous Areas. J Med Assoc Thai 2016; 99:1355-1359. [PMID: 29953171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Superficial fungal cutaneous infection is commonly found in intertriginous area. OBJECTIVE To assess 1% clotrimazole powder (1% CP) efficacy for adjuvant treatment of superficial fungal cutaneous infection in intertriginous areas. MATERIAL AND METHOD The study performed as an open-label, randomized, comparative study for evaluating the effects of 1% clotrimazole cream (1% CC) with 1% CP in patients infected with dermatophytes (DMPs) or Candida spp. in intertriginous area, comparing to patients treated with 1% CC as control by demonstrating complete cure rate at 4, 8, and 12 weeks as well as relapse rates during a 24-week period including patient satisfaction. RESULTS Sixty-seven patients with mean age of 54.6 years were included in this study. Of those, 61.2% were males. Thirty-five patients were infected with DMPs and 32 with Candida spp. The complete cure rates of experimental group were significantly higher than the control group, as observed within four weeks (p = 0.01), especially for dermatophyte infection (p = 0.039). Two cases had recurrent candidiasis in the control group. In both groups, relapse up to 24 weeks were not statistically different. Additionally, there was no difference in patients’ satisfaction towards convenience of drug application. CONCLUSION Using of the 1% CP could be suggested as an adjuvant therapy and possibly preventive agent for superficial fungal cutaneous infection in intertriginous areas.
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Björn C, Mahlapuu M, Mattsby-Baltzer I, Håkansson J. Anti-infective efficacy of the lactoferrin-derived antimicrobial peptide HLR1r. Peptides 2016; 81:21-8. [PMID: 27155369 DOI: 10.1016/j.peptides.2016.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
Antimicrobial peptides (AMPs) have emerged as a new class of drug candidates for the treatment of infectious diseases. Here we describe a novel AMP, HLR1r, which is structurally derived from the human milk protein lactoferrin and demonstrates a broad spectrum microbicidal action in vitro. The minimum concentration of HLR1r needed for killing ≥99% of microorganisms in vitro, was in the range of 3-50μg/ml for common Gram-negative and Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), and for the yeast Candida albicans, when assessed in diluted brain-heart infusion medium. We found that HLR1r also possesses anti-inflammatory properties as evidenced by inhibition of tumor necrosis factor alpha (TNF-α) secretion from human monocyte-derived macrophages and by repression of interleukin-6 (IL-6) and plasminogen activator inhibitor-1 (PAI-1) secretion from human mesothelial cells, without any cytotoxic effect observed at the concentration range tested (up to 400μg/ml). HLR1r demonstrated pronounced anti-infectious effect in in vivo experimental models of cutaneous candidiasis in mice and of excision wounds infected with MRSA in rats as well as in an ex vivo model of pig skin infected with S. aureus. In conclusion, HLR1r may constitute a new therapeutic alternative for local treatment of skin infections.
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Affiliation(s)
- Camilla Björn
- Pergamum AB, Karolinska Institutet Science Park, Fogdevreten 2, SE-171 65 Solna, Sweden; SP Technical Research Institute of Sweden, Medical Device Technology, Box 857, SE-501 15 Borås, Sweden; The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 5, SE-413 45 Gothenburg, Sweden
| | - Margit Mahlapuu
- Pergamum AB, Karolinska Institutet Science Park, Fogdevreten 2, SE-171 65 Solna, Sweden; The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine, The Sahlgrenska Academy at University of Gothenburg, Blå stråket 5, SE-413 45 Gothenburg, Sweden
| | - Inger Mattsby-Baltzer
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Box 440, SE-405 30 Gothenburg, Sweden
| | - Joakim Håkansson
- Pergamum AB, Karolinska Institutet Science Park, Fogdevreten 2, SE-171 65 Solna, Sweden; SP Technical Research Institute of Sweden, Medical Device Technology, Box 857, SE-501 15 Borås, Sweden.
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Hercogovấ J, Tirant M, Bayer P, Coburn M, Donnelly B, Kennedy T, Gaibor J, Arora M, Clews L, Fioranelli M, Gianfaldoni S, Chokoeva AA, Tchernev G, Wollina U, Novotny F, Roccia MG, Maximov GK, França K, Lotti T. Successful treatment of recalcitrant candidal intertrigo with Dr Michaels® (Fungatinex®) product family. J BIOL REG HOMEOS AG 2016; 30:89-93. [PMID: 27498664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Candidal intertrigo is an infection of the skin caused by Candida albicans that typically occurs in opposing cutaneous or muco-cutaneous surfaces. Because Candidiasis requires a damaged and moist environment for infection, it typically occurs in areas of friction such as the skin folds of the body. Candidal intertrigo is often difficult to treat and results are often unsatisfactory. In addition, there is a lack of evidence-based literature supporting prevention and treatments for candidal intertrigo. The aim of the study was to evaluate the efficacy of Dr Michaels® (also branded as Fungatinex®) products in the treatment of fungal intertrigo, in 20 women and 2 men with a mean age of 72. Five patients (3 female and 2 male) had type 2 diabetes and 16 (14 female and 2 male) were obese. The patients were treated with Dr Michaels® (Fungatinex®) moisturising bar, topical ointment (twice daily application) and oral herbal formulation, PSC 200 two tablets twice daily with food. After 2 weeks of treatment, the lesions had mostly resolved in all patients with only slight erythema evident. After six weeks of treatment using the moisturising bar, topical ointment and oral herbal formulations from the Dr Michaels® (Fungatinex®) product family, the lesions had totally resolved in 18 patients, while 4 patients had to continue the therapeutic protocol for another 2 weeks. Our results demonstrate that the Dr Michaels® (Fungatinex®) complementary product family is efficacious in the treatment of recalcitrant candidal intertrigo. Furthermore, this study highlights that the Dr Michaels® (Fungatinex®) product family is fast-acting and well tolerated with no serious adverse events reported. These data have important implications for resistant cases of candidal intertrigo where traditional therapies have failed.
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Affiliation(s)
- J Hercogovấ
- 2nd Medical Faculty, Charles University, Bulovka Hospital, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - M Tirant
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - P Bayer
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - M Coburn
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - B Donnelly
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - T Kennedy
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - J Gaibor
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - M Arora
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - L Clews
- Psoriasis and Skin Clinic, Melbourne, Australia
| | - M Fioranelli
- Department of Nuclear Physics, Sub-nuclear and Radiation, Guglielmo Marconi University, Rome, Italy
| | - S Gianfaldoni
- Dermatological Department University of Pisa, Pisa, Italy
| | - A A Chokoeva
- Onkoderma-Policlinic for dermatology and dermatologic surgery, Sofia, Bulgaria; Department of Dermatology and Venereology, Medical University of Plovdiv, Medical faculty, Plovdiv, Bulgaria
| | - G Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
| | - U Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
| | - F Novotny
- PRO SANUM Ltd, Sanatorium of Prof. Novotný, Štěpánská Prague 1, Czech Republic
| | - M G Roccia
- University B.I.S. Group of Institutions, Punjab Technical University, Punjab, India
| | - G K Maximov
- Department Medicinal Information and Non-interventional studies, Bulgarian Drug Agency, Sofia, Bulgaria
| | - K França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry and Behavioral Sciences, Institute for Bioethics and Health Policy, University of Miami, Miller School of Medicine, Miami, FL, USA; Centro Studi per la Ricerca Multidisciplinare e Rigenerativa, Università Degli Studi "G. Marconi", Rome, Italy
| | - T Lotti
- Chair of Dermatology, University of Rome G. Marconi Rome, Italy
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Rosen T. Mycological Considerations in the Topical Treatment of Superficial Fungal Infections. J Drugs Dermatol 2016; 15:s49-s55. [PMID: 26885799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Trichophyton rubrum remains the most common pathogenic dermatophyte in the United States, Europe, and industrialized Asia, although other species are predminant elsewhere. Candida albicans is the most common pathogenic yeast, with other species occasionally encountered. Just a few of the 14 described species of Malassezia cause pityriasis versicolor worldwide. FDA approval does not always accurately reflect the potential utility of any given topical antifungal agent. Azole, hydroxypyridone, and allylamine agents are beneficial in the management of dermatophytosis; however, the allylamines may lead to faster symptom resolution and a higher degree of sustained response. Although in actual clinical use the allylamines have all shown some activity against superficial cutaneous candidiasis and pityriasis versicolor, the azole agents remain drugs of choice. Ciclopirox is an excellent broad-spectrum antifungal agent. Optimal topical therapy for superficial fungal infections cannot yet be reliably based upon in-vitro laboratory determination of sensitivity. Inherent antibacterial and anti-inflammatory properties possessed by some antifungal agents may be exploited for clinical purposes. Candida species may be azole-insensitive due to efflux pumps or an altered target enzyme. So-called "antifungal resistance" of dermatophyets is actually due to poor patient adherence (either in dosing or treatment duration), or to reinfection.
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Qi J, Jourabchi N, Balagula Y, Sheu M, Fischer MK. Folliculocentric cutaneous presentation of disseminated Candida krusei infection in a patient with acute myeloid leukemia. Dermatol Online J 2015; 21:13030/qt52j7w4g1. [PMID: 26632935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 06/05/2023] Open
Abstract
Candida krusei (C. krusei) is a multidrug-resistant opportunistic fungal pathogen that may cause disseminated infections in immunocompromised hosts. However, its clinical and histologic features are not well-characterized. We present a unique case to contribute to the growing knowledge base associated with this organism. During hospitalization for neutropenic fever, a 19-year-old man with acute myeloid leukemia, who underwent hematopoietic stem cell transplantation, developed a generalized folliculocentric eruption following initiation of antifungal therapy for newly diagnosed C. krusei fungemia. Despite adequate antifungal coverage and negative blood cultures, the follicular-based erythematous papules persisted. Biopsies demonstrated yeast within ruptured follicles, without angiotropism or involvement of the interfollicular dermis, subcutaneous tissue, or stratum corneum. Concurrent skin tissue cultures confirmed C. krusei. The patient remained febrile despite aggressive antifungal therapy, with relapse of leukemia and subsequent death. Our case is unusual given the development of cutaneous lesions following clearance of fungemia, with yeast limited to ruptured follicular lumina, possibly indicating a primary cutaneous source or early transfollicular/transepidermal elimination. Given the limited available descriptions of cutaneous histopathology for C. krusei, we seek to add to the understanding of its pathophysiology and aid in the diagnosis and treatment of this often fatal infection.
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Tucker AT, Emerson AN, Wyatt JP, Brodell RT. Case report: Diaper dermatitis presenting as pustules. J Drugs Dermatol 2014; 13:1153-1154. [PMID: 25362747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diaper dermatitis is the most common dermatologic disorder of infancy. Its cause can often be determined clinically based on the clinical presentation. Primary diaper dermatitis is associated with irritants and spares the deep skin folds. Secondary diaper dermatitis is most often caused by Candida yeast overgrowth and typically presents as a well-defined area of beefy red erythema covering the diaper area and including the deep folds of skin with hallmark satellite pustules. Other causes include seborrheic dermatitis, psoriasis, acrodermatitis enteropathica, allergic contact dermatitis, Langerhans cell histiocytosis, and, in the setting of a primarily pustular eruption, bacterial folliculitis. A simple potassium hydroxide preparation (KOH) can confirm the diagnosis of candida diaper dermatitis and guide proper treatment.
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Siriratsivawong R, Pavlis M, Hymes SR, Mintzer JP. Congenital candidiasis: an uncommon skin eruption presenting at birth. Cutis 2014; 93:229-232. [PMID: 24897134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present the case of a preterm neonate who was born with respiratory distress and a papulovesicular rash that was diagnosed as congenital candidiasis (CC). The mother was asymptomatic. The cutaneous eruption and respiratory distress improved following treatment with systemic antifungals. Congenital candidiasis ranges in presentation from isolated cutaneous involvement to severe multisystem disease. Given its rarity among neonatal skin eruptions, heightened suspicion is required for prompt diagnosis and treatment.
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Affiliation(s)
| | - Michelle Pavlis
- Stony Brook Medicine, Department of Dermatology, 181 Belle Mead Rd, Ste 5, East Setauket, NY 11733, USA.
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Abstract
BACKGROUND Although breast pain remains a common cause of weaning, controversy exists regarding the etiology of chronic pain. Prospective studies are needed to define optimal treatment regimens. We evaluated patient history, exam, and bacterial cultures in breastfeeding women with chronic breast pain. We compared pain resolution and breastfeeding complications in patients responding to conservative therapy (CTX) (n=38) versus those in patients failing CTX and receiving oral antibiotic treatment (OTX) (n=48). SUBJECTS AND METHODS We prospectively enrolled 86 breastfeeding women with breast pain lasting greater than 1 week and followed up patients through 12 weeks. RESULTS Higher initial breast (p=0.012) and nipple pain severity (p=0.004), less response to latch correction (p=0.015) at baseline visit, and breastmilk Staphylococcus aureus growth (p=0.001) were associated with failing CTX. Pain type was not associated with failure of CTX. When culture results were available at 5 days, breast pain remained higher (p<0.001) in patients failing CTX and starting antibiotics. OTX patients then had more rapid breast pain reduction between 5 and 14 days (score of 3.1 vs. 1.3; p<0.001). By 4 weeks there was no difference (1.8/10 vs. 1.4/10; p=0.088) in breast pain level between groups. Median length of OTX was 14 days. At 12 weeks, weaning frequency (17% vs. 8%; p=0.331) was not statistically different. CONCLUSIONS Initial pain severity and limited improvement to latch correction predicts failure of CTX. S. aureus growth is more common in women failing CTX. For those women not responding to CTX, OTX matched to breastmilk culture may significantly decrease their pain and is not associated with increased complications.
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Affiliation(s)
- Ann M. Witt
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Breastfeeding Medicine of Northeast Ohio, Cleveland, Ohio
- Senders Pediatrics, Cleveland, Ohio
| | - Kelly Burgess
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Thomas R. Hawn
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Steven Zyzanski
- Department of Family Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
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13
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Abstract
BACKGROUND Nipple pain and damage are common in the early postpartum period and are associated with early cessation of breastfeeding and comorbidities such as depression, anxiety, and mastitis. The incidence of nipple vasospasm has not been reported previously. This article describes nipple pain and damage prospectively in first-time mothers and explores the relationship between method of birth and nipple pain and/or damage. SUBJECTS AND METHODS A prospective cohort of 360 primiparous women was recruited in Melbourne, Australia, in the interval 2009-2011, and after birth participants were followed up six times. The women completed a questionnaire about breastfeeding practices and problems at each time point. Pain scores were graphically represented using spaghetti plots to display each woman's experience of pain over the 8 weeks of the study. RESULTS After birth, before they were discharged home from hospital, 79% (250/317) of the women in this study reported nipple pain. Over the 8 weeks of the study 58% (198/336) of women reported nipple damage, and 23% (73/323) reported vasospasm. At 8 weeks postpartum 8% (27/340) of women continued to report nipple damage, and 20% (68/340) were still experiencing nipple pain. Ninety-four percent (320/340) of the women were breastfeeding at the end of the study, and there was no correlation between method of birth and nipple pain and/or damage. CONCLUSIONS Nipple pain is a common problem for new mothers in Australia and often persists for several weeks. Further studies are needed to establish the most effective means of preventing and treating breastfeeding problems in the postnatal period.
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Affiliation(s)
- Miranda L Buck
- 1 Mother and Child Health Research, La Trobe University , Melbourne, Victoria, Australia
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Sket KV, Giachetti A, Sojo M, Garrido D, Lupo E, Brener P. [Congenital cutaneous candidiasis]. ARCH ARGENT PEDIATR 2013; 111:556-558. [PMID: 24196777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Guo Z, Liu Y, Zheng S, Qiu L, Wu J, Xiao T. Chronic unilateral facial ulcer revealing Wegener's granulomatosis in a patient with rheumatoid arthritis. Acta Derm Venereol 2013; 93:196-7. [PMID: 22735567 DOI: 10.2340/00015555-1405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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MESH Headings
- Administration, Oral
- Administration, Topical
- Antifungal Agents/administration & dosage
- Antifungal Agents/therapeutic use
- Candidiasis/diagnosis
- Candidiasis/drug therapy
- Candidiasis/prevention & control
- Candidiasis, Chronic Mucocutaneous/diagnosis
- Candidiasis, Chronic Mucocutaneous/drug therapy
- Candidiasis, Chronic Mucocutaneous/prevention & control
- Candidiasis, Cutaneous/congenital
- Candidiasis, Cutaneous/diagnosis
- Candidiasis, Cutaneous/drug therapy
- Candidiasis, Cutaneous/prevention & control
- Candidiasis, Oral/diagnosis
- Candidiasis, Oral/drug therapy
- Candidiasis, Oral/prevention & control
- Candidiasis, Vulvovaginal/diagnosis
- Candidiasis, Vulvovaginal/drug therapy
- Candidiasis, Vulvovaginal/prevention & control
- Dermatitis, Contact/diagnosis
- Diagnosis, Differential
- Female
- Humans
- Infant, Newborn
- Intertrigo/diagnosis
- Intertrigo/drug therapy
- Intertrigo/microbiology
- Male
- Onychomycosis/diagnosis
- Onychomycosis/drug therapy
- Pregnancy
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Psoriasis/diagnosis
- Secondary Prevention
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Rotta I, Otuki MF, Sanches ACC, Correr CJ. Efficacy of topical antifungal drugs in different dermatomycoses: a systematic review with meta-analysis. Rev Assoc Med Bras (1992) 2012; 58:308-318. [PMID: 22735222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 02/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. METHODS A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure. RESULTS Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]). CONCLUSION There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.
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Affiliation(s)
- Inajara Rotta
- Programa de Ciências Farmacêuticas, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Moorhead AM, Amir LH, O'Brien PW, Wong S. A prospective study of fluconazole treatment for breast and nipple thrush. Breastfeed Rev 2011; 19:25-29. [PMID: 22263374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Breastfeeding women with continuous burning nipple pain, often associated with post-feed radiating breast pain, may be diagnosed with nipple and breast Candida (thrush) infection. This project examined the efficacy of the three fuconazole capsule regime (one 150 mg capsule alternate days) and explored factors associated with longer courses of fluconazole. METHODS Women diagnosed with nipple and breast Candida and treated with oral fuconazole at a tertiary hospital (n = 96) were followed up until pain resolution. RESULTS Women took between 1 and 29 fluconazole capsules, mean = 7.3, median = 6. The number of capsules was not related to socio-demographic or health characteristics of mothers or babies; women with more severe breast pain were more likely to take > 3 capsules than women with less severe breast pain. Only minor side-effects were reported. DISCUSSION Most women require more than three capsules of fluconazole, but two-thirds of women will require six or less.
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Kamińska-Winciorek G, Spiewak R. [Pitted keratolysis--how to treat?]. Pol Merkur Lekarski 2011; 31:127-129. [PMID: 21936353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Pitted keratolysis is a common and problematic skin condition affecting the feet caused by the keratolytic activity of Corynebacterium, Micrococcus, Dermatophilus. Skin lesions are characterized by crater-like pits of the epidermis accompanied by a burning sensation, itching, pain and malodor. The purpose of the present paper was to characterise the disease's clinical features and possibilities for the therapy. Due to its interdisciplinary nature, not only dermatologists ought to be familiar with the disease, but also physicians, pediatricians, surgeons, orthopedists, military doctors and occupational health doctors.
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Affiliation(s)
- Grazyna Kamińska-Winciorek
- Uniwersytet Jagielloński Collegium Medicum, Kraków, Zakład Dermatologii Doświadczalnej i Kosmetologii, Wydział Farmaceutyczny.
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21
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Stollery N. Infant problems. Practitioner 2011; 255:26-27. [PMID: 21932503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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22
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Tinsa F, Boussetta K, Ben Hassine D, Kharfi M, Bousnina S. Congenital cutaneous candidiasis associated with respiratory distress in a full-term newborn. Tunis Med 2010; 88:844-846. [PMID: 21049416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Congenital candidiasis is rare occurring in most cases in premature and low birth weight new born. It can produce a spectrum of disease ranging from a diffuse skin eruption to a severe systemic disease with or without skin involvement. Amphotericin B is the first-line agent for the treatment of systemic disease. AIM To describe a congenital candidiasis in a full-term newborn. CASE REPORT At birth, the newborn had a generalized, erythematous, papulovesicular eruption. He was treated by topic antifungal therapy. However, on the third day, he developed a systemic disease with respiratory distress and fever. Ear, skin swab and gastric aspirate grew to Candida albicans. The newborn was given fluconazole for 10 days with favourable outcome. CONCLUSION Early topic therapy did not prevent systemic spread of congenital cutaneous candidiasis in our case. Treatment with fluconazole, as the first-line agent, seems effective and safe.
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Affiliation(s)
- Faten Tinsa
- Department of Pediatrics B, Children's Hospital of Tunis, Tunis, Tunisia
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23
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Andersson M, Helldén A. [Treatment of nipple candidiasis in breast feeding mothers]. Lakartidningen 2010; 107:2170. [PMID: 21043157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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24
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Geddes ERC, Polder K, Cutlan JE, Torres-Cabala CA, Hymes SR. Ulcerated plaque under a ruby ring in an immunosuppressed patient. Dermatol Online J 2010; 16:4. [PMID: 20804681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
We report a primary inoculation fungal infection in a 76-year-old man with acute myeloid leukemia. The patient presented with a painful red plaque located where he routinely wore a ruby ring. Histopathology revealed multiple branching septate hyphae. Cultures confirmed Fusarium and Candida parapsilosis infection. A short discussion of these organisms follows.
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25
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Marks S, Cantrell W, Varma R, Elewski B. Naftifine, a topical allylamine. J Drugs Dermatol 2010; 9:750. [PMID: 20677526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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26
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Vano-Galvan S, Guisado-Vasco P, Jaén P. Giant inguinoscrotal hernia. Aust Fam Physician 2009; 38:222-223. [PMID: 19350072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Giant inguinoscrotal hernia are uncommon in developed countries. They are defined as 'hernias that extend below the midpoint of the inner thigh in the standing position'. As well as the classic complications of inguinoscrotal hernia, patients will encounter difficulty in walking, sitting or lying down, with mobility dramatically restricted. patients will also often develop cutaneous complications such as irritative eczema, candidiasis, and gangrene or ulcers. When the ureter or bladder are contained in the hernia's sac, recurrent urinary tract infections may also occur.
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Affiliation(s)
- Sergio Vano-Galvan
- Department of Dermatology, Ramon y Cajal University Hospital, Madrid, Spain.
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Mansur AT, Aydingöz IE, Uygur T, Gündüz S. Long-term use of fluconazole for verrucous plaques of cutaneous candidiasis in KID syndrome. Eur J Dermatol 2008; 18:469-470. [PMID: 18573732 DOI: 10.1684/ejd.2008.0452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Affiliation(s)
- Buenaventura Hernandez-Machin
- Department of Dermatology, Hospital Universitario Materno-Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
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Xi L, Li X, Zhang J, Lu C, Xie T, Yin R. Good response in a patient with deep-seated subcutaneous ulcer due to Candida species. Mycopathologia 2007; 164:77-80. [PMID: 17551846 DOI: 10.1007/s11046-007-9030-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
Abstract
Deep-seated subcutaneous ulcers infected with Candida species are rare. We are reporting a 51-year-old Cantonese woman who had a large, deep-seated subcutaneous ulcer on her right shoulder for more than a year. Direct smears of the purulent extrusion revealed many pseudohyphae and yeast cells. Candida species were isolated from the purulent extrusion and further identified as Candida albicans and C. parapsilosis. A skin lesion biopsy contained yeast cells and pseudohyphae. C. parapsilosis were once isolated from the biopsy specimen. Total healing was obtained with itraconazole (200 mg twice daily for 16 days and then 100 mg twice daily for 14 days) combined with phototherapy.
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Affiliation(s)
- Liyan Xi
- Department of Dermatology, The Second Affiliated Hospital, Sun Yat-Sen University, 107 West Yanjiang Rd, Guangzhou, 510120, China.
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Abstract
BACKGROUND The different causes of diaper dermatitis (DD) in the elderly are not well known and the treatment is often empirical. OBJECTIVES To determine the causes of DD in the elderly and to evaluate the efficacy of antifungal treatments in this indication. METHODS Consecutive patients presenting with DD were included. Clinical evaluation, skin swabs for bacterial and mycological cultures, patch testing and skin biopsy were performed at inclusion. This was followed by 1 month of topical antifungal cream and, if needed, by oral fluconazole for the second month. RESULTS Forty-six patients were included (mean age 85 years). Causes of DD were established for 38 patients: 24 had candidiasis (63%), six irritant dermatitis (16%), four eczema (11%) and four psoriasis (11%). After 2 months of treatment, 27 of 37 (73%) patients were cured and five of 37 were improved. CONCLUSIONS Mycoses and irritant dermatitis are the main causes of DD in the elderly, and emollient skin care and topical antifungal treatment can be considered a first-line therapy for this indication.
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Affiliation(s)
- N Foureur
- Service de Gérontologie V et Consultation de Dermatologie, Hôpital Charles Foix, 7 avenue de la République, 94205 Ivry sur Seine, France
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31
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Danielsen AG, Thomsen JS, Svejgaard EL. [Severe skin rash in patients treated with terbinafine]. Ugeskr Laeger 2006; 168:3825-6. [PMID: 17118244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We report on five cases of severe skin rash in patients treated with oral terbinafine. Four patients were treated without mycological testing. Two patients were diagnosed with candidiasis on the skin or in the fingernails and were incorrectly treated with terbinafine.
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Abstract
There are two main types of fungal infections in the oncology patient: primary cutaneous fungal infections and cutaneous manifestations of fungemia. The main risk factor for all types of fungal infections in the oncology patient is prolonged and severe neutropenia; this is especially true for disseminated fungal infections. Severe neutropenia occurs most often in leukemia and lymphoma patients exposed to high-dose chemotherapy. Fungal infections in cancer patients can be further divided into five groups: (i) superficial dermatophyte infections with little potential for dissemination; (ii) superficial candidiasis; (iii) opportunistic fungal skin infections with distinct potential for dissemination; (iv) fungal sinusitis with cutaneous extension; and (v) cutaneous manifestations of disseminated fungal infections. In the oncology population, dermatophyte infections (i) and superficial candidiasis (ii) have similar presentations to those seen in the immunocompetent host. Primary cutaneous mold infections (iii) are especially caused by Aspergillus, Fusarium, Mucor, and Rhizopus spp. These infections may invade deeper tissues and cause disseminated fungal infections in the neutropenic host. Primary cutaneous mold infections are treated with systemic antifungal therapy and sometimes with debridement. The role of debridement in the severely neutropenic patient is unclear. In some patients with an invasive fungal sinusitis (iv) there may be direct extension to the overlying skin, causing a fungal cellulitis of the face. Aspergillus, Rhizopus, and Mucor spp. are the most common causes. We also describe the cutaneous manifestations of disseminated fungal infections (v). These infections usually occur in the setting of prolonged neutropenia. The most common causes are Candida, Aspergillus, and Fusarium spp. Therapy is with systemic antifungal therapy. The relative efficacies of amphotericin B, fluconazole, itraconazole, voriconazole, and caspofungin are discussed. Recovery from disseminated fungal infections is unlikely, however, unless the patient's neutropenia resolves.
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Affiliation(s)
- Steven R Mays
- Department of Dermatology, University of Texas Medical School, Houston, Texas 77030, USA.
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Abstract
The clinical presentation of fungal infections of the skin, hair, or nails may be varied and confusing. To avoid delays in treatment and early spread of the infection, adequate diagnostics are necessary. This requires both the clinical expertise of the physicians as well as the capability to perform various laboratory tests. Classical methods are based on microscopy, different culture procedures, and histological examination. Genotypic approaches for the detection and identification of fungal pathogens have improved the speed and accuracy of laboratory diagnosis in the last few years, although further evaluation using molecular biology-based methods should be routinely applied in practice.
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Affiliation(s)
- B Beifuss
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität, Frauenlobstrasse 9-11, 80337, München.
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Abstract
Topical antifungal agents are not absorbed when given orally. They act by direct contact on the fungus, this type of action requires the simultaneous presence of antifungal and fungus for a minimum of time. There are a large number of compounds belonging to different families of antifungals: polyens, azoles, allylamine and morpholine and antiseptic substances. The treatment of oropharyngeal candidiasis is based on topical antifungal agents: amphotericin B or nystatin, imidazoles such as clotrimazole or miconazole. Systemic antifungal agents are indicated in case or poor compliance to topical agents, in prophylaxis of highly relapsing disease, in oesophageal candidiasis and in Candida onychomycosis. A topical antifungal agent is the first choice to treat Candida intertrigo. In any case predisposing factors should be eradicated or amended. Infection to Malassezia spp. are treated topically with azoles or selenium sulphur. Oral ketoconazole is an alternative in severe cases. Dermatophytosis requires a systemic antifungal treatment such as terbinafine in chronic, dry, moccassin type palmoplantar infection and for onychomycosis. Intertrigo and tinea corporis are treated with topical agents such as azoles, terbinafine or tolnaftate. Tinea capitis responds to oral griseofulvine, however a topical antifungal must be added to eradicate contagious conidia. Whatever the localisation is, an other superficial site of infection must be looked for and a source of infection should be investigated and eradicated.
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Affiliation(s)
- Bertrand Dupont
- Maladies Infectieuses et Tropicales, Université Paris 5, Hôpital Necker-Enfants Malades, Paris, France.
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35
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Spraker MK, Gisoldi EM, Siegfried EC, Fling JA, de Espinosa ZD, Quiring JN, Zangrilli SG. Topical miconazole nitrate ointment in the treatment of diaper dermatitis complicated by candidiasis. Cutis 2006; 77:113-20. [PMID: 16570675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Diaper dermatitis (DD) complicated by candidiasis is a common problem in diaper-wearing infants and children. We report a double-blind, vehicle-controlled, parallel-group study evaluating the efficacy and safety of a low concentration of miconazole nitrate in a zinc oxide/petrolatum ointment for the treatment of DD complicated by candidiasis. Patients (N=330) who had DD with a severity score of 3 or higher were enrolled. Those patients with a baseline potassium hydroxide (KOH) preparation and a baseline culture specimen that both tested positive for Candida were retained for efficacy analysis (n=236). Miconazole nitrate 0.25% ointment or a zinc oxide/petrolatum vehicle control were applied to all clinically affected areas of patients with DD for 7 days at each diaper change and after bathing. A follow-up test-of-cure visit was conducted at day 14. Among the patients completing the study, the overall rate of cure (clinical cure plus microbiologic cure) was 23% for the miconazole nitrate group and 10% for the vehicle control group (P=.005); the rate of clinical cure (complete rash clearance, DD severity score=0 at day 14) was 38% for the miconazole nitrate group and 11% for the vehicle control group (P<.001); and the rate of microbiologic cure (no culture growth of Candida) was 50% for the miconazole nitrate group and 23% for the vehicle control group. The vehicle control resulted in mild improvement at day 3 but little or no subsequent improvement. The discontinuation rate due to clinical failure was substantially lower for the miconazole nitrate group (4%) than the vehicle control group (47%). The mean DD severity index score for the miconazole nitrate group was significantly lower from day 3 through day 14 compared with that of the vehicle control group (P<.001). Adverse events were assessed as either unlikely to be related to study medication or unrelated to study medication. By including only those patients with microbiologically confirmed Candida infection, the study population may not be fully indicative of patients treated for DD in routine clinical practice. Our data show that miconazole nitrate 0.25% ointment was well tolerated and significantly more effective than the zinc oxide/petrolatum vehicle control for treatment of DD complicated by candidiasis.
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Affiliation(s)
- Mary K Spraker
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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37
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Sundaram SV, Srinivas CR, Thirumurthy M. Candidal intertrigo: Treatment with filter paper soaked in Castellani′s paint. Indian J Dermatol Venereol Leprol 2006; 72:386-7. [PMID: 17050941 DOI: 10.4103/0378-6323.27763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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38
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D'Auria FD, Tecca M, Strippoli V, Salvatore G, Battinelli L, Mazzanti G. Antifungal activity of Lavandula angustifolia essential oil against Candida albicans yeast and mycelial form. Med Mycol 2005; 43:391-6. [PMID: 16178366 DOI: 10.1080/13693780400004810] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The antifungal activity of the essential oil of Lavandula angustifolia Mill. (lavender oil) and its main components, linalool and linalyl acetate, was investigated against 50 clinical isolates of Candida albicans (28 oropharyngeal strains, 22 vaginal strains) and C. albicans ATCC 3153. Growth inhibition, killing time and inhibition of germ tube formation were evaluated. The chemical composition of the essential oil was determined by gas chromatography and mass spectrometry. Lavender oil inhibited C. albicans growth: mean minimum inhibitory concentration (MIC) of 0.69% (vol./vol.) (vaginal strains) and 1.04% (oropharyngeal strains); mean MFC of 1.1% (vaginal strains) and 1.8% (oropharyngeal strains). Linalool was more effective than essential oil: mean MIC of 0.09% (vaginal strains) and 0.29% (oropharyngeal strains); mean MFC of 0.1% (vaginal strains) and 0.3% (oropharyngeal strains). Linalyl acetate was almost ineffective. Lavender oil (2%) killed 100% of the C. albicans ATCC 3153 cells within 15 min; linalool (0.5%) killed 100% of the cells within 30 s. The essential oil inhibited germ tube formation (mean MIC of 0.09%), as did the main components (MIC of 0.11% for linalool and 0.08% for linalyl acetate). Both the essential oil and its main components inhibited hyphal elongation of C. albicans ATCC 3153 (about 50% inhibition at 0.016% with each substance). Lavender oil shows both fungistatic and fungicidal activity against C. albicans strains. At lower concentrations, it inhibits germ tube formation and hyphal elongation, indicating that it is effective against C. albicans dimorphism and may thus reduce fungal progression and the spread of infection in host tissues.
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Affiliation(s)
- F D D'Auria
- Department of Public Health, University La Sapienza, Rome, Italy
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39
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Abstract
Fungi including Malassezia furfur and Candida albicans are involved in the development of atopic dermatitis (AD), due to increased sensitivity to these allergens or increased serum immunoglobulin E levels in AD patients. Previously, I reported successful treatment of AD with oral administration of the anti-mycotic agent, itraconazole. Recently, I developed protocols for AD treatment, based on the determined minimum effective dose. Three oral administration regimens with itraconazole were studied: single-phase treatment (regimen 1), 100 mg/day for 1 week with a 3-week rest, repeating; regimen 2, 200 mg/week for 4 weeks, repeating; and dual-phase treatment (regimen 3), 100 mg/day for 1 week (introduction phase) then 200 mg/week (maintenance phase) for 11 weeks. For regimens 1 and 2, each treatment cycle was 4 weeks, and three cycles were undertaken. Each regimen was completed in 12 weeks. All three regimens reduced AD symptoms, regimen 3 being the most effective and efficient therapy as evaluated by overall efficacy and low drop-out rate.
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Affiliation(s)
- M Takechi
- Tsuchibashi Shinryosho (clinic), Kochi City, Kochi, Japan.
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40
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Abstract
Dermatophytoses, commonly known as ringworm or tinea, represent superficial fungal infections caused by dermatophytes, which are among the most common infections encountered in medicine. The use of corticosteroid-containing combinations in dermatophyte infections that are usually treated with topical medications is still a much-debated issue. The addition of a corticosteroid to local antifungal therapy may be of value in reducing local inflammatory reaction and thus carries the theoretical advantage of rapid symptom relief in acute dermatophyte infections associated with heavy inflammation. However, the use of such combinations requires caution as they have some potential risks, especially with long-term use under occlusive conditions. Corticosteroid-induced cutaneous adverse effects have been reported primarily in pediatric patients due to inappropriate application of these preparations on diaper areas. Additionally, the corticosteroid component may interfere with the therapeutic actions of the antifungal agent, or fungal growth may accelerate because of decreased local immunologic host reaction, such that underlying infection may persist, and dermatophytes may even acquire the ability to invade deeper tissues. Analysis of the literature documenting clinical study data and adverse reactions related to combination therapy, drew the following conclusions: (i) combination products containing a low potency nonfluorinated corticosteroid may initially be used for symptomatic inflamed lesions of tinea pedis, tinea corporis, and tinea cruris, in otherwise healthy adults with good compliance; (ii) therapy should be substituted by a pure antifungal agent once symptoms are relieved, and should never exceed 2 weeks for tinea cruris and 4 weeks for tinea pedis/corporis; and (iii) contraindications for the use of these combinations include application on diaper or other occluded areas and facial lesions, as well as in children <12 years of age and in immunosuppressed patients for any reason.
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Affiliation(s)
- Zulal Erbagci
- Department of Dermatology, Gaziantep University Medical Faculty, Gaziantep, Turkey.
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41
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Adler A, Litmanovitz I, Regev R, Arnon S, Bauer S, Dolfin T. Breakthrough candida Infection in a preterm infant with congenital cutaneous Candida albicans infection. Am J Perinatol 2005; 22:169-72. [PMID: 15838753 DOI: 10.1055/s-2005-864855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Amphotericin B is the primary antifungal agent used for candida sepsis in neonates. Breakthrough candidemia was not reported in neonates during either amphotericin B or liposomal amphotericin B (AmBisome) treatment. We describe a case of a premature infant with congenital cutaneous candida infection, who had two episodes of breakthrough infection, from Candida albicans and Candida parapsilosis, while he was treated with amphotericin B and AmBisome, respectively. We discuss the pathogenesis of breakthrough infections, and the relevance of antifungal resistance and sensitivities testing.
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Affiliation(s)
- Amos Adler
- Department of Neonatology, Meir Medical Center, Kfar-Saba 95847, Israel
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42
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Olaizola C, Pérez C, Mata-Essayag S, Hartung C, Collela MT, Magaldi S, Roselló A. Experience with thymol in chloroform solution for the treatment of paronychia. Mycopathologia 2005; 159:209-11. [PMID: 15770445 DOI: 10.1007/s11046-004-6270-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Accepted: 11/12/2004] [Indexed: 11/26/2022]
Affiliation(s)
- Carolina Olaizola
- Medical Mycology Department, Instituto de Medicina Tropical, Universidad Central de Venezuela, Caracas, Venezuela
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43
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Abstract
Eruptions in the diaper area are the most common dermatologic problem in infancy. Such eruptions can be subdivided into primary diaper dermatitis, an acute inflammation of the skin in the diaper area with an ill-defined and multifactorial etiology, and secondary diaper dermatitis, a term which encompasses eruptions in the diaper area with defined etiologies. The most important factors in the development of primary diaper dermatitis are: (i) water/moisture, (ii) friction, (iii) urine, (iv) feces, and (v) microorganisms (sometimes). Possible treatments include minimizing diaper use and using disposable diapers, barrier creams, mild topical cortisones, and antifungal agents. A variety of other inflammatory and infectious processes can occur in the diaper area and an awareness of these secondary types of diaper dermatitis aids in the accurate diagnosis and treatment of patients.
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Affiliation(s)
- Noah Scheinfeld
- Department of Dermatology, St Lukes Roosevelt Hospital Center, New York 10025, USA.
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44
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Gallup E, Plott T. A multicenter, open-label study to assess the safety and efficacy of ciclopirox topical suspension 0.77% in the treatment of diaper dermatitis due to Candida albicans. J Drugs Dermatol 2005; 4:29-34. [PMID: 15696982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Ciclopirox is a broad-spectrum antifungal, antibacterial, and anti-inflammatory agent. This open-label study investigated the safety and efficacy of ciclopirox topical suspension 0.77% in the treatment of diaper dermatitis due to Candida albicans (C. albicans). Forty-four male and female subjects aged 6 to 29 months were included in the study. Study medication was applied topically to the affected diaper area twice daily for 1 week. Subjects were clinically evaluated at baseline and days 3, 7, and 14 (7 days post-treatment). Safety and efficacy variables included adverse events, mycological culture studies, KOH tests, Severity Scores, and Global Evaluation of Clinical Response. All adverse events were mild to moderate and considered not related to the study medication. Treatment provided statistically significant improvement (P < .05) for both the rate of mycological cure and reduction of Severity Score at each time point compared with baseline. Ciclopirox was safe and effective in the treatment of diaper dermatitis due to C. albicans.
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45
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Abstract
Superficial fungal infections are common, especially onychomycosis, dermatophytoses, and superficial Candida infections. Most superficial fungal infections are treated with topical antifungal agents unless the infection covers an extensive area or is resistant to initial therapy. Onychomycosis often requires systemic therapy with griseofulvin, itraconazole, or terbinafine. The objective of this review is to provide the practicing dermatologist with the recommended available therapy for the treatment of common superficial fungal infections.
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Affiliation(s)
- David B Huang
- Department of Internal Medicine, Division of Infectious Diseases, Baylor College of Medicine, Houston, TX 77030, USA.
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Cribier BJ, Bakshi R. Terbinafine in the treatment of onychomycosis: a review of its efficacy in high-risk populations and in patients with nondermatophyte infections. Br J Dermatol 2004; 150:414-20. [PMID: 15030322 DOI: 10.1046/j.1365-2133.2003.05726.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The prevalence of onychomycosis is higher in certain high-risk populations, such as the immunocompromised, diabetics and human immunodeficiency virus (HIV)-positive patients. These patients can also develop onychomycosis due to nondermatophyte fungi. Although the efficacy of terbinafine is well demonstrated in the treatment of conventional dermatophyte nail infection, there are few data on the efficacy of terbinafine in high-risk patient groups or in nondermatophyte fungi, which can be difficult to treat. OBJECTIVES To review previously published data regarding the safety and efficacy of terbinafine in special patient populations, such as those with diabetes mellitus or HIV infection, those receiving immunosuppressive therapy, and patients with onychomycosis due to nondermatophyte fungi. METHODS A Medline literature search up to October 2002 was performed in order to identify relevant studies. Pertinent abstracts presented at international meetings were also included. Cure rates (per-protocol and intention-to-treat) were extracted or calculated. All available safety data were also collated. RESULTS Terbinafine was highly effective and well tolerated in patients with diabetes mellitus. Mycological cure rates of 62-78% were achieved in three studies, which is comparable with the efficacy in nondiabetic populations. Mycological cure rates of 64-91% were achieved in subsets of diabetic patients with Candida-positive nail cultures. The efficacy of terbinafine in patients receiving immunosuppressive therapy was also similar to that reported in immunocompetent patients. Levels of ciclosporin in the blood clearly decreased, with little clinical consequence; however, consideration should be given to the monitoring of ciclosporin levels in patients concomitantly receiving immunosuppressive therapy and terbinafine. Two small studies reported that terbinafine was also effective in treating onychomycosis in HIV-positive patients. Terbinafine was also effective and well tolerated in the treatment of nondermatophyte onychomycosis. CONCLUSIONS This review suggests that terbinafine is a safe and effective treatment for onychomycosis in high-risk populations. However, the majority of these studies only included small numbers of patients and larger clinical trials are needed, especially in patients with HIV infection.
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Affiliation(s)
- B J Cribier
- Clinique Dermatologique des Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, 67091 Strasbourg, France.
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Kreuter A, Teichmann M, Stuecker M, Altmeyer P, Tietz HJ, Brockmeyer NH. Generalized fungal infection in a patient with AIDS appearing as skin papules. Eur J Med Res 2003; 8:435-7. [PMID: 14594649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
Human immunodeficiency virus infection (HIV) is unique among cutaneous fungal infections caused by defects of the cell-mediated immune system. Infections with Candida albicans occur with increased frequency and severity among HIV-infected individuals. Oral candidiasis is the most common manifestation, superficial cutaneous infections of the dermis are rarely seen. We report a HIV-positive man from Cameroon presenting with generalized cutaneous papules and nodes, oral candidiasis, and soor esophagitis, who was successfully treated with fluconazole monotherapy.
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Affiliation(s)
- A Kreuter
- Department of Dermatology and Allergology, Ruhr-University Bochum, D-44791 Bochum, Germany
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Abstract
CAN-296 is a naturally occurring, heat-stable complex carbohydrate isolated from the cell wall of Mucor rouxii. Previously, CAN-296 demonstrated impressive in vitro fungicidal activity against a wide spectrum of pathogenic yeast, including azole-resistant isolates. The effect of CAN-296 on Candida albicans is rapid, concentration-dependent, and lethal. CAN-296-P is a chitosan-pyrithione derivative of CAN-296 containing 4% solution of chitosan with 25% substitution of pyrithione. Like CAN-296, it has in vitro fungicidal activity with a minimum inhibitory concentration (MIC) of 0.156 mg/l for C. albicans. The therapeutic effect of topical CAN-296-P on cutaneous candidiasis caused by C. albicans in guinea pigs was investigated. Three different C. albicans isolates, including one fluconazole-resistant strain (R 637601-9), were tested. After immunosuppression with cyclophosphamide, infection under occlusive dressing was achieved and treated within 48 h after the initial infection. Once-a-day topical application of 0.125, 0.25, 0.5, 1, 2, and 4% CAN-296-P solution was administrated for a period of 1, 3, 5, and 7 days. CAN-296-P at a concentration > or =0.25% was found to be as effective in clearing the infection as was 2% miconazole. Effectiveness in eradicating candidiasis with CAN-296-P was concentration-dependent and free of local adverse effects. Can-296-P is a novel, highly active topical fungicidal agent, with broad potential for clinical use.
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Affiliation(s)
- Avital M Ben-Josef
- Division of Infectious Diseases, Department of Medicine, Wayne State University, 427 Lande Building, 505E Canfield, Detroit, MI 48201, USA.
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Hameleers SJ, Bergman KA, Rulo HF, Kuiper H, Semmekrot BA. [Diagnostic image (143). A neonate with a skin disorder. Congenital cutaneous candidiasis]. Ned Tijdschr Geneeskd 2003; 147:1173. [PMID: 12845837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
A premature neonate was born with a generalized eruption of vesicles, within a day developing into an erythrodermia, with bullae and widespread desquamation, due to congenital cutaneous candidiasis.
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MESH Headings
- Antifungal Agents/therapeutic use
- Candidiasis, Cutaneous/congenital
- Candidiasis, Cutaneous/drug therapy
- Candidiasis, Cutaneous/pathology
- Female
- Fluconazole/therapeutic use
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/pathology
- Skin/pathology
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Affiliation(s)
- S J Hameleers
- Canisius-Wilhelmina Ziekenhuis, afd. Kindergeneeskunde, Postbus 9015, 6500 GS Nijmegen
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50
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Dennerstein G. Nipple thrush. Aust Fam Physician 2003; 32:392; author reply 392. [PMID: 12833757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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