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Mahdi Abastabar, Iman Haghani, Tahereh Shokohi, Mohammad Taghi Hedayati, Seyed Reza Aghili, Ali Jedi, Sulmaz Dadashi, Shafigheh Shabanzadeh, Tahereh Hosseini, Narges Aslani, Jacques F Meis, Hamid Badali
The in vitro activity of tavaborole, a FDA approved antifungal drug, was compared to four antifungal agents against 170 clinical fungal isolates originating from patients with onychomycosis. Tavaborole had low activity against all isolates compared to itraconazole, terbinafine and fluconazole, the principal choices for the treatment of onychomycosis. Thus it appears that tavaborole is not a candidate for the treatment of onychomycosis due to Candida species, Aspergillus species and dermatophytes.
September 17, 2018: Antimicrobial Agents and Chemotherapy
S De Bruyne, R Speeckaert, J Boelens, M-P Hayette, M Speeckaert, J Delanghe
BACKGROUND: The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy-to-perform diagnostic tool with highly distinctive capacities. OBJECTIVES: To determine whether ATR-FTIR spectroscopy can detect and differentiate causative agents in a culture based, ex vivo nail and in vivo nail model. METHODS: A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital...
September 14, 2018: British Journal of Dermatology
Blair A Becker, Marc A Childress
Most foot disorders do not require podiatry referral or complex interventions. After the clinical diagnosis is made, these conditions can typically be managed with over-the-counter (OTC) and home remedies, with guidance from the primary care physician. Stretching and strengthening exercises, along with the use of heel cups, resolve most plantar fasciitis cases and are at least as effective as nonsteroidal anti-inflammatory drugs or steroid injections. Hallux rigidus is best managed with a hard-soled shoe or rigid insert that relieves pain by restricting motion across the metatarsophalangeal joint...
September 1, 2018: American Family Physician
Matthew K Hawks, Jedda P Rupert, Jennifer E Svarverud
No abstract text is available yet for this article.
August 1, 2018: American Family Physician
Elena Cutrín-Gómez, Soledad Anguiano-Igea, M Begoña Delgado-Charro, José Luis Gómez-Amoza, Francisco J Otero-Espinar
Aqueous-based nail lacquers have shown potential in promoting the diffusion of drugs into the nail. In our laboratory, we have recently developed a transungual delivery system based on an aqueous dispersion of cyclodextrin-poloxamer soluble polypseudorotaxanes, supramolecular host-guest assemblies that improves the drug permeation into the nail. However, the high-water content and the rheological and adhesive properties of this lacquer negatively affect properties that play a fundamental role in the patients' acceptance such as stickiness, nail film formation or drying rate, properties...
September 11, 2018: Pharmaceutics
Avner Shemer, Aditya K Gupta, Meir Babaev, Aviv Barzilai, Renata Farhi, C Ralph Daniel Iii
Background: Onychomycosis is a difficult-to-treat fungal infection of the nails. The efficacy of monotherapy is not ideal, and combination therapies provide an alternative that may increase treatment efficacy. Method: A retrospective analysis of data from 91 patients was undertaken. Treatment for toenail onychomycosis occurred between 2014 and 2016 and consisted of combination therapy with oral terbinafine (250 mg/day for 12 weeks) or itraconazole (3 pulses, 400 mg/day for 7 days) + K101 nail solution daily, or K101 nail solution monotherapy...
August 2018: Skin Appendage Disorders
Avner Shemer, Ralph Daniel, Dimitris Rigopoulos, Renata Farhi, Meir Babaev
Wide differences in the cure rates of onychomycosis in various clinical studies can be avoided if we bear in mind some insights that will help us make study results more consistent. We suggest less rigid criteria in defining the cure rate, the inclusion of all toenails in studies, and the exclusion of nails with a history of trauma. Rather than address patients as a homogenous group, regardless of age, we suggest dividing them into age groups. Researchers should not forget inflammatory diseases that can imply changes on the nails and should take into account the duration of onychomycosis, nail changes caused by asymmetry, and the possibility of dermatophytoma...
August 2018: Skin Appendage Disorders
Aditya K Gupta, Jessie Carviel, Neil H Shear
Onychomycosis is a difficult-to-treat chronic fungal infection of the nail. The chronic nature of onychomycosis, with relevance to current treatment practices, could be attributed to host anergy, development of increased virulence in causal agents (multidrug resistance efflux pump), and biofilms. Biofilms must be disrupted prior to antifungal treatment suggesting the necessity of combination treatment. Once the biofilm has been disrupted, further techniques in addition to antifungal usage are suggested to ensure a positive prognosis including use of antimicrobial photodynamic therapy or low-frequency surface acoustic waves...
August 2018: Skin Appendage Disorders
H Mirhendi, Y Nishiyama, A Rezaei-Matehkolaei, K Satoh, K Makimura
[This corrects the article DOI: 10.18869/acadpub.cmm.2.2.2.].
March 2018: Advances in Medical Mycology (Iran)
Utako Kimura, Yasushi Suga
Various treatment methods other than oral and topical antifungal medications have been employed to treat onychomycosis. Treatment methods include mechanical removal of the affected part of the nail plate by using a toenail cutter or grinder and chemical removal by using occlusive dressing therapy with salicylic acid plaster or urea cream. In recent years, laser therapies have received attention as modalities for treatment of onychomycosis. Favorable outcomes in patients with onychomycosis have been reported in Japan from treatment combining carbon dioxide laser and topical antifungal drug, treatment with photodynamic therapy, and treatment with Nd:YAG laser...
2018: Medical Mycology Journal
Marc Brown, Rob Turner, Sean Robert Wevrett
Onychomycosis is the most prevalent nail condition, affecting between 5% and 20% of the population in western countries. Oral therapies are not the treatment of choice due to poor patient compliance, high relapse rates, severe side effects, and contraindication. However, the difficultly in curing the condition using topical delivery is partly due to both the nail structure presenting a complex barrier and the lack of understanding of how best to achieve delivery of drug to the nail bed. Areas covered: Several novel in vitro models incorporating human nails discussed in this article have been developed in recent years that allow for the study of the mechanisms of ungual drug absorption and formulation efficacy to be assessed...
September 7, 2018: Expert Opinion on Drug Delivery
Enrique Alberdi, Clara Gómez
BACKGROUND: Photodynamic therapy (PDT) or intense pulsed light (IPL) are efficient therapeutic methods in the treatment of superficial skin infections, and thus, they could be good options for onychomycosis treatment, the most common nail disorder. METHODS: Forty patients, affected with different diagnosed types of onychomycosis in nails of the first toe, were randomly divided into two groups of 20 patients to be treated by PDT or IPL. Nail plates were softened with urea 40% by occlusive dressing for 12 hours during 3-7 days before treatments...
August 31, 2018: Photodermatology, Photoimmunology & Photomedicine
Shinichi Watanabe, Ichiro Tsubouchi, Akihiro Okubo
Fosravuconazole L-lysine ethanolate (F-RVCZ) is a prodrug of ravuconazole, a novel triazole antifungal agent, exerting broad and potent antifungal activity. The efficacy and safety of F-RVCZ, compared with a placebo, were investigated in a multicenter, double-blind, randomized study of Japanese onychomycosis patients with 25% or more clinical involvement of the target toenail. Subjects (n = 153) were randomly assigned to receive F-RVCZ (100 mg RVCZ, n = 101) or placebo (n = 52) p.o. once daily for 12 weeks...
August 29, 2018: Journal of Dermatology
Pawel Pietkiewicz, Monika Bowszyc-Dmochowska, Justyna Gornowicz-Porowska, Marian Dmochowski
Pemphigus vulgaris lesions have a tendency to localize around natural body orifices. The aim here was to analyze the involvement of nail apparatus in pemphigus vulgaris. Sixty seven ethnic Poles suffering from pemphigus vulgaris on photographic files archiving initial presentation were retrospectively evaluated. Pemphigus vulgaris was diagnosed using combination of clinical data, H+E histology, direct immunofluorescence of plucked scalp hair and/or perilesional tissue also for IgG1 and IgG4 deposits evaluation, indirect immunofluorescence on mosaic substrate and/or monkey esophagus, mono-analyte ELISA with desmoglein 1/3 or multi-analyte ELISA...
2018: Frontiers in Medicine
Bruno Méhul, Niccolo de Coi, Philippe Grundt, Alexandre Genette, Johannes J Voegel, Monod Michel
BACKGROUND: Onychomycosis is the most prevalent nail disease and is mainly caused by two dermatophyte species Trichophyton rubrum and Trichophyton interdigitale with a frequency in the range of 80% and 20%, respectively. The secreted protease Sub6 of the subtilisin family, which was never detected in vitro growth conditions, was found to be a robust marker of onychomycosis. OBJECTIVE: The aim of this work was to detect tinea unguium using anti-Sub6 monoclonal antibodies in proteins extracted from clinical nail samples...
August 28, 2018: Mycoses
Miki Hirose, Hiromitsu Noguchi, Takashi Yaguchi, Tadahiko Matsumoto, Masataro Hiruma, Satoshi Fukushima, Hironobu Ihn
We describe a case of a 23-year-old female patient with no apparent underlying diseases. She showed a discoloration of the proximal portion of the left big toenail with paronychia. Direct microscopy revealed septate hyphae with conidiophores, and a periodic acid-Schiff-stained nail specimen revealed septate hyphae branching at angles of approximately 45°. On the basis of phylogenetic analysis, we finally arrived at the diagnosis of ungual aspergillosis caused by Aspergillus subramanianii. After p.o. administration of terbinafine and topical application of 10% efinaconazole solution, the disease resolved in 6 months...
August 25, 2018: Journal of Dermatology
M Feuilhade de Chauvin
Dermatomycoses are dermatological infections very commonly encountered in private dermatological practice since they affect up to one third of the population. However, the symptoms are very often shared by other skin infections and disorders and may be highly atypical. It is thus impossible to make a diagnosis with any certainty on clinical grounds alone. For this reason, mycological diagnosis is essential to either confirm or rule out dermatomycosis, and is unavoidable when antifungal therapy is required for the treatment of ringworm of the scalp or beard, or for onychomycosis...
August 21, 2018: Annales de Dermatologie et de Vénéréologie
Ryan R Riahi, Philip R Cohen, Leonard H Goldberg
Subungual amelanotic melanoma can masquerade as onychomycosis. Recently a man whose amelanotic nail bed melanoma presented as persistent onychodystrophy was reported in the Dermatology Online Journal. The patient had a persistent nail dystrophy; culture and biopsy of the nail demonstrated Candida and dermatophyte infection, respectively. However, he subsequently presented with a nodule that was biopsied and demonstrated melanoma. Similar to that patient, we recently described a 67-year-old woman with a four-year history of persistent nail dystrophy of the left fourth fingernail who had a periodic acid-Schiff staining of the nail plate demonstrating fungal hyphae...
June 15, 2018: Dermatology Online Journal
E G Hasche, M Podda
BACKGROUND: Onychomycosis is one of the most common nail diseases with an increasing number of cases. There is always a need for therapy because fungal nail infection never shows a tendency to spontaneous self-healing. Thus, the disease belongs to core competency of dermatologists. CONCLUSION: Successful treatment requires a correct diagnosis based on meticulous anamnesis, the clinical findings as well as the identification of the pathogen fungus. Dermatoscopy and histological examination play an important role in this context...
September 2018: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
A Ben Youssef, A Kallel, Z Azaiz, S Jemel, N Bada, A Chouchen, N Belhadj-Salah, N Fakhfakh, S Belhadj, K Kallel
Onychomycosis is a fungal infection of nails caused by dermatophytes, yeasts or non-dermatophyte molds. The aim of our study was to describe the epidemiological features of onychomycoses encountered in the Tunis region. A retrospective study concerned 3458 cases of onychomycosis, confirmed by direct examination and/or a positive culture, was conducted in Parasitology - Mycology Laboratory, Rabta hospital, over a five-year period (2012-2016). Our patients were aged 1 to 85; more than half of the patients were aged over 60 years with a female predominance (67%)...
August 11, 2018: Journal de Mycologie Médicale
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