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Dermatology AND Tinea unguium [keywords]
- [Onychomycosis mycological profile in Abidjan (Cote d'Ivoire).] [JOURNAL ARTICLE]
- J Mycol Med 2014 Apr 18.
The epidemiological profile of onychomycosis is poorly determined in Cote d'Ivoire. This study aimed to determine the fungal aetiologies of these onychomycosis in Abidjan.This cross-sectional study was conducted from February to August 2011 at the Department of Dermatology of the University Hospital of Treichville. All patients who consulted for onycholysis were interviewed. All samples were analyzed by direct examination and Sabouraud-chloramphenicol and Sabouraud-chloramphenicol-actidione culture was performed. Species identification was based on microscopic characteristics of the fungus observed.A total of 53 patients were included. The prevalence of onychomycosis was estimated at 66 %. The unilateral lesions were statistically different from bilateral lesions (P=0.010). Women were more affected at the hands than men (P=0.010). Five species of yeasts and two dermatophytes species were identified. Yeasts species were essentially Candida tropicalis (36.4 %) and Candida albicans (30.3 %). Trichophyton rubrum and Trichophyton soudanense were the only dermatophytes isolated. No contributing factors were statistically related to the occurrence of onychomycosis in our series.The observed onychomycosis in Côte d'Ivoire are mainly caused by yeasts. Although in our series the risk factors have not been identified, hygiene of the nails should provide effective prevention.
- Putting onychomycosis under the microscope. [Journal Article]
- Nurse Pract 2014 May 12; 39(5):8-11.
- Occult tinea pedis in an Israeli population and predisposing factors for the acquisition of the disease. [JOURNAL ARTICLE]
- Int J Dermatol 2014 Apr 16.
Tinea pedis is a commonly encountered dermatophytic infection with a clinical prevalence of 15-25%. Limited studies have evaluated the prevalence of occult tinea pedis.The aims of this study were to evaluate the prevalence of occult tinea pedis in asymptomatic subjects with feet that appeared healthy and to identify possible related risk factors.A prospective study of 221 asymptomatic subjects with apparently normal feet was conducted. All subjects completed a questionnaire covering anamnestic details (personal and family histories of tinea pedis, preferred footwear) and were examined for foot odor and the clinical presence of tinea pedis and onychomycosis. Samples were taken from the foot for direct microscopic examination and culture.Among the 221 patients, 31 (14.0%) were positive for occult tinea pedis. Positive cultures from both the anterior and posterior aspects of the foot were obtained in 22 patients. The most common pathogen isolated was Trichophyton rubrum. Strong correlations emerged between occult tinea pedis and characteristics such as male gender, foot odor, previous personal and family histories of tinea pedis, and clinical and mycological evidence of onychomycosis. No significant associations were found between occult tinea pedis and age or preferred footwear.The prevalence of occult tinea pedis is similar to that of clinical tinea pedis. This may imply that patients with subclinical infection carry a risk for transmitting disease similar to that of clinical carriers. This is of great importance in the prevention and management of the disease as high-risk asymptomatic carriers can be identified.
- Opportunistic toenail onychomycosis. The fungal colonization of an available nail unit space by non-dermatophytes is produced by the trauma of the closed shoe by an asymmetric gait or other trauma. A plausible theory. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Apr 8.
Opportunistic onychomycosis is defined, when a non-dermatophyte mould is cultured from an abnormal nail unit in the absence of a dermatophyte. The presumption is that the mould has caused the abnormal clinical appearance of the nail unit, yet there are no data available to substantiate this claim. Reports have only identified the mould being recovered from the nail unit niche. A review of the published dermatologic literature describing toenail opportunistic onychomycosis by non-dermatophyte fungi has shown toenails with onycholysis, nail bed (NB) keratosis and nail plate surface abnormalities. The appearance of these clinical changes is indistinguishable from the diagnosis of the Asymmetric Gait Nail Unit Signs (AGNUS). AGNUS is produced by the friction of the closed shoe in patients with an asymmetric gait, resulting primarily from the ubiquitous uneven flat feet. Most commonly, species of Acremonium (Cephalosporium), Aspergillus, Fusarium, Scopulariopsis and rarely species of many different fungi genera are capable of surviving and reproducing in a keratinous environment and change the clinical appearance of the involved nail unit. AGNUS toenails predispose to the colonization by the non-dermatophyte opportunistic fungi but not by dermatophyte fungi.
- Do Genetic Mutations and Genotypes Contribute to Onychomycosis? [JOURNAL ARTICLE]
- Dermatology 2014 Mar 27.
Background: The variability in susceptibility to onychomycosis for individuals exposed to the same environmental risk factors raises the possibility that there may be individuals with a genetic predisposition to dermatophyte infection. Objective: To determine whether there are genetic mutations or genotypes which contribute to onychomycosis. Methods: The PubMed database was searched for examples of immune deficiencies resulting in dermatophyte infections. Results: There are mutations in the innate immune receptors Dectin-1 and its adaptor protein CARD9 which result in familial mucocutaneous infections. There are also specific human leukocyte antigen genotypes that are more common in individuals and families with a high prevalence of onychomycosis. In addition, some patients have been reported with insufficient levels of CD4+CD25+ regulatory T cells. These deficits impair a full innate and adaptive immune response and may result in chronic or recurrent infections. Conclusions: There are documented mutations and genotypes that contribute to familial and individual susceptibility to onychomycosis. © 2014 S. Karger AG, Basel.
- Morphopathological aspects of healthy nails and nails affected by onychomycosis. [JOURNAL ARTICLE]
- Mycoses 2014 Mar 24.
Patients of onychomycosis are common in the dermatology practice. Contemporary morphology creates opportunities to study the functional units of the nail when such infections occur from morphopathological point of view. There were 22 nails biopsies from onychomycosis patients taken for the research of morphopathological changes in the thickened nail plate affected by onychomycosis. Samples of cadaverous' nails were used as a control material. The material was stained with haematoxylin and eosin and immunohistochemical methods. Terminal deoxynucleotidyl transferase dUTP nick end labelling reaction and periodic acid-Schiff reaction were also performed. We found patchy hypertrophy in the granulose layer of the epidermis, with focal acanthosis. In the horn layer, we identified nests of parakeratosis of various sizes, with incorporations of homogenous and eosinophil masses. We found high levels of interleukin 6 and interleukin 10 positive cells in the nail bed and in the bloodstream. Interleukin 1, however, was not a part of any of the functional units of any of the nails. Significant amount of fibres containing human beta defensin-2 were found in the bed and plate of the nail. Therefore one can conclude that as regards the nails affected by onychomycosis, the most effective morphopathogenical processes include cytokine and defensin excretion occurrence in the nail bed.
- Efficacy of antifungal PACT in an in vitro model of onychomycosis. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Mar 24.
The difficulty of antifungal substances to penetrate keratin and slow nail growth limit the efficacy of topical therapy in onychomycosis. One promising alternative is photodynamic antimicrobial chemotherapy, or PACT: an irradiated photosensitizer creates singlet oxygen molecules which destroy pathogens without damaging human cells.As PACT has demonstrated strong antifungal capabilities, we wanted to investigate its efficacy in an in vitro model of onychomycosis.PACT was tested in a microdilution assay, in an in vitro onychomycosis model as well as in a patient.PACT inhibited fungal growth in the microdilution assay with no colonies of T. rubrum detectable. Fungal growth was also inhibited in an onychomycosis model, after 30 min of LED irradiation. Subsequently, a patient with distolateral onychomycosis was treated on three consecutive days and showed significant and durable improvement of nail morphology 6 months after.PACT appears to be an effective treatment of onychomycosis in vitro. The promising results need to be validated by clinical trials.
- Diabetic neuropathy and Nd-YAG (1064 nm) laser for onychomycosis: be careful. [LETTER]
- J Eur Acad Dermatol Venereol 2014 Mar 24.
- Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. [Journal Article]
- J Am Acad Dermatol 2014 May; 70(5):918-23.
Traditional pharmacotherapy for onychomycosis has low to moderate efficacy and may be associated with adverse reactions and medication interactions limiting its use in many patients.We evaluated the clinical efficacy and safety of a fractional carbon-dioxide laser with topical antifungal therapy in the treatment of onychomycosis.In all, 24 patients were treated with fractional carbon-dioxide laser therapy and a topical antifungal cream. The laser treatment consisted of 3 sessions at 4-week intervals. Efficacy was assessed based on the response rate from standardized photographs, a microscopic examination of subungual debris, and subjective evaluations.Among the patients, 92% showed a clinical response and 50% showed a complete response with a negative microscopic result. The factors that influenced a successful outcome were the type of onychomycosis and the thickness of the nail plate before treatment. The treatment regimen was well tolerated and there was no recurrence 3 months after the last treatment episode.The study followed up only 24 patients and there were no relevant treatment controls.Fractional carbon-dioxide laser therapy, combined with a topical antifungal agent, was effective in the treatment of onychomycosis. It should be considered an alternative therapeutic option in patients for whom systemic antifungal agents are contraindicated.
- Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: A randomized, controlled trial. [Journal Article]
- J Am Acad Dermatol 2014 May; 70(5):911-7.
Laser therapies have been Food and Drug Administration approved for temporary nail plate clearance; however, there is minimal evidence of their long-term efficacy.We sought to evaluate the clinical and mycological clearance of toenails treated with 1064-nm neodymium:yttrium-aluminum-garnet laser versus no treatment.This was a randomized, controlled, single-center trial comparing 2 treatments with 1064-nm neodymium:yttrium-aluminum-garnet laser (fluence of 5 J/cm(2), rate of 6 Hz) spaced 2 weeks apart versus no treatment in 27 patients (N = 125 affected nails) with clinical and mycological diagnosis of onychomycosis. At 3 months, patients were assessed with mycological cultures and proximal nail plate measurements. Patients treated with laser were also assessed with proximal nail plate measurements at 12 months.At 3 months, 33% of patients treated with laser achieved a negative mycological culture compared with 20% of the control group (P = .49), and had more proximal nail plate clearance compared with control subjects (0.44 vs 0.15 mm, P = .18), which was not statistically significant. At 12 months, there was no difference in nail plate clearance between laser versus control subjects (0.24 vs 0.15 mm, P = .59).Our study was limited by the small sample size and number of treatments.There was no significant mycological culture or clinical nail plate clearance with 1064-nm neodymium:yttrium-aluminum-garnet laser compared with control.