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Dermatology AND Tinea unguium [keywords]
- A Case of Onychomycosis Caused by Rhodotorula glutinis. [Journal Article]
- Case Rep Dermatol Med 2014.:563261.
Rhodotorula spp. have emerged as opportunistic pathogens, particularly in immunocompromised patients. The current study reports a case of onychomycosis caused by Rhodotorula glutinis in a 74-year-old immunocompetent female. The causative agent was identified as R. glutinis based on the pinkish-orange color; mucoid-appearing yeast colonies on Sabouraud Dextrose Agar at 25°C; morphological evaluation in the Corn Meal-Tween 80 agar; observed oval/round budding yeast at 25°C for 72 hours; no observed pseudohyphae; positive urease activity at 25°C for 4 days; and assimilation features detected by API ID 32C kit and automated Vitek Yeast Biochemical Card 2 system. Antifungal susceptibility test results were as follows: amphotericin B (MIC = 0.5 µg/mL), fluconazole (MIC = 128 µg/mL), itraconazole (MIC = 0.125 µg/mL), voriconazole (MIC = 1 µg/mL), posaconazole (MIC = 0.5 µg/mL), anidulafungin (MIC = 0.5 µg/mL), and caspofungin (MIC = 16 µg/mL). Antifungal therapy was initiated with oral itraconazole at a dose of 400 mg/day; seven-day pulse therapy was planned at intervals of three weeks. Clinical recovery was observed in the clinical evaluation of the patient before the start of the third cure. Although R. glutinis has rarely been reported as the causative agent of onychomycosis, it should be considered.
- Combined Oral Terbinafine and Long-Pulsed 1,064-nm Nd: YAG Laser Treatment Is More Effective for Onychomycosis Than Either Treatment Alone. [JOURNAL ARTICLE]
- Dermatol Surg 2014 Oct 14.
Onychomycosis is difficult to cure. Systemic and topical treatments, including the 1,064-nm Nd:YAG laser, are not very effective when used individually.To compare the efficacy and safety of combined treatment with a long-pulsed 1,064-nm Nd:YAG laser and oral terbinafine with those of either treatment alone.We randomly divided 53 patients with a total of 90 infected nails into 3 treatment groups: the T group received oral terbinafine, the L group received long-pulsed Nd:YAG laser treatment, and the T + L group received both treatments. We evaluated the mycological clearance rate (MCR) and the clinical clearance rate (CCR) of the 3 groups at Weeks 4, 8, 12, 16, and 24.The MCR and CCR increased in all 3 groups in a time-dependent manner. The MCR and CCR of the T + L group were significantly higher than those of the T group and the L group at Weeks 8, 12, 16, and 24 (p < .05).These data indicate that 12 weeks of combined treatment with a long-pulsed Nd:YAG laser and oral terbinafine produce more rapid and effective mycological and clinical clearance in patients with onychomycosis than either treatment alone, without any obvious side effects.
- Onychomycosis in qassim region of saudi arabia: a clinicoaetiologic correlation. [Journal Article]
- J Clin Diagn Res 2014 Aug; 8(8):YC01-4.
Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The aetiological agents of the disease may show geographic variation.The aim of the present study was to isolate the causative pathogens and to correlate the various clinical patterns of onychomycosis with causative pathogens.The study population comprised 170 patients with clinical suspicion of onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patterns were noted and correlated with causative pathogens.Out of total 170 cases included in the study, 140 (82.4%) were positive by microscopy and 77 (45.3%) showed positive mycological findings by both microscopy and culture. The male: female ratio was 1:2.5 and the mean age was 35.29 ± 16.47 years. Fingernails were involved in 51.9%, toenails in 28.6% and both fingernails and toenails in 19.5% of the 77 patients. The clinical types noted were distal lateral subungual onychomycosis (71.4%), proximal subungual onychomycosis (10.4%), total dystrophic onychomycosis (10.4%), superficial white onychomycosis (3.9%) and mixed pattern onychomycosis (3.9%). Yeasts were the most common pathogens isolated, being found in 36 patients (46.8%) followed by nondermatophyte molds which were isolated from 28 patients (36.4%) followed by dermatophytes which were isolated from 13 patients (16.9%).Distal lateral subungual onychomycosis was the most common clinical presentation. Candida albicans, Aspergillus species and Tricophyton rubrum were the major pathogens. A single pathogen can give rise to more than one clinical type.
- Luliconazole for the treatment of fungal infections: an evidence-based review. [Journal Article, Review]
- Core Evid 2014.:113-24.
Luliconazole is an imidazole antifungal agent with a unique structure, as the imidazole moiety is incorporated into the ketene dithioacetate structure. Luliconazole is the R-enantiomer, and has more potent antifungal activity than lanoconazole, which is a racemic mixture. In this review, we summarize the in vitro data, animal studies, and clinical trial data relating to the use of topical luliconazole. Preclinical studies have demonstrated excellent activity against dermatophytes. Further, in vitro/in vivo studies have also shown favorable activity against Candida albicans, Malassezia spp., and Aspergillus fumigatus. Luliconazole, although belonging to the azole group, has strong fungicidal activity against Trichophyton spp., similar to that of terbinafine. The strong clinical antifungal activity of luliconazole is possibly attributable to a combination of strong in vitro antifungal activity and favorable pharmacokinetic properties in the skin. Clinical trials have demonstrated its superiority over placebo in dermatophytosis, and its antifungal activity to be at par or even better than that of terbinafine. Application of luliconazole 1% cream once daily is effective even in short-term use (one week for tinea corporis/cruris and 2 weeks for tinea pedis). A Phase I/IIa study has shown excellent local tolerability and a lack of systemic side effects with use of topical luliconazole solution for onychomycosis. Further studies to evaluate its efficacy in onychomycosis are underway. Luliconazole 1% cream was approved in Japan in 2005 for the treatment of tinea infections. It has recently been approved by US Food and Drug Administration for the treatment of interdigital tinea pedis, tinea cruris, and tinea corporis. Topical luliconazole has a favorable safety profile, with only mild application site reactions reported occasionally.
- An unusual skin manifestation in a patient with peutz-jeghers syndrome. [Journal Article]
- Acta Dermatovenerol Croat 2014 Sep; 22(3):213-4.
Peutz-Jeghers Syndrome (PJS; MIM 175200) is a rare autosomal dominant syndrome with variable inheritance, characterized by hamartomatous polyps in the gastrointestinal tract, mostly in the small bowel, and pigmented muco-cutaneous lesions (1). Hereditary disorders constitute 70% of PJS cases. The other 30% of cases occur without any previous family history, as a result of spontaneous genetic mutations. The prevalence is estimated at 1/25,000 to 1/230,000 live births, with no racial or sexual predilection (2). The majority of patients that meet the clinical diagnostic criteria have a causative mutation in the serine/threonine kinase 11 (STK11) gene, which is located at 19p13.3. Melanic spots are the earliest manifestation of PJS, typically appearing in the first year of life, and represent the muco-cutaneous marker of this syndrome. They are most commonly seen on the lips and buccal mucosa, anal and intestinal mucosa, nasal and periorbital regions, hands and feet. Rarely, nail pigmentation is observed (3). Melanonychia is a brown or black pigmentation of the nail plate caused by the presence of melanin, and is extremely rare in PJS. We report on a case of a 60-year-old woman diagnosed with Peutz Jeghers syndrome who presented an unusual acral pigmentation with longitudinal melanonychia. A 60 year old woman was referred in our department in September 2012 for evaluation of hyperpigmented macules of the fingers, lips, buccal mucosa, and nails, present from the age of 15. Brown macules of 1-3 mm were found on the lower and upper lips and gingival mucosa (Figure 1). There was no ulceration inside the mouth. The patient presented brown, round, and oval macules 1-5 mm in diameter on the fingers.The nails of the first and second finger of the right hand showed 4-5 mm thick longitudinal brownish bands (Figure 2). There was no history of any drug intake (including antimalarials, minocycline, or gold therapy), exposure to radiation, PUVA, or any trauma prior to the onset of the pigmentation. The Hutchinson sign was also negative. Physical examination showed abdominal bloating. The patient reported a minor pain throughout the abdomen on palpation. Rectal examination showed no pathological mass, and there were traces of feces on the glove. Laboratory tests were also within normal ranges except for a mild anemia, with microcytosis and iron depletion, but the stool was positive for occult blood. We then decided on further endoscopic investigation. Upper digestive endoscopy discovered more than 20 polyps in the stomach, 5-10 mm in diameter. Multiple biopsies were performed from the polyps. Colonoscopy subsequently showed two 1-1.5 cm pedunculated polyps in the sigmoid colon, which were all resected endoscopically. Histologic examination of bioptic fragments from the stomach, as well as of the polyps removed from the colon, showed proliferation and ramification of myocytes from the muscularis mucosae, surrounding the glandular epithelium and spreading in the submucosa and the muscularis propria. No sign of malignancy was observed. The presence of buccal pigmentation and multiple polyps as determined by endoscopy suggested a diagnosis of PJS. The patient reported no similar manifestations in other family members; genetic testing was not performed. The patient was subjected to gastroenterological checkups with periodic gastroscopy and colonoscopy. Peutz-Jeghers syndrome is a rare familial disorder, characterized by mucocutaneous pigmentation, gastrointestinal and extragastrointestinal hamartomatous polyps, and increased risk of malignancy (2,3). Cutaneous pigmentation is present in more than 90% of patients with PJS, appearing in early childhood, usually before five years of age, in the form of flat pigmented lesions that are irregularly oval and usually measure less than 5 mm in diameter (4). They are most commonly seen around the mouth, nose, lower lip, buccal mucosa, hands, and feet. Perianal and genital regions may also be involved, whereas the nails are rarely pigmented. A rare cutaneous manifestation associated with the PJ is longitudinal melanonychia (LM) that presents as a longitudinal pigmented band on the nail (5). LM is frequently observed in other syndromes, such Laugier-Hunziker syndrome which is typically characterized by pigmentation of the oral mucosa but with no systemic manifestations. Several other syndromes must be considered in the differential diagnosis of nail and mucocutaneous pigmentary abnormalities, including such McCune-Albright syndrome, LEOPARD syndrome, Addison Disease, LAMB syndrome, Gardener syndrome, and Cronkhite-Canada syndrome (6). LM can have many causes, including genetic predisposition, trauma, drugs, pregnancy, onychomycosis, benign nail matrix nevi, melanoma, and chemotherapeutic agents. We report on this case to emphasize the peculiarity of longitudinal melanonychia in the PJS and to stress the importance of differential diagnosis of nails pigmentation with regard to other diseases, especially nail melanoma. Since the patients with PJS are at high risk for a number of malignancies, cutaneous and mucosal manifestation may be very important early signs for proper diagnosis of the syndrome.
- Onychomycosis: 1064-nm Nd:YAG q-switch laser treatment. [Journal Article]
- J Cosmet Dermatol 2014 Sep; 13(3):232-5.
Laser Treatment of onychomycosis is a quick and easy method without complications.Laser therapy is efficient for the Treatment of onychomycosis.One hundred and twenty patients with a KOH (+) confirmed clinical diagnosis of onychomycosis were included in this study, all of the patients were treated in a single sesión with a 1064-nm neodymium-doped yttrium-aluminum garnet (Nd:YAG) q-switch laser.There was a 100% clinical response rate within the 9 month follow-up period with no side effects. CONCLUSIÓN: This method is proposed as a novel and safe method for the treatment of this ungual pathology.
- When is Onychomycosis, Onychomycosis? [JOURNAL ARTICLE]
- Br J Dermatol 2014 Sep 5.
The presence of fungal organisms in healthy-looking toenails has previously been reported in individuals with a known dermatophyte infection and in those with onycholysis, but has not been extensively studied in individuals who do not present with foot pathology.The objective of the current study was to determine the prevalence of fungal organisms in the toenails and on the soles of normal-appearing feet.Adults who visited a dermatology clinic between June 2012 and February 2013 for concerns unrelated to fungal infection of the nails and feet participated in this study. Participants' feet were clinically examined and skin and nail samples were collected and sent to the laboratory for potassium hydroxide (KOH) light microscopy and culture.Five-hundred and eighty-five individuals with normal-appearing feet and toenails participated in this study. Fungal organisms were detected in 9.2%, 3.9% and 3.1% of participants' toenails by KOH, culture, and a combination of KOH and culture, respectively; while fungal organisms were present on the soles of the feet of 7.0%, 2.9%, and 1.4% of participants by KOH, culture, and both these methods combined, respectively. A significant association between the presence of fungal organisms in toenails and on the soles of the feet was found (p < .001).The presence of fungal organisms in the nail even in the absence of clinical signs may be termed 'subclinical' onychomycosis. The normal-appearing nail plate may act as a reservoir for infectious dermatophyte and non-dermatophyte organisms. When left unimpeded by the host's immune system, these organisms are inclined to proliferate to produce clinically-apparent disease. This article is protected by copyright. All rights reserved.
- Mycology - an update Part 2: Dermatomycoses: Clinical picture and diagnostics. [Journal Article]
- J Dtsch Dermatol Ges 2014 Sep; 12(9):749-77.
Most fungal infections of the skin are caused by dermatophytes, both in Germany and globally. Tinea pedis is the most frequent fungal infection in Western industrial countries. Tinea pedis frequently leads to tinea unguium, while in the elderly, both may then spread causing tinea corporis. A variety of body sites may be affected, including tinea glutealis, tinea faciei and tinea capitis. The latter rarely occurs in adults, but is the most frequent fungal infection in childhood. Following antifungal treatment of tinea unguium and also tinea capitis a dermatophytid or hyperergic reaction to dermatophyte antigens may occur. Yeast infections affect the mucous membranes both of the gastro-intestinal system and the genital tract as candidiasis mostly due to Candida albicans. Cutaneous candidiasis affects predominantely the intertriginous regions such as groins and the inframammary area, but also the intertriginous space of fingers and toes. In contrast, pityriasis versicolor is a superficial epidermal fungal infection primarily on the the trunk. Mold infections are rare in dermatology; they play a role nearly exclusively in nondermatophyte-mold (NDM) onychomycosis. The diagnosis of dermatomycoses comprises the microscopic detection of fungi using the potassium hydroxide preparation or alternatively the fluorescence optical Blankophor preparation together with culture. The histological fungal detection with PAS staining possesses a high sensitivity, and it should play a more important role in particular for diagnosis of onychomycosis. Molecular biological methods, based on the amplification of fungal DNA with use of specific primers for the distinct causative agents are on the rise. With PCR, such as dermatophyte-PCR-ELISA, fungi can be detected directly in clinical material in a highly specific and sensitive manner without prior culture. Today, molecular methods, such as Matrix Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI TOF MS) as culture confirmation assay, complete the conventional mycological diagnostics.
- The Impact of Fingernail Psoriasis on Patients' Health-Related and Disease-Specific Quality of Life. [JOURNAL ARTICLE]
- Dermatology 2014 Aug 27.
Background: The impact of various dermatological conditions on quality of life (QoL) has been extensively studied, however the impact of nail psoriasis on QoL is an underexplored area. Objective: To investigate the impact of fingernail psoriasis on patients' QoL. Methods: A cross-sectional observational study using validated questionnaires concerning QoL (SF-36, modified onychomycosis questionnaire) was performed in 49 patients with fingernail psoriasis. Results: The mean SF-36 scores for fingernail psoriasis patients were comparable to the mean scores of the Dutch reference population. However, mean scores on the modified onychomycosis QoL questionnaire for all domains were reduced. Localisation, gender and duration of nail psoriasis influenced the impact of nail psoriasis on patients' QoL. Conclusion: Fingernail psoriasis can interfere with patients' social, mental and physical well-being. Assessing patients' QoL in daily practice offers the opportunity of a patient-centred approach to treatment. © 2014 S. Karger AG, Basel.
- Laser treatment for onychomycosis: a review. [JOURNAL ARTICLE]
- Mycoses 2014 Aug 6.
It has always been difficult to treat onychomycosis due to decrease ability of topical agents to penetrate the nail and reach the affected nail bed. Oral antifungal have shown good response but due to longer duration course it has potential to cause systemic side effects, leading to patient non-adherence and adverse events. Lasers, therefore, have been suggested for the treatment of onychomycosis due to their minimally invasive nature and the potential for requiring fewer treatment sessions. The aim of writing this article is to review a literature regarding treatment of onychomycosis by laser. This article will discuss about all the available laser treatment options for onychomycosis as well as their currently published, peer-reviewed literature.