Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Dermatology AND Tinea unguium [keywords]
- 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.
- Clinical comparison and complete cure rates of terbinafine efficacy in affected onychomycotic toenails. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2014 Jul 30.
Clinical studies regarding complete cure rate of onychomycosis using oral Terbinafine have a very broad range (14-90%) based solely on response to treatment on the big toenail.To evaluate the efficacy of Terbinafine in all affected onychomycotic toenails and, furthermore, to evaluate differences in mycological, clinical and complete cure rate between affected onychomycotic toenails.Inclusion criteria are as follows: distolateralsubungual onychomycotic involvement of the hallux and additional involvement of at least two more toenails of the same foot. Exclusion criteria are as follows: patients with nail traumata and hypersensitivity to Terbinafine. Patients were treated with oral Terbinafine 250 mg/day for 16 weeks. Mycological analysis was performed using direct microscopy and culture. Clinical improvement was assessed using digital photography.Statistically significant difference was found in clinical improvement between the great toenail and all other involved toenails. The rate of complete cure (100% clinical cure and mycological cure) of the big toenail was lower (23%) as compared to the second (65%), third (51%) and the fourth toenail (67%).This is a case series study that was based on a single-centre cohort.Our results support findings that efficacy of Terbinafine should be based on all involved onychomycotic toenails; the big toenail is not superior in response compared to other affected toenails.
- Psychosocial perception of adults with onychomycosis: a blinded, controlled comparison of 1,017 adult Hong Kong residents with or without onychomycosis. [Journal Article]
- Biopsychosoc Med 2014.:15.
A survey was conducted amongst 1,017 Hong Kong residents ages 18 and over to determine their knowledge of fungal nail infections (onychomycosis) and the psychosocial impact of the disease on the relationships, social lives and careers of sufferers.The Fungal Nail Perception Survey was conducted by email and online between May 29th and June 10th, 2013. Participants were shown three photographs of people with and without onychomycosis of the toenails. Respondents were asked ten questions (repeated for each picture) to ascertain their perceptions of the people in the pictures. Questions were related to perceptions around the ability of sufferers and non-sufferers to form relationships with others, social activities of sufferers and non-sufferers, perceptions of the effect of the disease on the potential for career success, and awareness of fungal nail disease and health. The sub-population who themselves suffered from onychomycosis were asked about self-perception as well as their perception of others with onychomycosis.Compared with non-sufferers, survey respondents perceived those with onychomycosis as less likely to be able to form good relationships. They also indicated that they would be more likely to exclude sufferers than non-sufferers from social activities and that they would be more likely to feel uncomfortable when sitting or standing beside an infected person than beside an uninfected person. Respondents perceived people with onychomycosis to be less able to perform well in their chosen career than with someone without onychomycosis. Interestingly, those respondents who themselves were infected felt socially excluded, upset and embarrassed by their infection.Onychomycosis may lead to stigmatization and social exclusion. Misconceptions of onychomycosis are high and education about the disease needs to be improved. Early recognition and treatment of the disease is essential to avoid complications and improve treatment outcomes, which would lead to reduced psychosocial impact on those with fungal nail infections.
- The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. [Journal Article, Review]
- J Clin Aesthet Dermatol 2014 Jul; 7(7):10-8.
Onychomycosis is a common infection of the nail unit that is usually caused by a dermatophyte (tinea unguium) and most frequently affects toenails in adults. In most cases, onychomycosis is associated with limited treatment options that are effective in achieving complete clearance in many cases. In addition, recurrence rates are high in the subset of treated patients who have been effectively cleared, usually with an oral antifungal agent. There has been a conspicuous absence of medical therapies approved in the United States since the introduction of topical ciclopirox (8% nail lacquer), with no new effective agents introduced for more than 10 years. Fortunately, newer agents and formulations have been under formal development. While patients might prefer a topical therapy, efficacy with ciclopirox 8% nail lacquer, the only available agent until the very recent approval of efinaconazole 10% solution, has been disappointing. The poor therapeutic outcomes achieved with ciclopirox 8% nail lacquer were not unexpected as the cure rates achieved in the clinical trials were unimpressive, despite concomitant nail debridement, which was an integral part of the pivotal trials with ciclopirox 8% nail lacquer. Efinaconazole 10% solution and tavaborole 5% solution are new topical antifungals specifically developed for the treatment of dermatophyte onychomycosis. In Phase 3 clinical trials, both newer agents were applied once daily for 48 weeks without concomitant nail debridement. Mycologic cure rates with efinaconazole 10% solution are markedly superior to what was achieved with ciclopirox 8% nail lacquer. To add, they appear to be nearly comparable to those achieved with oral itraconazole in pivotal clinical trials. However, it is important to remember that direct comparisons between different studies are not conclusive, are not generally considered to be scientifically sound, and may not be entirely accurate due to differences in study design and other factors. Well-designed and properly powered head-to-head studies are needed in order to draw definitive conclusions about efficacy comparisons between therapies, at least based on academic and regulatory standards. Although tavaborole 5% solution is in an earlier phase of development for onychomycosis, treatment success rates reported thus far for both efinaconazole 10% solution and tavaborole 5% solution are superior to ciclopirox 8% nail lacquer. As a result, a new era of onychomycosis appears to be upon us that incorporates topical therapy more effectively than in the past. Not only may these newer topical agents provide viable monotherapy alternatives to oral therapy for onychomycosis, topical therapy for onychomycosis that is effective, well tolerated, and easy to use may also find a role in combination therapy, and/or as continued therapy after initial clearance to reduce recurrence or re-infection.
- Aspergillus pragensis sp. nov. discovered during molecular reidentification of clinical isolates belonging to Aspergillus section Candidi. [JOURNAL ARTICLE]
- Med Mycol 2014 Jun 20.
The identity of nine clinical isolates recovered from Czech patients and presumptively identified as Aspergillus sp. section Candidi based on colony morphology was revised using sequences of β-tubulin, calmodulin gene sequence, and internal transcribed spacer rDNA. Six isolates were from suspected and proven onychomycosis, one from otitis externa, and two associated with probable invasive aspergillosis. The results showed that one Aspergillus candidus isolate was the cause of otitis externa, and both isolates obtained from sputa of patients with probable invasive aspergillosis were reidentified as A. carneus (sect. Terrei) and A. flavus (sect. Flavi). Three isolates from nail scrapings were identified as A. tritici, a verified agent of nondermatophyte onychomycosis. One isolate from toenail was determined to be A. candidus and the two isolates belonged to a hitherto undescribed species, Aspergillus pragensis sp. nov. This species is well supported by phylogenetic analysis based on β-tubulin and calmodulin gene and is distinguishable from other members of sect. Candidi by red-brown reverse on malt extract agar, slow growth on Czapek-Dox agar and inability to grow at 37°C. A secondary metabolite analysis was also provided with comparison of metabolite spectrum to other species. Section Candidi now encompasses five species for which a dichotomous key based on colony characteristics is provided. All clinical isolates were tested for susceptibilities to selected antifungal agents using the Etest and disc diffusion method. Overall sect. Candidi members are highly susceptible to common antifungals.