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Dermatology AND Tinea unguium [keywords]
- 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.
- Comorbidity of Tinea Pedis and Onychomycosis and Evaluation of Risk Factors in Latino Immigrant Poultry Processing and Other Manual Laborers. [JOURNAL ARTICLE]
- South Med J 2014 Jun; 107(6):374-379.
Latino immigrant workers experience elevated rates of skin disease that result from their working and living conditions. Working in manual occupations exposes workers to a variety of challenges, including occlusive shoes, vigorous physical activity, and wet conditions. These challenges predispose workers to fungal infection. The objectives of this article are to examine the comorbidity of tinea pedis and onychomycosis and to identify possible risk factors among Latino immigrant poultry and nonpoultry workers in western North Carolina.Data were obtained from a cross-sectional study conducted between June 2009 and November 2010 in rural western North Carolina among 518 manual Latino immigrant workers to assess their occupational injuries. Participants completed a face-to-face interview and a dermatologic examination.Nearly one-third of the participants (32%) were diagnosed as having onychomycosis and more than one-third (37.8%) were diagnosed as having tinea pedis. There was a greater prevalence of tinea pedis in men than women (71.3% vs 28.7%, respectively). Of the 518 participants, 121 (23.5%) had both conditions. Participants who reported the use of occlusive shoes as "always" or "most of the time" had a higher prevalence of comorbid onychomycosis and tinea pedis than the rest of the group.Comorbidity of tinea pedis and onychomycosis is common among immigrant Latino men and women who perform manual labor. Further studies confirming the presence and type of dermatophyte should be conducted.
- Can persistent toenail fungus be successfully treated with a laser? [Journal Article]
- Med Mycol J 2014; 55(2):J65-71.
Onychomycosis is a common disease seen in dermatology practice. Most patients with onychomycosis opt for treatment due to the social stigma attached to the unsightly appearance, as well as the pain that can at times make walking difficult. However, in many cases, onychomycosis is resistant to oral antifungal medication, which is the first-line therapy for this disease. In recent years, we have attempted a new treatment method using a long-pulsed 1,064nm Nd :YAG laser (Cutera Inc., Brisbane, CA, USA) in refractory cases with onychomycosis. Using 1) a laser beam with a spot size of 5.0 mm and 2) sequential irradiation at low fluence, we 3) applied the laser to the infected lesions in a motion similar to showering, while maintaining a distance of several centimeters from the skin (Laser Genesis(TM)). Treatment efficacy was assessed using nail turbidity scores on a five-point scale. Improvement in onychomycosis was noted in more than 68.8% of all cases, thus demonstrating the high efficacy of this method. No major adverse reactions were observed during the treatment period. Since its mechanism of action clearly differs from that of antifungal agents, it can be considered a useful treatment option for cases with onychomycosis resistant to antifungal therapy. Future studies should examine "combined therapy" with oral / topical antifungal agents and this laser treatment, which may provide a significant improvement in the level of satisfaction among patients with onychomycosis.
- A retrospective cohort study of tinea pedis and tinea unguium in inpatients in a psychiatric hospital. [Journal Article]
- Med Mycol J 2014; 55(2):E35-41.
We conducted a retrospective cohort study on clinical and mycological features of tinea pedis and tinea unguium in psychiatric inpatients in Japan. Of the 317 inpatients (152 with schizophrenia and 165 with depression), 46.1% had tinea pedis and 23.7% had tinea unguium. Of those with tinea pedis, 48.6% also had tinea unguium. The most common clinical type of tinea pedis was the combination of interdigital type and hyperkeratotic type. The mean clinical score of tinea pedis was 5.9, and that of tinea unguium based on the Scoring Clinical Index for Onychomycosis (SCIO) was 15.8. The main causative species of tinea pedis were Trichophyton rubrum (68.4%) and T. mentagrophytes (26.3%). No statistically significant differences were observed in incidence rates of tinea pedis or tinea unguium between men and women or between patients with schizophrenia and those with depression. As for incidence rates by age, patients with depression showed a single peak for tinea pedis and / or tinea unguium in their 50's, while patients with schizophrenia exhibited twin peaks for tinea pedis and / or tinea unguium in their 50's and 70's. Both tinea pedis and tinea unguium tended to become more severe in patients with chronic schizophrenia. Our study suggests that schizophrenia and depression, like diabetes mellitus and HIV infections, should be regarded as risk factors for tinea pedis and tinea unguium.