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Dermatology AND Tinea unguium [keywords]
- Treatment of Onychomycosis Using a 1064nm Nd : YAG Laser. [Journal Article]
- Med Mycol J 2013; 54(4):333-9.
We investigated the efficacy of 1064nm Nd:YAG laser for the treatment of onychomycosis caused by dermatophytes. The study population consisted of 12 patients (6 male, 6 female ; average age 53.5 years), with onychomycosis confirmed by fungal culture and/or real-time PCR identification of the pathogen. The causative agent was identified as Trichophyton rubrum in 11 cases and a mixture of T. rubrum and T. mentagrophytes in 1 case. For each patient, laser treatment was given to a single hallux nail, with turbidity at baseline affecting <75% of the nail surface and thickness at baseline <3mm. Treatment was given in 3 sessions at 4-week intervals, and nail turbidity was evaluated 3 and 6 months after the first laser treatment. After 6 months the efficacy results were as follows : 3 cases, turbidity significantly improved ( >70%) ; 2 cases, turbidity improved (50-70%), 1 case, turbidity slightly improved (30-50%) ; 5 cases, no change in turbidity (<30% improvement) ; and 1 case, turbidity worsened. Overall, the total lesion area with turbidity in 12 patients decreased from 664.4mm(2) to 481.0mm(2), corresponding to a 27.6% improvement after treatment. Pain during laser treatment was well tolerated, and all patients underwent all 3 treatments. These results suggest that the 1064nm Nd:YAG laser could be a useful treatment alternative for patients with mild onychomycosis.
- The prevalence of onychomycosis in the global population - A literature study. [JOURNAL ARTICLE]
- J Eur Acad Dermatol Venereol 2013 Nov 28.
Onychomycosis is a common disorder, and high prevalence figures are commonly cited in the literature.Evaluate the prevalence of onychomycosis based on published studies.Relevant studies were identified in Medline by using specific search criteria.Eleven population-based and 21 hospital-based studies were identified. The mean prevalence in Europe and North America was 4.3% [95% Confidence Interval (CI): 1.9-6.8] in the population-based studies, but it was 8.9% (95% CI: 4.3-13.6) for the hospital-based studies. Both population-based and hospital-based studies showed that onychomycosis is more common in toenails and is seen more frequently in males. The main causative agent was a dermatophyte in 65.0% (95% CI: 51.9-78.1) of the cases. Trichophyton rubrum was the single most common fungus and was cultured on average in 44.9% of the cases (95% CI: 33.8-56.0). Moulds were found on average in 13.3% (95% CI: 4.6-22.1) and yeasts in 21.1% (95% CI: 11.0-31.3).We may not have been able to locate all studies.Onychomycosis is a common disorder, but it may not be as common as cited in the literature, because hospital-based studies might overestimate the prevalence of onychomycosis. It is more frequent in males, and toenails are more commonly affected. Dermatophytes, particularly T. rubrum, are the main causative agents.
- Non-dermatophyte mould onychomycosis: a clinical and epidemiological study at a dermatology referral centre in Bogota, Colombia. [JOURNAL ARTICLE]
- Mycoses 2013 Nov 27.
Worldwide prevalence of non-dermatophyte mould onychomycosis has increased in recent years; however, available information on the topic is confusing and oftentimes contradictory, probably due to the small number of reported cases. The aim of this study was to determine and describe the aetiological agents, as well as the epidemiological and clinical characteristics of non-dermatophyte mould onychomycosis in a dermatology referral centre in Bogota, Colombia. A cross-sectional descriptive study was conducted between January 2001 and December 2011 among patients who attend the National Institute of Dermatology with a confirmed diagnosis of onychomycosis by non-dermatophytes moulds. There were 317 confirmed cases of non-dermatophyte mould onychomycosis in 196 women and 121 men whose average age was 43 years. Twenty-seven per cent of them had a history of systemic disease. The habit of walking and showering barefoot was the major infection-related factor. Distal and lateral subungual presentation was the most common pattern of clinical presentation. The most frequent non-dermatophyte mould was Neoscytalidium dimidiatum followed by Fusarium spp. No relationship was observed with predisposing factors previously reported in the literature. Clinical features found in this population are indistinguishable from onychomycosis caused by dermatophytes. High prevalence of N. dimidiatum found here was in contrast to a large number of studies where other types of moulds predominate.
- Terbinafine-induced subacute cutaneous lupus erythematosus in two patients with systemic lupus erythematosus successfully treated with topical corticosteroids. [JOURNAL ARTICLE]
- Postepy Dermatol Alergol 2013 Aug; 30(4):261-264.
So far in the literature there have been reported only 5 patients with a recognized and well-documented history of systemic lupus erythematosus (SLE) who developed SCLE after terbinafine introduction. Here we report two women suffering from SLE who developed SCLE after initiation of oral terbinafine for onychomycosis. Skin lesions in both of them were extensive, located on the trunk, and upper and lower extremities. No exacerbation of SLE symptoms was observed at that time. Despite severe skin lesions, patients revealed good response to topical corticosteroids within a few weeks. The systemic review of the literature and our experience on terbinafine-induced SCLE developing in patients with SLE allowed to create a description for this special subset: a) terbinafine-induced SCLE usually develop in 1-8 weeks after terbinafine introduction, b) skin lesions are usually severe, disseminated including lower extremities, c) patients present Ro/SS-A La/SS-B antibodies, but anti-histone antibodies are rarely observed, d) exacerbation of SLE symptoms is rather not observed, e) eruptions clear within 2-8 weeks, f) withdrawal of terbinafine and topical corticosteroids should be considered as a first-line therapy in these cases, g) terbinafine should be carefully used in patients suffering from SLE.
- Efinaconazole solution 10%: topical antifungal therapy for toenail onychomycosis. [Journal Article]
- Cutis 2013 Oct; 92(4):203-8.
Toenail onychomycosis is a common disease with limited treatment options, as treatment failures and relapses frequently are encountered. Many patients experience long-term disease that affects multiple toenails and causes substantial discomfort and pain. Although many patients prefer topical therapies, treatment efficacy with ciclopirox and amorolfine lacquers has been disappointing. Efinaconazole solution 10% is a new triazole antifungal agent specifically developed for the treatment of onychomycosis. Efinaconazole has shown a broad spectrum of antifungal activity in vitro and is more potent than ciclopirox against common onychomycosis pathogens. It has lower keratin binding and quicker drug release from keratin than ciclopirox and amorolfine and exhibits remarkably greater in vivo activity. Efinaconazole has limited or no potential for drug interactions and a low resistance potential. Efinaconazole provides a viable alternative to oral therapy for the treatment of toenail onychomycosis.
- A study on clinico-mycological profile, aetiological agents and diagnosis of onychomycosis at a government medical college hospital in kashmir. [Journal Article]
- J Clin Diagn Res 2013 Sep; 7(9):1983-5.
Background:Onychomycosis is a major public health problem with a high incidence, associated morbidity and a long lasting treatment with anti-fungal agents. This study was carried out to know the clinico-mycological pattern of onychomycosis, which could help in the control of this infection.
Aims:The aim of this study was to determine the prevalence of various causative agents of onychomycosis and to study the clinical and mycological patterns of onychomycosis. Material and
Methods:This was a prospective study which was carried over a period of one year, from 1(st) February 2011 to 31(st) January 2012 on samples from 150 patients with clinically suspected nail infections, who attended the Dermatology Department of SKIMS Medical college, Kashmir, India. The nails were evaluated clinically and the nail samples were subjected to direct microscopy and culture.
Results:60% samples were found to be positive by direct microscopy and culture. Males were infected more than females. The commonest age group which was infected was the 21-30 years age group. Finger nails were affected more frequently than toe nails and distolateral subungal onychomycosis was the most common clinical type of infection which was seen in 64.44% patients. The aetiological agents were dermatophytes (61.66%), Non-Dermatophyte Moulds (NDM) (31.66%) and yeasts (6.66%). Among dermatophytes, T. rubrum was the commonest aetiological agent.
Conclusion:Although dermatophytes were the main causative agents, NDM and yeasts were also not uncommon aetiological agents of onychomycosis. This study also emphasized the need of performing both a direct examination and culture to improve sensitivity. Since onychomycosis can cause physical, psycological and occupational problems, the clinico-epidemiological data can be helpful in development of preventive and diagnostic strategies.
- Psychosocial impact of onychomycosis: a review. [Journal Article]
- Int J Dermatol 2013 Nov; 52(11):1300-7.
Onychomycosis (tinea unguium) is the most common nail disorder. Nonetheless, it requires lengthy, often ineffective treatments, and recurrence is frequent. Predominantly a disease of the elderly, onychomycosis is becoming more and more common. Besides interfering with normal nail function, fungal nail infections are relatively painful, unsightly in appearance, disrupt daily activities, and have a negative psychosocial connotation. Commonly reported psychosocial factors are embarrassment, low self-esteem, and social withdrawal. Yet advances in therapy have been achieved since these reports were made, and many of these treatment options have proven to be more effective. Thus, the impact of these advances on psychosocial well-being of patients with onychomycosis is worth analyzing. The objective of this paper is to review studies that investigated the psychosocial impact of onychomycosis on a variety of patient populations. An alternative, total patient approach that dermatologists and general practitioners alike could use to incorporate patients' psychosocial well-being into the holistic management of onychomycosis will also be discussed.
- Promoting and maintaining or restoring healthy nails: practical recommendations for clinicians and patients. [Journal Article, Research Support, Non-U.S. Gov't]
- Semin Cutan Med Surg 2013 Jun; 32(2 Suppl 1):S13-4.
The American Academy of Dermatology guidelines for managing patients with onychomycosis, published almost 2 decades ago, provide sound, basic recommendations for clinicians. This article provides a quick reference for clinicians and includes a handout for patients to support the health care provider's educational efforts.
- Current and emerging options in the treatment of onychomycosis. [Journal Article, Research Support, Non-U.S. Gov't]
- Semin Cutan Med Surg 2013 Jun; 32(2 Suppl 1):S9-12.
Currently approved options for the treatment of onychomycosis include systemic therapy (the antifungal agents fluconazole, itraconazole, and terbinafine), topical agents (ciclopirox, which has been available since 1996, efinaconazole, currently pending approval), and laser systems. Phase III studies on another topical, tavaborole, have been completed and this medication also shows promise. Mechanical modalities are sometimes used but are seldom necessary. Recurrence of infection is common; the risk for recurrence may be reduced by adherence to preventive measures, especially avoiding (if possible) or promptly treating tinea pedis infections.
- Trichosporon mucoides causing onychomycosis in an immunocompetent patient. [JOURNAL ARTICLE]
- Int J Dermatol 2013 Oct 18.