Cutaneous and superficial fungal infections affecting the skin, nails, and hair of humans are caused primarily by dermatophytes of the genera Trichophyton, and Epidermophyton, or by yeasts of the genera Candida and Malassezia Onychomycosis is a common fungal infection of the nail frequently coexisting with tinea pedis, the most prevalent mycotic skin infection. Efficacy rates for current topical onychomycosis therapies are hampered by low drug penetration across the nail plate that is theoretically obviated with nitric oxide (NO)-based topical therapies.The Nitricil technology platform is comprised of polysiloxane-based macromolecules that stably release therapeutic levels of NO. In the reported studies NVN1000, the lead candidate of the platform, was assessed for its spectrum of in vitro activity against a broad range of filamentous fungi and yeast species commonly associated with cutaneous fungal infections. Time-kill assays demonstrated that NVN1000 exhibited fungicidal activity in as early as 4 hours. Additionally, the penetration of several unique NVN1000 NO-releasing drug product formulations (gel, cream, lacquer) was evaluated following a single topical application in an in vitro infected human nail assay with all formulations showing similar inhibition of fungal growth. Repeated topical application in this model demonstrated that a lower strength dose of NO could achieve the same efficacy as a higher strength dose after 7 days. Together these in vitro results demonstrate that NO-releasing treatments rapidly penetrate the nail plate and eradicate the fungal infection, representing promising novel topical therapies for the treatment of onychomycosis and other cutaneous fungal infections.

　Patients usually consult a dermatologist for the treatment of onychomycosis. However, in the case of home care, visiting nurses may assist with bathing, which offers the opportunity to observe patients' feet for possible signs of onychomycosis without causing anxiety. It is estimated that more than 30% of patients receiving home care have onychomycosis. Before the approval of efinaconazole, healthcare personnel hesitated to treat onychomycosis because of: 1) possible side effects, especially liver dysfunction and pain due to repeated blood collection, as a major goal of home care is to minimize pain; and 2) the questionable efficacy of previously available antifungal medications. In addition, many patients report fear of "transmitting athlete's foot to others" and "do not want to show my dirty toenails". On the other hand, caregivers reportedly worry about "athlete's foot being transmitted to them".

Tinea pedis is a chronic, recurrent superficial fungal infection that most commonly involves the toe web spaces.1 Previous culture-based studies have incompletely defined the microbial landscape associated with tinea pedis, which was considered the result of infection with a single fungus. However, the recalcitrant course of the disease suggests that microbial community shifts have a role in disease pathogenesis.2 This study was conducted to characterize the bacterial and fungal microbiome changes associated with interdigital tinea pedis. This article is protected by copyright. All rights reserved.

A key enzyme in cholesterol synthesis is placed firmly on the oncogenic map and demonstrated to be a potential therapeutic target in liver cancer by repurposing a common antifungal agent (Liu et al, this issue).

Proximal subungual onychomycosis (PSO), which predominantly involves the nail plate from the proximal nail fold, is the rarest form of onychomycosis. Classically associated with an immunocompromised state, PSO is an uncommon diagnosis in individuals without immunodeficiency. We present a case of a healthy 51-year-old man, who presented with a three-month history of white discoloration of multiple toenails. Physical examination revealed white, opaque patches on the proximal third nail plates of multiple toenails. The affected digits also demonstrated proximal onycholysis, subungual debris, and mild paronychia. Laboratory examinations, including routine serologic studies as well as human immunodeficiency virus and antinuclear antibodies, were within normal limits. Proximal nail fragments of the left hallux showed sections of dystrophic nail plate with mounds of parakeratosis, collections of neutrophils, and hyphae that highlighted with periodic acid-Schiff staining. The patient was diagnosed with PSO and tinea pedis bilaterally and treated with oral fluconazole with gradual improvement. This case of PSO highlights the potential for its rare occurrence in a healthy host. However, the clinical presentation of PSO should trigger an evaluation for possible immunodeficiency. <p><em>J Drugs Dermatol. 2018;17(4):475-478.</em></p>.

Interdigital tinea pedis is a mycotic infection of the feet which occurs mainly in adult males. The transmission is due to repeated contacts with the soil. In Italy, Trichophyton rubrum, T. mentagrophytes (including T. mentagrophytes var. interdigitale) and Epidermophyton floccosum are the most frequently involved species. Interdigital tinea pedis is characterized clinically by maceration, erythema, vesicles, scales, crusts, erosions and ulcers located at the 2nd , 3rd and 4th interdigital folds. Interdigital tinea pedis may be asymptomatic; however, when erosions and ulcers occur, the patients may complain of pruritus, burning sensation and pain. Superinfections, caused by Candida albicans and Gram-negative bacteria, are not rare.1 We present four cases of interdigital tinea pedis which was probably acquired in Turkish mosques and holy Muslim places. This article is protected by copyright. All rights reserved.

To evaluate efficacy of combined therapy with ozonated water and oil on patients with tinea pedis.
 Methods: A total of 60 patients with tinea pedis were divided into 2 groups in a randomized and blinded test. Patients in a control group were treated with naftinfine hydrochloride and ketoconazole cream once a day. Patients in an ozone group were treated with ozonated water bath and then ozonated oil topical application once a day. Patients in the 2 groups were treated for 4 weeks. Clinical and laboratory data were collected for both groups at the end of the 1st week, the 2nd week, and the 4th week. The Pearson chi-square was performed to compare scores of the clinical signs and symptoms (CSS) and the mycological result between the 2 groups. Independent samples T-test was performed to compare the curative effect between the 2 groups.
 Results: After 4 weeks' treatment, 6 patients were positive in the control group determined by mycological examination while 1 patient was positive in the ozone group, with no significant difference between the 2 groups (P>0.05). Changes in CSS at the end of the 1st week, 2nd week, and 4th week were obtained and showed no significant difference between the 2 groups at the 3 different time points (P>0.05). No side effects were observed.
 Conclusion: Combination of ozonated water with oil is effective on treatment of tinea pedis and it shows no side effects.