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Fungal Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Uwe Wollina, Pietro Nenoff, Shyam Verma, Uta-Christina Hipler
Clinical presentation: This is the most common nail disorder. Risk factors include age, peripheral vascular disease, diabetes, and systemic immunosuppression, but tinea ungium may occur in many patients, in whom the toes nails have thickening, disintegration, color changes, and hardening (Figure 8.6). Onychomycosis can be due to infection with dermatophytes (tinea unguis, in about 80% of cases), molds, or yeasts. Onychomycosis occasionally may be a risk factor for bacterial soft tissue infections.
Novel and emerging pharmacotherapy and device-based treatments for onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Jose W. Ricardo, Shari R. Lipner
The treatment armamentarium for onychomycosis is rapidly expanding. Novel therapies center on topical formulations and device-based options because their adverse effects are limited to the application site, with negligible risks of systemic toxicity and drug interactions. In addition, device-based alternatives have the potential to reduce the need for long-term patient compliance. Laser-based treatments are only considered for cosmetic improvements and not for treatment; therefore, meaningful comparison with oral/topical therapies is challenging. Furthermore, standardized treatment parameters with lasers are lacking. These developments may help to improve the efficacy of onychomycosis treatment in the near future. More research and published data with the newer therapeutic modalities will help determine the efficacy of these modalities in the management of dermatophyte and nondermatophyte onychomycosis.
Rhodotorula spp.
Published in Rossana de Aguiar Cordeiro, Pocket Guide to Mycological Diagnosis, 2019
Rejane Pereira Neves, Ana Maria Rabelo de Carvalho, Carolina Maria da Silva, Danielle Patrícia Cerqueira Macêdo, Reginaldo Gonçalves de Lima-Neto
Samples should be collected after cleansing the area with 70% isopropyl alcohol to prevent contamination. For the diagnosis of onychomycosis, nail scales should be collected. Once the specimen has been obtained, office microscopy can be performed by preparing the samples with 10%–20% potassium hydroxide (KOH) solution. The KOH will dissolve keratin, leaving the fungal cell intact (Westerberg & Voyack, 2013).
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
Onychomycosis can be managed in several ways: pharmaceutically, mechanically (via nail debridement or laser therapy), and surgically. Compared to nail debridement and surgical avulsion of the nail, the pharmaceutical agents have robust data showing mycological cure. From a pharmaceutical perspective, oral or systemic antifungal options and topical options are available on the market. Systemic antifungals are currently assumed to be the most effective treatment for onychomycosis according to meta-analyses conducted [35]. Oral antifungal agents (e.g. terbinafine [an allylamine] and itraconazole [an imidazole]) are considered treatments of choice for onychomycosis because they can effectively reach the nail bed through systemic circulation [36]. However, these agents have limitations including: drug-drug interactions with agents that are metabolized by specific cytochrome P450 (CYP) enzymes (more often itraconazole), potential inhibition of certain CYP subtypes, and adverse effects such as congestive heart failure and hepatotoxicity, the latter of which requires liver functioning tests completed prior to initiation of therapy [29,30,36]. Itraconazole has boxed warnings of rare cases of serious hepatotoxicity with treatment, including liver failure and death. Even patients with no preexisting liver disease or serious underlying medical condition are at risk for hepatotoxicity as well as congestive heart failure [30]. Fosravuconazole (BFE1224) is an oral triazole antifungal agent approved for the treatment of onychomycosis in Japan [37], though it is not approved in the US.
Update on current approaches to diagnosis and treatment of onychomycosis
Published in Expert Review of Anti-infective Therapy, 2018
Aditya K. Gupta, Rachel R. Mays, Sarah G. Versteeg, Neil H. Shear, Vincent Piguet
Onychomycosis is a chronic fungal infection of the nail bed, matrix or plate and accounts for roughly 50% of all nail disease. It can be caused by dermatophytes, non-dermatophytes moulds (NDM) and/or yeasts, and can present in a variety of clinical forms [1]. Toenail involvement is approximately ten times more common than fingernail involvement [2]. Onychomycosis is difficult to treat with relapses and reinfection a common occurrence [3]. Onychomycosis is caused by a number of organisms and is most often caused by dermatophytes of the genus Trichophyton. In temperate climates onychomycosis is generally caused by dermatophytes, most commonly Trichophyton rubrum and Trichophyton mentagrophytes [4]. Fingernails and patients with chronic mucocutaneous candidiasis are generally infected with the Candida organism [5]. Non-dermatophyte mold (NDM) infections are less common, accounting for approximately 10% of onychomycosis cases globally [6].
Use of in vitro performance models in the assessment of drug delivery across the human nail for nail disorders
Published in Expert Opinion on Drug Delivery, 2018
Marc Brown, Rob Turner, Sean Robert Wevrett
Despite only a few hundred fungal species being regarded as pathogenic to humans out of the approximate 5 million total fungal species on Earth [12,13], fungi are responsible for causing around 50% of all nail disorders [14], with onychomycosis affecting between 5% and 20% of the population in western countries [15–17]. Onychomycosis is more prevalent in elderly, immunocompromised, diabetic, obese, and sports-active individuals. The condition can be uncomfortable, painful, and also lead to permanent disfiguration of the nail [18]. Although yeasts (Candida spp.) and molds (Scytalidium spp., Scopulariopsis spp., Fusarium spp., Acremonium spp., and Onychocola canadensis) [19] are also associated with nail infections, dermatophyte infections account for 85% of reported cases of onychomycosis. Trichophyton rubrum is the most commonly responsible dermatophyte, accounting for around 90% of infections [15–17].