Chemical Peeling as an Innovative Treatment Alternative to Oral Antifungals for Onychomycosis in Special Circumstances

Abstract

Toe nail onychomycosis (ONM) is a common problem in elderly patients. Treatment in diabetic patients with associated comorbidities such as congestive heart failure becomes a challenge. Oral antifungals are best avoided owing to most of them being contraindicated or unsafe due to comorbidities and/or risk of drug interactions stemming from polypharmacy. Topical agents alone are not effective. Unlike isolated ONM in healthy and younger patients, ONM involving multiple nails in geriatric and diabetic patients warrants treatment as it serves as a source of recurrent tinea of the feet and other sites, and even contributes to formation of diabetic foot ulcers. Long-pulsed Nd:YAG and fractional CO₂ laser (in addition to antifungals) have been reported to provide gratifying results in toe nail ONM. But high treatment cost is a major limitation. Nail peeling with glycolic acid (GA) and low-concentration croton-oil free phenol (CFP) peels have been used in different nail conditions but not specifically for ONM. We report the successful use of Black peel (a superficial-to-medium depth peel used typically for anti-acne and cosmetic indications), a combination of 50% black acetic acid, 0.5% salicylic acid, 6% tetrahydrojasmonic acid, 10% bio sulphur, and 0.1% potassium iodide, in two difficult cases with ONM of multiple nails, the rationale of use being the additional anti-fungal effects of all the peel components.

Onychomycosis: An Updated Review

“…Recently, Sonthalia et al . reported the successful use of Black peel (a combination of 0.5% salicylic acid, 50% black acetic acid, 6% tetrahydrojasmonic acid, 0.1% potassium iodide, 10% bio sulphur) in two recalcitrant cases of onychomycosis [ 163 ]. Further studies have to be done to confirm or refute their findings.…”

Acetic acid and the skin: a review of vinegar in dermatology

“…24 Black vinegar-a type of vinegar that contains higher concentrations of organic materials, minerals, and amino acids 25 -was included in a compound utilized as a nail chemical peeling agent to enhance the efficacy of topical 8% ciclopirox olamine nail lacquer in the treatment of onychomycosis. 26 Treatments for P. aeruginosa nail infection ("green nail") vary, including topical or systemic antibiotics as well as soaking in 2% sodium hypochlorite solution (bleach) twice daily. 27 Although there is a lack of supporting literature for vinegar in pseudomonas green nail, it is frequently recommended and listed as first line therapy in case studies 28 and professional educational websites.…”

Infecções Fúngicas Cutâneas Podais Como Preditoras De Complicações Em Pessoas Com Diabetes: Uma Revisão Integrativa

“…Em 2040, prevê-se que haverá mais de 642 milhões de pessoas com tal doença no mundo. 3 Trichophyton rubrum 16,19,20,24,[29][30][31] , mencionados em 7 estudos (63,6%), seguidos do Trichophyton metagraphyte (3 -27,2%) 20,29,30 e Trichophyton tonsurans (2 -18,1%). 20,30 Os fungos do tipo leveduras também apareceram como prevalentes:…”

“…Candida albicans (5 -45,4%) [15][16][17]28,30 e Candida tropicalis (2 -18,1%), 17,28 seguidos de Aspergillus niger (2 -18,1%). [28][29] No [37][38][39] Quadro 3.…”