Ciclopirox Hydroxypropyl Chitosan (HPCH) Nail Lacquer: A Review of Its Use in Onychomycosis

Piraccini, Bianca Maria; Iorizzo, Matilde; Lencastre, André; Nenoff, P.; Rigopoulos, Dimitrios

doi:10.1007/s13555-020-00420-9

Cited by 25 publications

(26 citation statements)

References 25 publications

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“…After four months of treatment, there were mycological cure and partial clinical improvement of the nail lesions (approximately 60% and 70%, respectively) with apparent growth of a healthy underlying nail in both patients (Figure 3). ese cure rates are close to those reported with synthetic drugs [5,13,14], and therefore, our results were considered promising.…”

Section: Resultssupporting

confidence: 85%

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The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

Vasconcellos-Pontello

Veiga

Gadêlha

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Aim. To evaluate the topical treatment of onychomycosis using a 10% hydroalcoholic propolis extract (PE) in two aleatorily chosen patients and analyze possible risk factors from hosts including some particularities of the isolated fungi that may justify the outcomes achieved. Materials and Methods. A topical treatment, with PE, was started in two cases of toe onychomycosis due to T. rubrum. The in vitro PE antifungal activity against these isolates was confirmed. Moreover, the ability of the fungi to infect the human nail was evaluated also in an ex vivo study, analyzed by histopathology. Results. Within four months, both patients showed evident improvement, but with different outcomes. The possible host-related risk factors justifying the poorer outcome in patient 1 include a longer duration time of onychomycosis (50 years). Some particularities in the T. rubrum strain isolated from this patient in relation to that found in patient 2 were observed: (1) the hypha morphology suggesting a major adaptation of the fungus to the host; (2) a 16 times greater propolis concentration was required in vitro; and (3) a faster ability to start a growth using the nail as the only nutritional source. Additionally, this isolate was more efficient in producing a biofilm on the nail surface. Conclusions. A partial clinical and complete mycological cure for the two patients was achieved after four months of PE daily use. Despite a complete recovery, a different outcome was observed between both cases. A more persistent onychomycosis, added to greater fungal potential to produce biofilm on the nail, seems to influence greatly the success of a topical treatment with PE.

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Section: Resultssupporting

confidence: 85%

“…e treatment of onychomycosis is still a challenge [8] and needs to be improved since it significantly influences people's quality of life [4]. Studies have shown that the combination of topical and oral treatment provides the best results [13], but in some groups, such as older people, an effective topical treatment would be more interesting.…”

Section: Resultsmentioning

confidence: 99%

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

Vasconcellos-Pontello

Veiga

Gadêlha

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…A study found that the presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis, which in diabetic patients represents the leading cause of death. [11]. The thickened, brittle nails typical of this infection are capable of causing damage to the surrounding skin that may go unnoticed due to coexistent neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…The thickened, brittle nails typical of this infection are capable of causing damage to the surrounding skin that may go unnoticed due to coexistent neuropathy. Enlarged, dystrophic toenails may also put increased pressure on the underlying toe, compromising its tenuous vascular supply and causing pressure ulcers [11,12]. The pressure required to clip thickened toenails may cause inadvertent damage to the surrounding skin.…”

Section: Discussionmentioning

confidence: 99%

“…If the patient is unable to perform appropriate foot hygiene, overgrowth of thickened toenails may cause damage to the surrounding skin as well. The subungual debris typical of distal subungual onychomycosis may become a reservoir for molds and bacteria [11,13], which may represent potential invaders of the compromised skin barrier. According to the Achilles Foot Screening Project, the most commonly clinically diagnosed foot diseases in the total population of patients who visited a dermatologist were fungal infections (35%), especially onychomycosis (23%) and tinea pedis (22%) [14].…”

Section: Discussionmentioning

confidence: 99%

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Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

Molina-Hernandez¹,

Ramírez-Marín²,

Bonifáz³

2021

Our Dermatol Online

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Background: Onychomycosis accounts for 30% of all superficial mycoses and 50% of all nail diseases. One of the most studied predisposing factors is diabetes mellitus, with a frequency of onychomycosis of 31.5% in these patients. Many show resistance to standard therapeutics and have “polypharmacy”, which represents a risk for pharmacological interactions. Objective: The objective was to assess the clinical response to therapy, evaluate with histopathology, direct examination with KOH and white-calcofluor, and culture the most frequent etiologic agents associated with the development of onychomycosis in patients with diabetes mellitus. Materials and Methods: A non-randomized, uncontrolled, open-ended, prospective cohort study was conducted on 46 patients with onychomycosis and diabetes mellitus. Treatment was assigned according to clinical findings and specific indications for treatment. Results: From the samples taken for direct examination with KOH and calcofluor-white, culture, and histopathological study, positive results were: 39 (84.1%) patients to the direct examination, 32 (69.6%) to the culture, 27 (65.2%) with a positive histopathological study, and 17 (54.86%) to the calcofluor-white. On clinical evaluation, we found no treatment response in 8 patients (20%), a partial response in 14 patients (25%), and a complete response in 18 patients (45%). Out of the 46 patients evaluated initially, 25 persisted with onychomycosis after six months of follow-up. Conclusion: The prevalence of onychomycosis is increasing and requires correct diagnosis since there are other non-fungal diseases of the nails that resemble onychomycosis. Presumably, the immunosuppression of diabetes, its systemic affection, and the foot abnormalities of a diabetic patient cause more nail dystrophy, an increased fungal load, and treatment resistance.

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Chitosan: The Versatile Biomaterial

Arya Lakshmi,

Jayakumar

2024

Advances in Polymer Science

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Ciclopirox Hydroxypropyl Chitosan (HPCH) Nail Lacquer: A Review of Its Use in Onychomycosis

Abstract: Ciclopirox 8% hydroxypropyl chitosan (HPCH)

Cited by 25 publications

References 25 publications

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features

Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

Chitosan: The Versatile Biomaterial

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