Guidelines for the management of dermatomycosis (2019)

Abstract

The "Guidelines for the management of dermatomycosis" of the Japanese Dermatological Association were first published in Japanese in 2009 and the Guidelines Committee of the Japanese Dermatological Association revised it in 2019. The first guidelines was prepared according to the opinions of the Guidelines Committee members and it was of educational value. The revised version is composed of introductory descriptions of the disease concepts, diagnosis, medical mycology and recent advances in treatment, along with clinical questions (CQ), which is intended to help in general practice for dermatologists. The CQ are limited to those involved in therapy but include some of the recently launched antifungal agents. The level of evidence and the degree of recommendation for each item were reviewed by the committee based on clinical studies published by 2018. For rare dermatomycoses, recommendations by the committee are described in the guidelines. In this field, there are still few good quality studies on treatment. Periodic revision in line with new evidence is necessary.

Treatment Outcome With Fosravuconazole L-lysine Ethanolate (F-RVCZ) for Onychomycosis

“…Generally, onychomycosis may present as a mixture of clinical types, but the most common type is DLSO [7,16], and our study found that oral F-RVCZ therapy is effective for treating DLSO. In addition, F-RVCZ therapy exhibited e cacy against dermatophytoma, an intractable clinical feature.…”

“…Therefore, proper treatments that completely cure onychomycosis would improve both clinical ndings and patient quality of life. According to several guidelines, systemic therapy is recommended for the treatment of onychomycosis [5][6][7]. Two oral antifungal agents, itraconazole and terbina ne hydrochloride, have a long history of use in Japan, and these agents received approval for insurance coverage for the treatment of onychomycosis in the 1990s.…”

Validation of a lateral flow immunochromatographic assay for tinea unguium diagnosis

“…1 To identify the true pathogen in onychomycosis, the guidelines and expert opinion recommend repeated examinations and the use of a combination of various diagnostic techniques. [1][2][3] The LFIA kit is generally cost-effective and easy and rapid to use for on-site diagnosis despite being more expensive than direct KOH microscopy. Its diagnostic value for tinea unguium depends on its sensitivity and specificity in comparison with direct KOH microscopy.…”

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Onychomycosis is a common fungal disease of the nails caused by dermatophytes, non-dermatophyte molds (NDM), and yeasts. [1][2][3] The term tinea unguium refers to a dermatophytic nail infection mainly caused by Trichophyton rubrum followed by Trichophyton interdigitale. Despite the widespread prevalence of onychomycosis, accurate methods of diagnosing this group of diseases and achieving a complete cure continue to be challenging.Various non-infectious nail disorders, including lichen planus, psoriasis, palmoplantar pustulosis (PPP), and pachyonychia clinically resemble onychomycosis.

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“…2 Direct potassium hydroxide (KOH) microscopy and fungal culture are considered the gold standard for diagnosing onychomycosis although other techniques such as histopathology, gene sequencing, and flow cytometry have been used in specific instances. [1][2][3] Direct KOH microscopy appears simple but requires skill for appropriate sampling, resolving the collected nail pieces, and identifying the organisms. 2 A supplementary diagnostic…”