Itraconazole therapy is effective for pedal onychomycosis caused by some nondermatophyte molds and in mixed infection with dermatophytes and molds: A multicenter study with 36 patients

Doncker, Piet R.G. De; Scher, Richard K.; Baran, Robert; Decroix, J.; Degreef, Hugo; Roseeuw, Diane; Havu, V. K.; Rosen, Theodore; Gupta, Aditya K.; Pierard, Gérald

doi:10.1016/s0190-9622(97)70275-5

Cited by 93 publications

(57 citation statements)

References 16 publications

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“…Firstly, however, it must be stated that the degree of interest in this matter naturally depends on whether any treatment issue depends on fungal identification. Some controversy attends this topic, but it is certainly well established that fungi in the order Microascales, including the nail-infecting Scopulariopsis species, and fungi in the order Hypocreales, including the nail-infecting Fusarium and Acremonium species, show distinctive and often (although not always) unpromising responses in vitro to currently used oral antifungals, including fluconazole, griseofulvin, terbinafine, and itraconazole (2,5,8,16,24,27,29,33,39,41). Although the situation in vivo may be more complex, as is suggested by apparent cure of some Fusarium and Scopulariopsis onychomycosis by itraconazole or terbinafine therapy (8,14,28,40), there appears to be good prima facie justification for a dermatologist wanting to know whether his or her patient is truly infected by one of these normally drug resistant organisms.…”

Section: Discussionmentioning

confidence: 99%

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

et al. 2001

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Opportunistic onychomycosis caused by nondermatophytic molds may differ in treatment from tinea unguium. Confirmed diagnosis of opportunistic onychomycosis classically requires more than one laboratory analysis to show consistency of fungal outgrowth. Walshe and English in 1966 proposed to extract sufficient diagnostic information from a single patient consultation by counting the number of nail fragments positive for inoculum of the suspected fungus. Twenty fragments were plated per patient, and each case in which five or more fragments grew the same mold was considered an infection by that mold, provided that compatible filaments were also seen invading the nail tissue by direct microscopy. This widely used and often recommended method has never been validated. Therefore, the validity of substituting any technique based on inoculum counting for conventional follow-up study in the diagnosis of opportunistic onychomycosis was investigated. Sampling of 473 patients was performed repeatedly. Nail specimens were examined by direct microscopy, and 15 pieces were plated on standard growth media. After 3 weeks, outgrowing dermatophytes were recorded, and pieces growing any nondermatophyte mold were counted. Patients returned on two to eight additional occasions over a 1-to 3-year period for similar examinations. Onychomycosis was etiologically classified based on long-term study. Opportunistic onychomycosis was definitively established for 86 patients. Counts of nondermatophyte molds in initial examinations were analyzed to determine if they successfully predicted both true cases of opportunistic onychomycosis and cases of insignificant mold contamination. There was a strong positive statistical association between mold colony counts and true opportunistic onychomycosis. Logistic regression analysis, however, determined that even the highest counts predicted true cases of opportunistic onychomycosis only 89.7% of the time. The counting criterion suggested by Walshe and English was correct only 23.2% of the time. Acremonium infections were especially likely to be correctly predicted by inoculum counting. Inoculum counting could be used to indicate a need for repeat studies in cases of false-negative results from laboratory direct microscopy. Inoculum counting cannot serve as a valid substitute for follow-up study in the diagnosis of opportunistic onychomycosis. It may, nonetheless, provide useful information both to the physician and to the laboratory, and it may be especially valuable when the patient does not present for follow-up sampling.

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Section: Discussionmentioning

confidence: 99%

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

et al. 2001

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“…In such a condition, BOAT could eventually aggravate the clinical condition. Hence, a mycological culture should be performed before initiating BOAT, and a broad-spectrum antifungal such as itraconazole [3,10] should be preferred. …”

Section: Discussionmentioning

confidence: 99%

The Boosted Oral Antifungal Treatment for Onychomycosis beyond the Regular Itraconazole Pulse Dosing Regimen

Pierard

Piérard-Franchimont²,

Arrese³

2000

Dermatology

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Background: Modern treatments for onychomycosis do not yield an ideal cure rate. Objective: The boosted oral antifungal treatment (BOAT) is introduced as a novel approach improving the efficacy of oral treatment with the itraconazole pulse dosing regimen. Method: The BOAT design targets resting fungal cells in order to produce sensitive hyphae which are less refractory to antifungals. This is performed by securing a piece of a Sabouraud’s agar slide onto the affected nail in alternance with oral intake of itraconazole. Results: The present comparative intraindividual trial suggests that BOAT improves the mycological cure rate compared to the regular treatment. Conclusion: BOAT is a promising simple and cheap combined therapy for onychomycosis. However, the present pilot study calls for further clinical investigations.

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“…De Doncker et al 9 Tosti et al 3 Tosti et al 4 Nolting et al 10 Tosti et al 11 Scher et al 12 GregurekNowak et al 14 Gianni et al 13 Gupta antifungal agents was not used. Some reports have suggested that partial or complete nail avulsion followed by topical therapy such as ciclopirox ointment, bifonazole ointment, or 8% ciclopirox nail lacquer may be effective for some cases of Fusarium toe onychomycosis.…”

Section: Efficacy Data For the Treatment Of Nondermatophyte Toe Onychmentioning

confidence: 99%

Itraconazole and Terbinafine Treatment of Some Nondermatophyte Molds Causing Onychomycosis of the Toes and a Review of the Literature

Gupta

Gregurek‐Novak

Konnikov

et al. 2001

Journal of Cutaneous Medicine and Surgery: Incorporating Medica

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In the present series itraconazole demonstrated efficacy against onychomycosis of the toenails caused by S. brevicaulis and Aspergillus species. A review of the literature confirms our experience with itraconazole and further suggests that terbinafine may also demonstrate efficacy against cases of S. brevicaulis and Aspergillus toe onychomycosis. Additionally, reports in the literature suggest that pedal onychomycosis caused by Fusarium species may also show response to itraconazole and terbinafine. For the other species, there are fewer data, making it difficult to draw conclusions.

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Itraconazole therapy is effective for pedal onychomycosis caused by some nondermatophyte molds and in mixed infection with dermatophytes and molds: A multicenter study with 36 patients

Cited by 93 publications

References 16 publications

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

Utility of Inoculum Counting (Walshe and English Criteria) in Clinical Diagnosis of Onychomycosis Caused by Nondermatophytic Filamentous Fungi

The Boosted Oral Antifungal Treatment for Onychomycosis beyond the Regular Itraconazole Pulse Dosing Regimen

Itraconazole and Terbinafine Treatment of Some Nondermatophyte Molds Causing Onychomycosis of the Toes and a Review of the Literature

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