Management of Onychomycosis in Canada in 2014

Abstract

Several options are available: terbinafine, itraconazole, fluconazole, ciclopirox 8% nail lacquer, efinaconazole 10% nail solution, and laser therapy. Further studies on lasers are needed before use can be recommended. Nondermatophyte molds or mixed infection can be managed with terbinafine or itraconazole with or without topicals. Itraconazole, fluconazole, and efinaconazole can be used for Candida infection. For dermatophytes, topicals can be considered for mild to moderate onychomycosis. For moderate to severe cases, any oral monotherapy can be used; however, we suggest terbinafine if there is a possibility of a drug interaction. These recommendations can be applied for all ages, immune function, or metabolic status, but proper monitoring and contraindications should be taken into consideration.

Aspergillus fumigatus carrying TR34/L98H resistance allele causing complicated suppurative otitis media in Tanzania: Call for improved diagnosis of fungi in sub-Saharan Africa

“…In most clinical settings in resource-constrained countries like Tanzania where fungal diagnostics is underdeveloped; treatment of fungal infections relies solely on the empirical use of topical azole agents, which has previously been reported to be in effective for A. versicolor [34], the most frequent moulds isolated here and is probably similarly ineffective for azole-resistant A. fumigatus , a significant emerging problem.…”

Global perspectives for the management of onychomycosis

“…Pulse terbinafine is recommended at 250 mg/day for 4 weeks on, 4 weeks off, and then 4 weeks on . Two pulses of itraconazole is recommended for fingernails and three pulses for toenails, where one pulse consists of 200 mg itraconazole twice daily for 1 week, followed by 3 weeks off . Fluconazole 150 mg weekly for more than 24 weeks is recommended for both fingernails and toenails until the diseased nail plate has grown out .…”

“…There may be a genetic element in the susceptibility of an individual for fungal infections such as defects in the innate and adaptive immune system . Genetics along with exposure to environmental risk factors can lead to chronic onychomycosis . There are a myriad of procedures and protocols used to diagnose and treat onychomycosis worldwide.…”

CH Oxidation of Ingenanes Enables Potent and Selective Protein Kinase C Isoform Activation

“…[5] This is reflected by comparing the biological activities of 12-Otetradecanoylphorbol-13-acetate (TPA), bryostatin 1, and ingenol mebutate (2): the first is as trong tumor promoter, the second shows antiproliferative properties,a nd latter has antitumoral properties and represents the active ingredient in Picato,amarketed product for the topical treatment of actinic keratosis (solar keratosis). [6] Thet wo-phase total synthesis of ingenol (1) [7] and the semisyntheses of ingenol mebutate (2) [8] and ingenol 3-amethylcyclohexanecarboxylate (3) [9] were reported previously ( Figure 1A). Tw o-phase terpene synthesis can both enable scalable access to the parent natural product and constitute atemplate for preparation of analogues with deepseated changes.…”

“…Finally,t ransformation of cyclase-phase endpoint 17 into ingenol analogue 14 led to another curious finding in oxidation chemistry (Path E): although 14 did not react under Pd(OH) 2 /TBHP conditions,it was successfully oxidized at C3 when using our recently developed Cr V -based allylic oxidation, [13] giving ingenane 26 with an inverted stereocenter at C3. This inversion of stereochemistry did not obstruct the synthetic plan, since it 26 was easily converted into analogues 11 and 9 in 1a nd 2 steps,respectively.Assuch, 10 new ingenol analogues (5)(6)(7)(8)(9)(10)(11)(12)(13)(14) were synthesized, with most of these products containing an a-methylcyclohexanecarboxylate ester for stability and potency. Thef eat of generating many derivatives with vastly different oxidation states was achieved by embracing the subtleties of CÀHoxidation in complex-molecule synthesis.…”