The Dermatologist’s Approach to Onychomycosis

Queller, Jenna N; Bhatia, Neal

doi:10.3390/jof1020173

Cited by 26 publications

(28 citation statements)

References 40 publications

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“…In our cases, only some patients received systemic therapy due to limitations such as their comorbidities, other concomitant therapies and inability to tolerate oral drugs. The topical agents prescribed for the patients were imidazole in forms of ketoconazole and miconazole cream which were covered by the national health insurance, even though the existing evidences suggest the use of newer agents, such as amorolfine and ciclopirox olamine, as they are proven to be more effective in treating onychomycosis …”

Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing the treatment outcome of onychomycosis Candida

Widaty

Miranda

Bramono

et al. 2019

Mycoses

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Onychomycosis contributes as many as half of all nail disorder cases. In 2017, the incidence of onychomycosis was 15% of all dermatomycosis cases at our hospital, a tertiary hospital in Indonesia, with only 25% of the patients achieving mycological cure. This study aims to identify the prognostic factors influencing the treatment outcome of onychomycosis Candida. This is a retrospective study, using data obtained from outpatient registry at our hospital. Fifty‐four onychomycosis patients were included in this study. Potential prognostic factors were analysed by STATA15.0. Retrospective analysis with cox proportional‐hazard was used to measure the contribution of each variable to the treatment's outcome. Onset of disease, history of nail disorder, and site of infection were not associated with mycological cure (P > .05). Based on retrospective analysis, age[odds ratio (OR)1.46; 95% confidence interval (CI)1.07‐2.03], onset of disease (OR 1.14; 95%CI 1.11‐1.17), comorbidities (OR 1.07; 95%CI 1.03‐1.11), type of onychomycosis (OR 1.08; 95%CI 1.05‐1.16), site of infection (OR 1.12; 95%CI 1.04‐1.22) and number of infected nails (OR 1.50; 95%CI 1.25‐1.68) were significantly associated with poor treatment outcome, while type of treatment and type of systemic agents showed no significant association with the outcome. Kaplan‐Meier curves showed that subjects elderly age and more than 3 infected nails had the lowest median survival. Elderly, longer onset, presence of comorbidities, multiple sites of infection, and high number of infected nails can affect the mycological cure negatively. Unstandardised treatment was associated with the mycological cure despite not affecting the prognosis. Therefore, the management's goal is to identify these specific prognostic features.

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Section: Discussionmentioning

confidence: 99%

Prognostic factors influencing the treatment outcome of onychomycosis Candida

Widaty

Miranda

Bramono

et al. 2019

Mycoses

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“…In this regard, the hyphae at the distal end of the nail are less likely to be viable and to grow on culture media [ 57 ]. In white superficial onychomycosis, the specimen can be obtained by scraping the affected superficial aspect of the nail plate with a number 15 blade [ 3 , 14 , 36 , 64 , 78 ]. In proximal subungual onychomycosis, the upper nail plate of the proximal nail should be debrided or pared and the underlying nail debris collected with a curette [ 3 , 14 , 36 , 64 , 78 ].…”

Section: Diagnosis and Diagnostic Studiesmentioning

confidence: 99%

“…Onychomycosis is an infection of the nail unit caused by fungi (dermatophytes, non-dermatophyte molds, and yeasts), presenting with discoloration of the nail, onycholysis, and nail plate thickening [ 1 , 2 ]. Any component of the nail unit, including the nail plate, nail matrix, and nail bed can be affected [ 3 ]. The term “onychomycosis” is derived from the Greek words “ onyx ” meaning nail and “ mykes ” meaning fungus [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Onychomycosis: An Updated Review

Leung

Lam

Leung

et al. 2020

IAD

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Background : Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results : Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.

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“…Indeed, in 2003 the Achilles project has shown a prevalence of 26.9% of onychomycosis in Europe [2]. Depending of the infecting fungus specie, the extent and the nail area involvement, and the clinical signs, onychomycosis can present four main clinical types: superficial, proximal subungual, distal lateral subungual, and total onychodystrophic onychomycosis [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Some different physical and chemical enhancement techniques have been proposed to improve the efficacy of topical treatments for onychomycosis. These techniques include the abrasion or the ablation of the nail plate [3], the use of laser treatment [3], iontophoresis [8,9], aqueous or water-alcoholic solutions [7,[10][11][12][13][14][15][16], cyclodextrins [15,16], or chemical penetration enhancers [10,17].…”

Section: Introductionmentioning

confidence: 99%

Optimization of Drug Permeation from 8% Ciclopirox Cyclodextrin/Poloxamer-Soluble Polypseudorotaxane-Based Nail Lacquers

et al. 2020

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Cyclodextrin/poloxamer-soluble polypseudorotaxane-based nail lacquers have demonstrated significant capacity for promoting the permeation of drugs into the nail plate. Furthermore, previous studies have shown that the use of hydroalcoholic blends as vehicles promotes drug permeation. The work described herein studies the effect of the type of alcohol used in the lacquer preparation, and the composition of the vehicle is optimized to obtain soluble doses of 8% and to promote the diffusion of ciclopirox base and olamine across the nail. Permeation studies on different types of alcohols show that optimum results are achieved with short-chain alcohols, and that results become less satisfactory the higher the number of alcohol carbons. In addition, solubility and penetration studies on the bovine hoof have enabled the composition of the lacquer to be optimized for both forms of ciclopirox. The results suggest that optimized lacquers have better ciclopirox diffusion and penetration properties than the commercial reference lacquer. Lastly, in vivo studies in which optimized ciclopirox olamine lacquer was applied for 45 days to the nails of healthy volunteers showed that it caused no negative effects or changes to the nail surface. These results demonstrate the significant potential of cyclodextrin/poloxamer-soluble polypseudorotaxane-based nail lacquers for the ungual administration of drugs.

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The Dermatologist’s Approach to Onychomycosis

Cited by 26 publications

References 40 publications

Prognostic factors influencing the treatment outcome of onychomycosis Candida

Prognostic factors influencing the treatment outcome of onychomycosis Candida

Onychomycosis: An Updated Review

Optimization of Drug Permeation from 8% Ciclopirox Cyclodextrin/Poloxamer-Soluble Polypseudorotaxane-Based Nail Lacquers

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