Treatment and management strategies of onychomycosis

Aggarwal, Remica; Targhotra, Monika; Kumar, Bhumika; Sahoo, Prabhat K.; Chauhan, Meenakshi Kanwar

doi:10.1016/j.mycmed.2020.100949

Cited by 59 publications

(58 citation statements)

References 117 publications

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“…Azole derivatives, other than terbinafine and naftifine, are commonly prescribed to topically treat superficial infections in the early stages ( Makimura et al., 1999 ; Gupta and Cooper, 2008 ; Aggarwal and Goindi, 2012 ). In extensive infections, chronic infections, or onychomycosis, oral drugs such as terbinafine, itraconazole, fluconazole, griseofulvin, and ketoconazole are used ( Gupta and Cooper, 2008 ; Aggarwal and Goindi, 2012 ; Aggarwal et al., 2020 ). Due to the long treatment period for these infections, coupled with the considerable toxicity of most oral antifungal agents, monitoring is necessary for the hepatic, renal, and hematopoietic functions ( Gupta and Cooper, 2008 ; Gupta,Versteeg, Shear, 2017a ).…”

Section: Introductionmentioning

confidence: 99%

2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms

Bila

Costa-Orlandi

Vaso

et al. 2021

Front. Cell. Infect. Microbiol.

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Dermatophytes, fungi that cause dermatophytosis, can invade keratinized tissues in humans and animals. The biofilm-forming ability of these fungi was described recently, and it may be correlated with the long treatment period and common recurrences of this mycosis. In this study, we evaluated the anti-dermatophytic and anti-biofilm activity of 2-hydroxychalcone (2-chalcone) in the dark and photodynamic therapy (PDT)-mediated and to determine its mechanism of action. Trichophyton rubrum and Trichophyton mentagrophytes strains were used in the study. The antifungal susceptibility test of planktonic cells, early-stage biofilms, and mature biofilms were performed using colorimetric methods. Topographies were visualized by scanning electron microscopy (SEM). Human skin keratinocyte (HaCat) monolayers were also used in the cytotoxicity assays. The mechanisms of action of 2-chalcone in the dark and under photoexcitation were investigated using confocal microscopy and the quantification of ergosterol, reactive oxygen species (ROS), and death induction by apoptosis/necrosis. All strains, in the planktonic form, were inhibited after treatment with 2-chalcone (minimum inhibitory concentration (MIC) = 7.8-15.6 mg/L), terbinafine (TRB) (MIC = 0.008–0.03 mg/L), and fluconazole (FLZ) (1–512 mg/L). Early-stage biofilm and mature biofilms were inhibited by 2-chalcone at concentrations of 15.6 mg/L and 31.2 mg/L in all tested strains. However, mature biofilms were resistant to all the antifungal drugs tested. When planktonic cells and biofilms (early-stage and mature) were treated with 2-chalcone-mediated PDT, the inhibitory concentrations were reduced by four times (2–7.8 mg/L). SEM images of biofilms treated with 2-chalcone showed cell wall collapse, resulting from a probable extravasation of cytoplasmic content. The toxicity of 2-chalcone in HaCat cells showed higher IC50 values in the dark than under photoexcitation. Further, 2-chalcone targets ergosterol in the cell and promotes the generation of ROS, resulting in cell death by apoptosis and necrosis. Overall, 2-chalcone-mediated PDT is a promising and safe drug candidate against dermatophytes, particularly in anti-biofilm treatment.

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Section: Introductionmentioning

confidence: 99%

2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms

Bila

Costa-Orlandi

Vaso

et al. 2021

Front. Cell. Infect. Microbiol.

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“…Nail diseases are one of the most frequently occurred topical disorders affecting nearly 6% of the entire human population [ 1 ]. The leading causes of nail diseases are fungal infections, psoriasis, and paronychia.…”

Section: Introductionmentioning

confidence: 99%

Constant Voltage Iontophoresis Technique to Deliver Terbinafine via Transungual Delivery System: Formulation Optimization Using Box–Behnken Design and In Vitro Evaluation

et al. 2021

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Topical therapy of antifungals is primarily restricted due to the low innate transport of drugs through the thick multi-layered keratinized nail plate. The objective of this investigation was to develop a gel formulation, and to optimize and evaluate the transungual delivery of terbinafine using the constant voltage iontophoresis technique. Statistical analysis was performed using Box–Behnken design to optimize the transungual delivery of terbinafine by examining crucial variables namely concentration of polyethylene glycol, voltage, and duration of application (2–6 h). Optimization data in batches (F1–F17) demonstrated that chemical enhancer, applied voltage, and application time have influenced terbinafine nail delivery. Higher ex vivo permeation and drug accumulation into the nail tissue were noticed in the optimized batch (F8) when compared with other batches (F1–F17). A greater amount of terbinafine was released across the nails when the drug was accumulated by iontophoresis than the passive counterpart. A remarkably higher zone of inhibition was observed in nails with greater drug accumulation due to iontophoresis, as compared to the passive process. The results here demonstrate that the optimized formulation with low voltage iontophoresis could be a viable and alternative tool in the transungual delivery of terbinafine, which in turn could improve the success rate of topical nail therapy in onychomycosis.

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“…Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical, and physical methods to improve drug delivery [2].…”

Section: Introductionmentioning

confidence: 99%

Excellent Response of Dermatophytoma and Nail Splitting to Nail Plate Debridement Plus Topical Ciclopirox Olamine 1% Solution

Abdo¹

2020

Skin Appendage Disord

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Onychomycosis often presents as thickened, discolored nails. Usually, one or both great toenails are affected. Eventually, the nail plate becomes friable and may split and break up, often due to trauma or invasion of the plate by dermatophytes that have keratolytic properties. Dermatophytoma is a unique feature of onychomycosis that occurred by abundant fungal filaments and spores forming a fungal ball under the nail plate. It is often refractory to traditional therapy. Based on the clinical and mycological examination, a case of onychomycosis in a 45-year-old woman presented as dermatophytoma with longitudinal nail splitting caused by <i>Trichophyton rubrum</i> is presented. The case was successfully treated with nail plate debridement plus topical ciclopirox olamine 1% solution. Nail debridement was performed using a 15-scalpel blade to remove the affected nail portion with the underlying subungual debris to enhance the effect of topical ciclopirox 1% solution which was then applied 3 times daily to the debrided area. Follow-up visits with nail photography were planned every 2 weeks after the procedure to check treatment progress. A complete clinical resolution was achieved after 5 months. This treatment option can be advocated for similar nail conditions avoiding unnecessary and expensive lines of treatment.

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Treatment and management strategies of onychomycosis

Cited by 59 publications

References 117 publications

2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms

2-Hydroxychalcone as a Potent Compound and Photosensitizer Against Dermatophyte Biofilms

Constant Voltage Iontophoresis Technique to Deliver Terbinafine via Transungual Delivery System: Formulation Optimization Using Box–Behnken Design and In Vitro Evaluation

Excellent Response of Dermatophytoma and Nail Splitting to Nail Plate Debridement Plus Topical Ciclopirox Olamine 1% Solution

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