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Clinics in Podiatric Medicine and... Oct 2021Onychomycosis is one of the most frequent nail pathologies in podiatry practices. Differential diagnoses with the clinical presentation may delay an accurate diagnosis... (Review)
Review
Onychomycosis is one of the most frequent nail pathologies in podiatry practices. Differential diagnoses with the clinical presentation may delay an accurate diagnosis and timely treatment. This article discusses the technique and benefits of using a dermatoscope to improve patient care of this common disorder.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Onychomycosis; Podiatry
PubMed: 34538427
DOI: 10.1016/j.cpm.2021.06.006 -
Journal of Fungi (Basel, Switzerland) Feb 2022The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the... (Review)
Review
The relationship between psoriasis and onychomycosis is controversial, and the exact nature of this association remains to be clearly elucidated. In healthy nails, the compact nail plate acts as a barrier, preventing any infection. In psoriatic nails, the nail plate involvement, together with abnormalities in the blood capillaries, may lead to decreased natural defenses against microorganisms. Moreover, onycholysis (detachment of the nail plate) induces a humid environment that may favor fungal proliferation. Treatment with immunosuppressive drugs may additionally enhance onychomycosis. In this comprehensive review, we present data regarding the incidence and pathogenic action of dermatophytes and other fungi in the development of fungal infection in psoriatic nails.
PubMed: 35205908
DOI: 10.3390/jof8020154 -
Clinics in Podiatric Medicine and... Oct 2021Recent studies have shown that a superficial fungal infection such as onychomycosis may form complex biofilms. Although most individuals susceptible to documented fungal... (Review)
Review
Recent studies have shown that a superficial fungal infection such as onychomycosis may form complex biofilms. Although most individuals susceptible to documented fungal biofilm infections are immunocompromised, physical damage to the nail or concurrent infection with other organisms is also a common risk factor in developing nail biofilm. The complex nature of the biofilm, which includes efflux pumps and the formation of a virulent extracellular matrix, helps it evade the immune system. Although there is no standardized treatment for fungal biofilms in onychomycosis, various studies using antimicrobials and lasers have shown some efficacy in treating human fingernails.
Topics: Antifungal Agents; Biofilms; Humans; Nails; Onychomycosis
PubMed: 34538430
DOI: 10.1016/j.cpm.2021.06.005 -
Journal of Cosmetic Dermatology Feb 2022There are a number of available methods for diagnosing onychomycosis, but more emerge as technology advances. This review briefly discusses the common diagnostic... (Review)
Review
BACKGROUND AND AIMS
There are a number of available methods for diagnosing onychomycosis, but more emerge as technology advances. This review briefly discusses the common diagnostic methods, the use of artificial intelligence (AI) as a diagnostic tool in dermatology as a whole, and then examines research on the use of AI for diagnosing onychomycosis. The studies discussed implemented convolutional neural networks (CNNs) to examine datasets of images of entire nails or histological images and then used the information learned from those datasets to make a diagnostic decision of onychomycosis or not.
RESULTS
Results: It was found that, on average, AI were able to diagnose onychomycosis from the images provided at an equivalent level as human dermatologists. However, there are a number of clear limitations for using AI in this manner. The AI models implemented relied solely on images and therefore were limited by image quality. As only images were examined, other clinical data were not taken into consideration, which could be important to the diagnostic outcome.
CONCLUSION
Conclusion: In conclusion, although AI can be a very helpful tool in the diagnostic process by increasing efficiency and reducing costs, it still requires the precision and expertise of professional dermatologists to be used optimally.
Topics: Artificial Intelligence; Humans; Onychomycosis
PubMed: 34918448
DOI: 10.1111/jocd.14681 -
Expert Opinion on Pharmacotherapy Apr 2024The reports of resistance to antifungal agents used for treating onychomycosis and other superficial fungal infections are increasing. This rise in antifungal resistance... (Review)
Review
INTRODUCTION
The reports of resistance to antifungal agents used for treating onychomycosis and other superficial fungal infections are increasing. This rise in antifungal resistance poses a public health challenge that requires attention.
AREAS COVERED
This review explores the prevalence of dermatophytes and the current relationship between dermatophyte species, their minimum inhibitory concentrations (MICs) for terbinafine (an allylamine) and itraconazole (an azole), and various mutations prevalent in these species. The most frequently isolated dermatophyte associated with resistance in patients with onychomycosis and dermatophytosis was . However, emerged as the most prevalent isolate with mutations in the gene, exhibiting the highest MIC of 8 µg/ml for terbinafine and MICs of 8 µg/ml and ≥ 32 µg/ml for itraconazole.Overall, the most prevalent mutations were Phe397Leu, Leu393Phe, Ala448Thr, Phe397Leu/Ala448Thr, and Lys276Asn/Leu415Phe (relatively recent).
EXPERT OPINION
Managing dermatophyte infections requires a personalized approach. A detailed history should be obtained including details of travel, home and occupational exposure, and clinical examination of the skin, nails and other body systems. Relevant testing includes mycological examination (traditional and molecular). Additional testing, where available, includes MIC evaluation and detection of mutations. In case of suspected terbinafine resistance, itraconazole or voriconazole (less commonly) should be considered.
Topics: Antifungal Agents; Humans; Drug Resistance, Fungal; Microbial Sensitivity Tests; Tinea; Mutation; Arthrodermataceae; Terbinafine; Itraconazole; Onychomycosis
PubMed: 38623728
DOI: 10.1080/14656566.2024.2343079 -
The Medical Clinics of North America Jan 2021Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel... (Review)
Review
Primary care providers frequently care for complaints of the hands and feet. Here, the author describes the typical presentations of hand osteoarthritis, carpal tunnel syndrome, ganglion cysts, plantar fasciitis, onychomycosis, and Morton neuroma. Useful physical examination techniques are described. The history and physical examination are usually sufficient to diagnose these conditions without the need for more advanced testing. All of these conditions have evidence-based therapy that can be initiated by the primary care provider. These treatments as well as reasons to refer to a specialist are reviewed.
Topics: Carpal Tunnel Syndrome; Fasciitis, Plantar; Foot Diseases; Ganglion Cysts; Hand; Hand Joints; Humans; Medical History Taking; Morton Neuroma; Onychomycosis; Osteoarthritis; Patient Education as Topic; Physical Examination; Self-Management
PubMed: 33246518
DOI: 10.1016/j.mcna.2020.08.016 -
Pediatric Dermatology Nov 2022Onychomycosis is one of the most common nail diseases in adults but is described as infrequent in children. Data are, however, scattered and diverse. Studies have... (Review)
Review
Onychomycosis is one of the most common nail diseases in adults but is described as infrequent in children. Data are, however, scattered and diverse. Studies have nevertheless suggested that the prevalence of onychomycosis is increasing in children lately and the aim of this review was therefore to examine this problem. Two authors individually searched PubMed, Embase, and Cochrane Library for articles on epidemiology and prevalence of onychomycosis in children. The literature search was conducted in accordance per PRISMA guidelines. In total 1042 articles were identified of which 23 were eligible for inclusion. One of the articles presented two studies and a total of 24 studies were therefore included. Seventeen studies presented data of the prevalence of onychomycosis in children in the general population and seven studies among children visiting a dermatological and pediatric department or clinic. The prevalence ranged from 0% to 7.66% with an overall discrete increase of 0.66% during the period 1972 to 2014 in population studies (not statistically significant). This review supports a trend towards an increased prevalence of onychomycosis in children, albeit based on a paucity of studies. The data suggests an increasing prevalence of onychomycosis with age, and co-infection with tinea pedis (reported in 25% of the studies). The most common pathogen reported was Trichophyton rubrum and onychomycosis was more prevalent in toenails compared to fingernails. The general characteristics of onychomycosis in children are thus similar to those described in adults.
Topics: Adult; Child; Humans; Nails; Onychomycosis; Prevalence; Tinea Pedis; Trichophyton
PubMed: 36130720
DOI: 10.1111/pde.15100 -
Expert Opinion on Drug Safety 2023Oral antifungals are used for the treatment of moderate-severe onychomycosis. Terbinafine and itraconazole are approved for onychomycosis treatment in North America;... (Review)
Review
INTRODUCTION
Oral antifungals are used for the treatment of moderate-severe onychomycosis. Terbinafine and itraconazole are approved for onychomycosis treatment in North America; additionally, fluconazole is indicated for onychomycosis in Europe. Other oral antifungals such as ketoconazole and griseofulvin are no longer used for the treatment of onychomycosis due to safety concerns and relatively lower efficacy.
SEARCH STRATEGY
On 7 March 2023, we conducted a comprehensive search in PubMed and Google Scholar, while also manually examining selected article bibliographies and package inserts.
AREAS COVERED
Terbinafine, itraconazole, and fluconazole have several interactions with cytochrome-p450, and either alone, or when co-administered with other drugs these interactions can facilitate a multitude of adverse events. This article identifies possible hepatic, renal, cutaneous, cardiovascular, neurological, hemopoietic, and obstetric adverse events. We have also compared the rates of hepatotoxicity, clinically apparent liver injury, and alanine transaminase elevations between oral antifungals, and recommendations for hepatic monitoring.
EXPERT OPINION
We recommend laboratory testing of liver function tests prior to the administration of any oral antifungals, especially when clinically indicated. In the event of a first treatment failure, the diagnosis of onychomycosis must be confirmed, and consideration given to antifungal susceptibility testing. Antifungal stewardship will help reduce the incidence of antifungal resistance.
Topics: Humans; Antifungal Agents; Onychomycosis; Terbinafine; Itraconazole; Fluconazole; Naphthalenes; Administration, Oral
PubMed: 37925672
DOI: 10.1080/14740338.2023.2280137 -
The Journal of Dermatological Treatment May 2022Onychomycosis is an uncommon condition in children with increasing global prevalence. Health practitioners should confirm the diagnosis through mycology examination and... (Review)
Review
BACKGROUND
Onychomycosis is an uncommon condition in children with increasing global prevalence. Health practitioners should confirm the diagnosis through mycology examination and examine family members of affected individuals for onychomycosis and tinea pedis.
OBJECTIVE
To comprehensively summarize the treatment and management strategies for pediatric onychomycosis.
METHODS
We performed a comprehensive literature search in the PubMed database to identify clinical studies on treatment for mycologically-confirmed dermatophyte onychomycosis in children <18 years. The exclusion criteria were combination therapy, case reports, reviews, systematic reviews and duplicate studies.
RESULTS
Per-weight dosing regimens of systemic antifungal agents such as terbinafine, itraconazole, and fluconazole are found to be safe in children and are used off-label for the treatment of pediatric onychomycosis with high efficacy. Topical antifungal agents such as ciclopirox, efinaconazole, and tavaborole have established safety and efficacy in children. Children respond better than adults to topical therapy due to their thinner, faster growing nails. There is no data on the efficacy of medical devices for onychomycosis in children.
CONCLUSION
Efinaconazole topical solution 10% and tavaborole topical solution 5% are FDA approved for the treatment of onychomycosis in children ≥6 years; ciclopirox topical solution 8% nail lacquer is approved in children ≥12 years.
Topics: Administration, Topical; Adult; Antifungal Agents; Child; Ciclopirox; Humans; Onychomycosis; Terbinafine
PubMed: 32799713
DOI: 10.1080/09546634.2020.1810607 -
BioMed Research International 2021Whether nail psoriasis can increase the risk of onychomycosis is still being debated, and data relating to the prevalence of onychomycosis among psoriasis patients...
BACKGROUND
Whether nail psoriasis can increase the risk of onychomycosis is still being debated, and data relating to the prevalence of onychomycosis among psoriasis patients receiving different treatments is limited.
OBJECTIVES
To investigate the overall prevalence and prevalence compared among psoriasis treatments of onychomycosis in patients with nail psoriasis and fungal involvement.
METHODS
A prospective study of three groups of nail psoriasis being treated with only topical medication, methotrexate, or biologics (25 patients per group, 150 nails) was conducted at Siriraj Hospital (Bangkok, Thailand) during November 2018 to September 2020. Demographic data, psoriasis severity, and nail psoriasis severity were recorded. The nail most severely affected with psoriasis on each hand was selected for mycological testing. Potassium hydroxide, periodic acid-Schiff stain, and fungal culture were performed.
RESULTS
The prevalence of onychomycosis in nail psoriasis was 35.3%. Among the treatment groups, the prevalence of onychomycosis was significantly higher in the methotrexate group than in the topical treatment and biologic treatment groups ( = 0.014). spp. was the main causative organism, followed by . Thumb was most commonly affected (59.3%). The most common abnormality of the nail matrix and the nail bed was pitted nail (71.3%) and onycholysis (91.3%), respectively. Multivariate analysis revealed diabetes, wet-work exposure, and methotrexate treatment to be predictors of onychomycosis.
CONCLUSIONS
Several factors, including psoriasis treatment, were shown to increase the risk of onychomycosis in nail psoriasis. Further research is needed to determine whether biologic agents, especially interleukin-17 inhibitors, can increase risk of onychomycosis and infection/colonization of the nails.
Topics: Administration, Topical; Antifungal Agents; Arthrodermataceae; Candida; Female; Humans; Male; Middle Aged; Nail Diseases; Nails; Nails, Malformed; Onychomycosis; Prevalence; Prospective Studies; Psoriasis; Thailand
PubMed: 34938812
DOI: 10.1155/2021/9113418