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Photodiagnosis and Photodynamic Therapy Sep 2016Other than a cosmetic concern, Onychomycosis is also a prevalent nail disease, which is extremely difficult to treat, and sometimes is refractory to conventional... (Review)
Review
Other than a cosmetic concern, Onychomycosis is also a prevalent nail disease, which is extremely difficult to treat, and sometimes is refractory to conventional therapy. Moreover, many patients are not eligible to take oral antifungals owing to polypharmacy and comorbidities. Systemic side effects seen with oral antifungals have lead to patient nonadherence and adverse events. Therefore, newer therapies are being investigated for onychomycosis that would be free of systemic complications posed by oral therapy. Photodynamic therapy (PDT) is one of those being currently studied, which involves the use of photosensitizer and a light source to excite the photosensitizer to generate reactive oxygen species. The present review will put some light on PDT as an upcoming treatment modality for onychomycosis. We performed a systematic review of the literature to find the articles relevant to the use of PDT for onychomycosis. From the primary search of 43 articles, 17 papers are included in this review.
Topics: Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Drug Therapy, Combination; Evidence-Based Medicine; Humans; Onychomycosis; Photochemotherapy; Photosensitizing Agents; Treatment Outcome
PubMed: 27477248
DOI: 10.1016/j.pdpdt.2016.07.010 -
Drug Discovery Today Jan 2024Recalcitrant nail plate infections can be life-long problems because localizing antifungal agents into infected tissues is problematic. In this systematic review, guided... (Review)
Review
Recalcitrant nail plate infections can be life-long problems because localizing antifungal agents into infected tissues is problematic. In this systematic review, guided by the SPIDER method, we extracted chemical nail permeation data for 38 compounds from 16 articles, and analyzed the data using quantitative structure-property relationships (QSPRs). Our analysis demonstrated that low-molecular weight was essential for effective nail penetration, with <120 g/mol being preferred. Interestingly, chemical polarity had little effect on nail penetration; therefore, small polar molecules, which effectively penetrate the nail, but not the skin, should be set as the most desirable target chemical property in new post-screen onychomycosis candidate selections.
Topics: Humans; Administration, Topical; Antifungal Agents; Nails; Onychomycosis; Skin; Quantitative Structure-Activity Relationship
PubMed: 38000719
DOI: 10.1016/j.drudis.2023.103844 -
Mycoses Oct 2023Sporotrichosis is a subcutaneous mycosis caused by a dimorphic fungus belonging to the genus Sporothrix. This fungal infection can affect both humans and domestic... (Review)
Review
Sporotrichosis is a subcutaneous mycosis caused by a dimorphic fungus belonging to the genus Sporothrix. This fungal infection can affect both humans and domestic animals, and in recent years, an increase in the geographic spread and prevalence of sporotrichosis has been observed globally. This systematic review aimed to examine the clinical-epidemiological and therapeutic aspects related to sporotrichosis co-infection with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). An extensive electronic search was conducted on databases including PubMed, Web of Science, Lilacs, Medline, Embase, Scopus and SciELO was performed to identify clinical cases of people living with HIV (PLWH) with sporotrichosis published until May 2023. As a result, we found that most co-infected patients were male, representing 71.76% (94/131) of cases. The most prevalent age group was 41-50 years, with a mean age of 36.98 years. The countries with the highest number of cases were Brazil (75.57%, 99/131) and the United States (16.03%, 21/131). The most frequent clinical presentation was systemic dissemination, accounting for 69.47% (91/131) of the cases, followed by cutaneous dissemination with 13% (17/131). The mean CD4 cell count was 154.07 cells/μL, and most patients used amphotericin B with at least one azole, which represented 47.33% (62/131) of cases, followed by azole monotherapy in 17.56% (23/131) of cases. As for the outcome, 51.15% (67/131) of the patients remained alive, and 37.4% (49/131) died. Therefore, it was concluded that sporotrichosis in PLWH is a disease with a high prevalence in Brazil and may be associated with systemic clinical manifestations requiring longer periods of systemic antifungal therapy.
Topics: Animals; Humans; Male; Adult; Middle Aged; Female; Sporotrichosis; Acquired Immunodeficiency Syndrome; HIV; Coinfection; Antifungal Agents; Sporothrix; Azoles; Brazil
PubMed: 37376902
DOI: 10.1111/myc.13627 -
PloS One 2023Tinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Tinea capitis accounts for25 to 30% of all fungal infections, but it is often ignored because it is not life threatening in nature. It is more common among schoolchildren particularly in developing countries. Due to the presence of significant variability among the previous studies, this study was conducted to provide a pooled prevalence and associated factors of tinea capitis in Ethiopian schoolchildren.
METHOD
We conducted a systematic search in five major databases for articles similar to our topic. This review included school-based cross-sectional studies that were reported in English and conducted from 2006 through 2022. The data were extracted using Microsoft Excel and further analysis was done using StataTM Version 17.0 statistical software. Forest plots were used to assess the presence of heterogeneity with 95% confidence intervals. A random effects meta- analysis model was used to pool primary estimates. To declare the presence or absence of association, 95% confidence interval with odds ratio was used.
RESULTS
Fourteen studies with a total of 9465 schoolchildren were included. The pooled prevalence was 29.03% (95%CI: 15.37-42.71). There was observed heterogeneity, which could be explained by publication bias (P = 0.04). Family history of tinea capitis (OR: 9.18, 95%CI: 3.5-24.02), under the age of 10 years (OR: 1.65, 95%CI: 1.17-2.33) were factors increasing the development of tinea capitis among schoolchildren and schoolchildren who had hair wash at least once a week (OR: 0.31, 95%CI: 0.24-0.42) was significantly associated with reduced risk for tinea capitis.
CONCLUSION
One of the most prevalent childhood health condition in Ethiopia is tinea capitis, which affects over one in every four schoolchildren. Schoolchildren who had family history of tinea capitis and under the age of 10 years were the identified risk factors but they had hair wash at least once a week was the protective factor of tinea capitis among schoolchildren. Clinical and public engagement activities are needed to overcome the burden of the disease.
Topics: Humans; Child; Ethiopia; Cross-Sectional Studies; Tinea Capitis; Prevalence; Schools
PubMed: 36763601
DOI: 10.1371/journal.pone.0280948 -
Journal of the American Academy of... Nov 2021Onychomycosis is the most common nail disorder, often causing physical, emotional, and aesthetic consequences. The effect of both the condition itself and treatment on...
BACKGROUND
Onychomycosis is the most common nail disorder, often causing physical, emotional, and aesthetic consequences. The effect of both the condition itself and treatment on quality of life has not been well studied.
OBJECTIVE
The objectives of this study were to systematically review the available literature describing the effect of onychomycosis and treatment on quality of life.
METHODS
We performed a search of the onychomycosis literature published before April 13, 2020. Articles were included in the review if primary data were presented, patient-reported outcome measures were used, and onychomycosis was specifically examined.
RESULTS
Thirty studies were included in the final analysis. Poorest quality-of-life scores were associated with women and fingernail involvement. Quality-of-life scores improved from baseline with all treatment types; there were greater improvements reported with oral treatments compared with topical ones.
CONCLUSIONS
This review affirms that onychomycosis significantly influences quality of life, warranting effective treatment. All treatments resulted in quality-of-life improvements; however, studies on oral and topical therapies were of higher quality than those evaluating devices. Increased efforts are needed to understand the effect of the disease and therapy as assessed by validated, nail-specific outcome measures that accurately assess patients' cosmetic, physical, and social difficulties.
Topics: Administration, Topical; Antifungal Agents; Female; Humans; Nails; Onychomycosis; Patient Reported Outcome Measures; Quality of Life
PubMed: 32502586
DOI: 10.1016/j.jaad.2020.05.143 -
Archives of Dermatology Oct 2010To determine the efficacy of topical or systemic agents in the treatment and prevention of pityriasis versicolor. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the efficacy of topical or systemic agents in the treatment and prevention of pityriasis versicolor.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
The Cochrane Skin Group Specialized Register (to June 2008), Cochrane Central Register of Controlled Trials, MEDLINE (1950 to June 2008), EMBASE (1974 to June 2008), LILACS (to March 2009), the gray literature, and sources for registered trials to November 2008. Reference lists of all retrieved trials and review articles were checked for additional trials.
STUDY SELECTION
Controlled trials that examined therapies used in children or adults with a clinical or microscopic diagnosis of pityriasis versicolor.
DATA EXTRACTION
The primary outcome measure included a negative result from mycological evaluation of participants with direct microscopy using potassium hydroxide smear. The secondary outcome measures were findings from Wood's light examination and a negative clinical evaluation result, with disappearance of visual signs (except pigmentary defects) and symptoms.
DATA SYNTHESIS
Results of treatment and prevention of pityriasis versicolor infection in 8327 participants in 93 controlled trials were examined. Overall, trials investigating the efficacy of therapeutic and prophylactic treatments for pityriasis versicolor are poorly reported and may be of low quality. Most trials did not adequately report the methods of randomization, concealment of allocation, and blinding, and many did not use intention-to-treat analysis. Most topical treatments used to treat pityriasis versicolor are effective compared with placebo, with numbers needed to treat of 1 to 3. Data suggest that longer durations of treatment and higher concentrations of active agents produce greater cure rates.
CONCLUSIONS
Most topical and systemic treatments used for pityriasis versicolor are effective compared with placebo. Randomized controlled clinical trials are needed to establish relative efficacy of topical and systemic agents used for treatment and prevention of pityriasis versicolor.
Topics: Controlled Clinical Trials as Topic; Humans; Tinea Versicolor
PubMed: 20956647
DOI: 10.1001/archdermatol.2010.259 -
Journal of the American Podiatric... 2023Onychomycosis is the most common nail disorder, with a global prevalence of approximately 5.5%. It is difficult to cure on both short-term and long-term bases. The most...
Onychomycosis is the most common nail disorder, with a global prevalence of approximately 5.5%. It is difficult to cure on both short-term and long-term bases. The most common treatments include the use of oral or topical antifungals. Recurrent infections are common, and the use of systemic oral antifungals raises concerns of hepatotoxicity and drug-drug interactions, particularly in patients with polypharmacy. A number of device-based treatments have been developed for onychomycosis treatment, to either directly treat fungal infection or act as adjuvants to increase the efficacy of topical and oral agents. These device-based treatments have been increasing in popularity over the past several years, and include photodynamic therapy, iontophoresis, plasma, microwaves, ultrasound, nail drilling, and lasers. Some, such as photodynamic therapy, provide more direct treatment, whereas others, such as ultrasound and nail drilling, aid the uptake of traditional antifungals. We conducted a systematic literature search investigating the efficacy of these device-based treatment methods. From an initial result of 841 studies, 26 were deemed relevant to the use of device-based treatments of onychomycosis. This review examines these methods and provides insight into the state of clinical research for each. Many device-based treatments show promising results, but require more research to assess their true impact on onychomycosis.
Topics: Humans; Onychomycosis; Antifungal Agents; Nails; Photochemotherapy; Administration, Topical
PubMed: 36905611
DOI: 10.7547/21-240 -
American Journal of Therapeutics 2019Onychomycoses are fungal nail infections affecting predominantly toenails, and mainly caused by dermatophyte fungi, molds and some Candida species. Nail infections can...
BACKGROUND
Onychomycoses are fungal nail infections affecting predominantly toenails, and mainly caused by dermatophyte fungi, molds and some Candida species. Nail infections can be mild with purely cosmetic implications, but they can also negatively influence quality of life. The deep-seated nature of fungi within the nail plate, prolonged treatment, poor patient adherence, frequent recurrences, and development of resistance to various antimicrobial agents make onychomycosis difficult to successfully treat.
AREAS OF UNCERTAINTY
When and how should clinicians prescribe systemic and topical antifungal drugs for onychomycosis?
DATA SOURCES
A narrative review was undertaken of the current literature identified in Medline, Scopus, CINAHL, the Cochrane library, and Google Scholar.
RESULTS
Treatment is often lengthy and requires persistence and patient education. Definitive mycological diagnosis, and an individualized evaluation of risks and benefits of different treatments are imperative before initiating therapy. The choice of treatment can be influenced by the age and general health of the patient, the causative organism, the number of affected nails, and the extent of nail involvement. Oral antifungals offer greater likelihood of a cure than topicals, but oral therapy carries greater risks and requires closer monitoring. Oral terbinafine is the treatment of choice, followed by itraconazole pulse regimen. The newly approved topical agents, efinaconazole and tavaborole, were superior to placebo in clinical trials and appear to produce slightly improved mycological cure rates compared to previous topicals, but further direct comparisons are needed.
CONCLUSIONS
The treatment of onychomycosis can be challenging, as most therapeutic options are lengthy, expensive and potentially unsuccessful.
Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Clinical Trials as Topic; Humans; Medication Adherence; Onychomycosis; Patient Education as Topic; Quality of Life; Recurrence; Time Factors; Treatment Outcome
PubMed: 31082864
DOI: 10.1097/MJT.0000000000000696 -
The British Journal of Dermatology Mar 2015Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the... (Review)
Review
Tinea cruris and tinea corporis are common fungal infections. Most can be treated with a variety of topical antifungals. This review aimed to assess the evidence for the effectiveness and safety of topical treatments for tinea cruris and tinea corporis. Searches included the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS and ongoing trials registries (August 2013). One hundred and twenty-nine randomized controlled trials (RCTs) with 18 086 participants evaluated a range of interventions - mostly azoles. Pooling of data for several outcomes was only possible for two individual treatments. In five studies, terbinafine showed a statistically significant higher clinical cure rate compared with placebo [risk ratio (RR) 4·51, 95% confidence interval (CI) 3·10-6·56]. Data for mycological cure could not be pooled owing to substantial heterogeneity. Across three studies, mycological cure rates favoured naftifine (1%) compared with placebo (RR 2·38, 95% CI 1·80-3·14) but the quality of the evidence was low. Combinations of azoles with corticosteroids were slightly more effective than azoles for clinical cure, but there was no statistically significant difference with regard to mycological cure. Sixty-five studies were assessed as 'unclear' and 64 as being at 'high risk' of bias; many were over 20 years old, and most were poorly designed and inadequately reported. Although most active interventions showed sufficient therapeutic effect, this review highlights the need for further, high-quality, adequately powered RCTs to evaluate the effects of these interventions, which can ultimately provide reliable evidence to inform clinical decision making.
Topics: Administration, Cutaneous; Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Child; Dermatologic Agents; Evidence-Based Medicine; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Tinea; Treatment Outcome; Young Adult
PubMed: 25294700
DOI: 10.1111/bjd.13441 -
The Journal of Dermatological Treatment Dec 2019Although labeling changes and market withdrawal have been implemented for oral ketoconazole (KTZ) due to serious adverse effects (AEs), topical KTZ is generally thought...
Although labeling changes and market withdrawal have been implemented for oral ketoconazole (KTZ) due to serious adverse effects (AEs), topical KTZ is generally thought to be effective and safe for the treatment of superficial fungal infections. New dermatologic indications for the use of topical KTZ have arisen such as onychomycosis, blepharitis, and hair loss. This article aims to review the literature on topical KTZ's efficacy and AEs, as well as provide an overview on current insights regarding its mechanism of action and upcoming developments. A PubMed search was done to include randomized controlled trials (RCTs) focusing on the use of topical KTZ in human subjects. Forty studies with 4566 patients were included in this review. Topical KTZ is clinically effective for the treatment of -related conditions such as seborrheic dermatitis (SD) and pityriasis versicolor (PV) with a reported efficacy of 63-90% and 71-89%, respectively. Topical KTZ demonstrates high clinical efficacy for -related conditions. More efficacious alternatives are now available for and . Although topical KTZ is safe, clinicians should be aware that allergic contact dermatitis may occur. Further studies should be completed to investigate the use of topical KTZ for hair loss and inflammatory dermatoses.
Topics: Administration, Topical; Alopecia; Antifungal Agents; Dermatitis, Seborrheic; Humans; Ketoconazole; Malassezia; Randomized Controlled Trials as Topic; Tinea Versicolor; Treatment Outcome
PubMed: 30668185
DOI: 10.1080/09546634.2019.1573309