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Allergy and Asthma Proceedings 2015Atopic dermatitis (AD) is a common skin disease characterized by a complex pathogenesis not completely understood despite numerous studies to date. The clinical patterns... (Review)
Review
Atopic dermatitis (AD) is a common skin disease characterized by a complex pathogenesis not completely understood despite numerous studies to date. The clinical patterns result from interactions between genetic disorders determining abnormalities in the epidermis differentiation complex, modification of the cutaneous barrier, and dysfunction of immune responses. Several studies have shown that an alteration of the skin barrier combined with immune dysfunction is important for the onset, maintenance, and risk of exacerbations of the disease. In recent years, new aspects regarding the pathogenesis of the disease, such as the effects of vitamin D (VD) on immunity at the skin level and the role of certain microorganisms (particularly Staphylococcus and Malassezia species) on eczema exacerbations, have been evaluated. This article provides an overview of the evidences supporting the link between VD (deficiency) and microorganisms (skin colonization/sensitization) in AD pathogenesis, based on comprehensive review of the literature. By considering different aspects of disease, it might be possible to improve our understanding, particularly in those patients refractory to conventional treatments. An electronic research strategy was used to search in Medline Pub-Med Library using as research words AD, exacerbation, VD, Staphylococcus aureus (SA), and Malassezia. The results were downloaded and analyzed for systematic review. Few studies actually consider the relationship between VD deficiency (VDD), AD, and SA and Malassezia, but many suggest a correlation between these factors. VDs play a major role against microorganisms in the development of AD and should be considered when treating patients.
Topics: Dermatitis, Atopic; Dermatomycoses; Disease Progression; Humans; Malassezia; Staphylococcal Infections; Staphylococcus aureus; Vitamin D; Vitamin D Deficiency
PubMed: 25562552
DOI: 10.2500/aap.2015.36.3807 -
Photodiagnosis and Photodynamic Therapy Sep 2020Fungal infections in skin, hair and nails affect up to 25 % of the global population. Conventional antifungal treatment is effective but due to resistance, treatment... (Review)
Review
BACKGROUND
Fungal infections in skin, hair and nails affect up to 25 % of the global population. Conventional antifungal treatment is effective but due to resistance, treatment failure, drug interactions, and treatment related toxicity, there is a need for alternative treatments. Photodynamic therapy (PDT) has shown antimicrobial properties and is used increasingly for fungal infections. This review investigates the reported efficacy and side effects of PDT of superficial mycoses.
METHODS
Pubmed and Embase were searched 26-01-2020 for "superficial fungal infections" and "photodynamic therapy" in "Human subjects" using a predefined search string. Criteria for inclusion were: clinical trials and cases involving PDT-treated patients with primary fungal infections in skin, hair and nails. Criteria for exclusion were: languages other than English, animal models, in vitro trials, secondary fungal infections, reviews and guidelines.
RESULTS
541 records were identified and 34 papers fulfilled the criteria. PDT of onychomycosis (n = 380 patients) found treatment with methylene blue (MB) photosensitizer (PS) more efficacious with complete cure rates of 70 %-80 % than 5-aminolevulinic acid (ALA)-PDT (mycological cure rates of 17 %-57 %) and methyl aminolevulinate (MAL)-PDT (mycological cure rate of 32 %). Other PDT-treated fungal diseases included (n = 55): foot infections (n = 19), tinea cruris (n = 10), scalp infections (n = 2), Malassezia infections (n = 9) and subcutaneous fungal infections (n = 15) achieved promising effect.
CONCLUSION
PDT-treatment of superficial mycoses can be efficacious as salvage therapy. In the light of increasing resistance and few licensed treatment alternatives, larger randomized controlled trials investigations and optimization of the PDT-treatment protocol are warranted to evaluate PDT's potential as a future antifungal treatment.
Topics: Aminolevulinic Acid; Dermatomycoses; Humans; Methylene Blue; Onychomycosis; Photochemotherapy; Photosensitizing Agents
PubMed: 32339671
DOI: 10.1016/j.pdpdt.2020.101774 -
Journal of the European Academy of... Jun 2015Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of... (Review)
Review
Onychomycosis is a fungal infection of the nail and is the most common nail affliction in the general population. Certain patient populations are at greater risk of infection and the prevalence of onychomycosis reported in the literature has yet to be summarized across these at-risk groups. We performed a systematic review of the literature and calculated pooled prevalence estimates of onychomycosis in at-risk patient populations. The prevalence of dermatophyte toenail onychomycosis was as follows: general population 3.22% (3.07, 3.38), children 0.14% (0.11, 0.18), the elderly 10.28% (8.63, 12.18), diabetic patients 8.75% (7.48, 10.21), psoriatic patients 10.22% (8.61, 12.09), HIV positive patients 10.40% (8.02, 13.38), dialysis patients 11.93% (7.11, 19.35) and renal transplant patients 5.17% (1.77, 14.14). Dialysis patients had the highest prevalence of onychomycosis caused by dermatophytes, elderly individuals had the highest prevalence of onychomycosis caused by yeasts (6.07%; 95% CI = 3.58, 10.11) and psoriatic patients had the highest prevalence of onychomycosis caused by non-dermatophyte moulds (2.49%; 95% CI = 1.74, 3.55). An increased prevalence of onychomycosis in certain patient populations may be attributed to impaired immunity, reduced peripheral circulation and alterations to the nail plate which render these patients more susceptible to infection.
Topics: Age Factors; Arthrodermataceae; Diabetes Mellitus; Foot Dermatoses; HIV Infections; Humans; Kidney Transplantation; Onychomycosis; Prevalence; Psoriasis; Renal Dialysis; Risk Factors; Yeasts
PubMed: 25413984
DOI: 10.1111/jdv.12873 -
Zhonghua Liu Xing Bing Xue Za Zhi =... Dec 2023Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among...
Tinea capitis is a superficial fungal infection of the scalp and hair caused by Dermatophytes. It represents the most prevalent superficial fungal infection among preadolescent children worldwide, including in developing countries such as China. The highly contagious nature of tinea capitis can result in outbreaks within communal settings for children. Furthermore, pustular lesions associated with this condition can lead to permanent scarring and hair loss, imposing a significant psychological burden on affected children and their parents. This article aims to provide a comprehensive literature review encompassing the susceptible person, epidemiological characteristics, trends, etiology, modes of transmission, clinical manifestations, treatment, and prevention strategies of tinea capitis. The ultimate objective is to raise awareness, implement effective prevention and control measures, interrupt the transmission cycle, and ultimately reduce the incidence of tinea capitis in the pediatric population.
Topics: Child; Humans; Antifungal Agents; China; Incidence; Tinea Capitis
PubMed: 38129158
DOI: 10.3760/cma.j.cn112338-20230613-00373 -
Journal of the American Academy of... Feb 2017The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear. (Review)
Review
BACKGROUND
The comparative efficacy and safety profiles of systemic antifungal drugs for tinea capitis in children remain unclear.
OBJECTIVE
We sought to assess the effects of systemic antifungal drugs for tinea capitis in children.
METHODS
We used standard Cochrane methodological procedures.
RESULTS
We included 25 randomized controlled trials with 4449 participants. Terbinafine and griseofulvin had similar effects for children with mixed Trichophyton and Microsporum infections (risk ratio 1.08, 95% confidence interval 0.94-1.24). Terbinafine was better than griseofulvin for complete cure of T tonsurans infections (risk ratio 1.47, 95% confidence interval 1.22-1.77); griseofulvin was better than terbinafine for complete cure of infections caused solely by Microsporum species (risk ratio 0.68, 95% confidence interval 0.53-0.86). Compared with griseofulvin or terbinafine, itraconazole and fluconazole had similar effects against Trichophyton infections.
LIMITATIONS
All included studies were at unclear or high risk of bias. Lower quality evidence resulted in a lower confidence in the estimate of effect. Significant clinical heterogeneity existed across studies.
CONCLUSIONS
Griseofulvin or terbinafine are both effective; terbinafine is more effective for T tonsurans and griseofulvin for M canis infections. Itraconazole and fluconazole are alternative but not optimal choices for Trichophyton infections. Optimal regimens of antifungal agents need further studies.
Topics: Antifungal Agents; Child; Humans; Randomized Controlled Trials as Topic; Tinea Capitis
PubMed: 27816294
DOI: 10.1016/j.jaad.2016.08.061 -
Anais Brasileiros de Dermatologia 2022Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the...
BACKGROUND
Chromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.
OBJECTIVES
The primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.
METHODS
MEDLINE, LILACS and Scielo databases were consulted using the terms "chromoblastomycosis" AND "diagnosis". The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.
RESULTS
Considering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%.
STUDY LIMITATIONS
The small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.
CONCLUSIONS
Direct mycological examination, culture, intradermal test and serology show sensitivity and specificity values for the diagnosis of chromoblastomycosis with no significant difference between the studies.
Topics: Chromoblastomycosis; Humans; Microbiological Techniques; Sensitivity and Specificity
PubMed: 35643736
DOI: 10.1016/j.abd.2021.09.007 -
Pediatric Dermatology 2013Because of the low prevalence of onychomycosis in children, little is known about the efficacy and safety of systemic antifungals in this population. PubMed and Embase... (Review)
Review
Because of the low prevalence of onychomycosis in children, little is known about the efficacy and safety of systemic antifungals in this population. PubMed and Embase databases and the references of related publications were searched in March 2012 for clinical trials (CTs), retrospective analyses (RAs), and case reports (CRs) on the use of systemic antifungals for onychomycosis in children (<18 years). Twenty-six studies (5 CTs, 3 RAs, and 18 CRs) were published between 1976 and 2011. Most of these studies reported the use of systemic terbinafine and itraconazole for the treatment of onychomycosis in children. Therapy with systemic antifungals alone in children ages 1 to 17 years resulted in a complete cure rate of 70.8% (n = 151), whereas combined systemic and topical antifungal therapy in one infant and 19 children age 8 and older resulted in a complete cure rate of 80.0% (n = 20). The efficacy and safety profiles of terbinafine, itraconazole, griseofulvin, and fluconazole in children were similar to those previously reported for adults. In conclusion, based on the little information available on onychomycosis in children, systemic antifungal therapies in children are safe and cure rates are similar to the rates achieved in adults.
Topics: Age Factors; Antifungal Agents; Child; Humans; Onychomycosis; Remission Induction
PubMed: 23278514
DOI: 10.1111/pde.12048 -
Mycopathologia Jun 2013Chromoblastomycosis is one of the most frequent chronic infections caused by melanized fungi. In order to evaluate the clinical characteristics of chromoblastomycosis in... (Review)
Review
Chromoblastomycosis is one of the most frequent chronic infections caused by melanized fungi. In order to evaluate the clinical characteristics of chromoblastomycosis in Mainland China, we performed an evidence-based review of published literature. PubMed and Chinese-language database of CNKI, VIP and Wanfang data during January 1990-August 2011 were searched. Epidemiology, clinical features, laboratory findings, therapy and prognosis were analyzed. Cladophialophora carrionii was the most common causative agent in the north of the Mainland China, and Fonsecaea monophora and F. pedrosoi were the most common agents in the southern part of the Mainland China. Infection commonly initiated after the etiologic agents gain entrance through puncture wounds and more common involved extremities of the males. Skin lesions were found in different sites, like the extremities, buttocks, trunk and face, and presented diversity morphology. There were about seven different clinical types found in Mainland China: plaque type, tumoral type, cicatricial type, verrucous type, pseudo-vacuole type, eczymatous type and mixed type of lesions. The success of treatment for chromoblastomycosis was related to the causative agent, the clinical form and severity of the lesions. Most of the patients could be treated successfully with the physical treatment, chemotherapy and/or combination therapy. The itraconazole, terbinafine or a combination of both were commonly medication for these mycosis patients. Physical methods were usually indicated to support chemotherapy with some severe forms and long-lasting cases. Photodynamic therapy has been extended from the oncological field to that of antimicrobial chemotherapy in these years. We applied it on some recalcitrant cases of chromoblastomycosis and found its good clinical response, and hopeful it could be a promising therapy in near future.
Topics: Antifungal Agents; Ascomycota; China; Chromoblastomycosis; Humans; Prognosis; Surgical Procedures, Operative; Treatment Outcome
PubMed: 23086329
DOI: 10.1007/s11046-012-9586-z -
Revista Da Associacao Medica Brasileira... 2012To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate and compare the efficacy of topical antifungal drugs applied to the treatment of each dermatomycosis.
METHODS
A systematic review of randomized clinical trials, published in Portuguese, Spanish and English until July 2010, which compared the use of azole and allylamine antifungal drugs among themselves and with placebo in the treatment of cutaneous candidiasis and T. versicolor, T. pedis, T. cruris and T. corporis was performed. The efficacy outcomes evaluated were mycological cure at the end of treatment and sustained cure.
RESULTS
Of the 4,424 studies initially identified, 49 met the selection criteria and were included in the meta-analyses. The grouped efficacy data evidenced the superiority of antifungal drugs compared to placebo, regardless of the dermatomycosis under evaluation, with odds ratio values ranging from 2.05 (95% CI 1.18-3.54) to 67.53 (95% CI 11.43-398.86). Allylamines were better than azoles only for the outcome sustained cure (OR 0.52 [95% CI 0.31-0.89]).
CONCLUSION
There is consistent evidence of the superiority of antifungal drugs over the use of placebo, and placebo-controlled studies are no longer justifiable. Allylamines maintain the mycological cure for longer periods compared to azole drugs. Given the significant cost difference among the classes, pharmacoeconomic analyses should be performed.
Topics: Administration, Cutaneous; Antifungal Agents; Candidiasis, Cutaneous; Humans; Randomized Controlled Trials as Topic; Tinea; Treatment Outcome
PubMed: 22735222
DOI: No ID Found -
Lasers in Medical Science Oct 2019Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A... (Meta-Analysis)
Meta-Analysis
Laser therapy for onychomycosis is emerging but its efficacy remains unestablished. To examine current evidence on efficacy of laser treatment of onychomycosis. A systematic review and one-arm meta-analysis, including all prospective clinical trials, identified on PubMed, Cochrane Library, and EMBASE databases. Trials with participants as unit of analysis (UOA), n = 13, were analyzed separately from trials with nails as UOA, n = 7. Summary proportions and 95% confidence intervals (95% CI) were calculated. Outcomes were mycological cure, clinical improvement, or complete cure. Twenty-two prospective trials (four randomized controlled trials and 18 uncontrolled trials) with a total of 755 participants were analyzed. Summary proportions with 95% CI for participants as UOA were mycological cure 70.4%, 95% CI 52.2-83.8%; clinical improvement 67.2%, 95% CI 43.2-84.7%; and complete cure 7.2%, 95% CI 1.9-23.5%. High statistical heterogeneity was detected (mycological cure I = 88%, P < 0.01; clinical improvement I = 69%, P < 0.01; complete cure I = 60%, P = 0.11). The current level of evidence is limited and with high heterogeneity, making it difficult to assess the true efficacy of laser treatment for onychomycosis. Larger randomized controlled trials with well-defined methodology are warranted.
Topics: Humans; Laser Therapy; Nails; Onychomycosis; Outcome Assessment, Health Care; Prospective Studies; Treatment Outcome
PubMed: 31254131
DOI: 10.1007/s10103-019-02802-8