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Expert Review of Anti-infective Therapy Jun 2024Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing... (Review)
Review
INTRODUCTION
Terbinafine is considered the gold standard for treating skin fungal infections and onychomycosis. However, recent reports suggest that dermatophytes are developing resistance to terbinafine and the other traditional antifungal agents, itraconazole and fluconazole. When there is resistance to terbinafine, itraconazole or fluconazole, or when these agents cannot used, for example, due to potential drug interactions with the patient's current medications, clinicians may need to consider off-label use of new generation azoles, such as voriconazole, posaconazole, fosravuconazole, or oteseconazole. It is essential to emphasize that we do not advocate the use of newer generation azoles unless traditional agents such as terbinafine, itraconazole, or fluconazole have been thoroughly evaluated as first-line therapies.
AREAS COVERED
This article reviews the clinical evidence, safety, dosage regimens, pharmacokinetics, and management algorithm of new-generation azole antifungals.
EXPERT OPINION
Antifungal stewardship should be the top priority when prescribing new-generation azoles. First-line antifungal therapy is terbinafine and itraconazole. Fluconazole is a consideration but is generally less effective and its use may be off-label in many countries. For difficult-to-treat skin fungal infections and onychomycosis, that have failed terbinafine, itraconazole and fluconazole, we propose consideration of off-label voriconazole or posaconazole.
Topics: Humans; Antifungal Agents; Onychomycosis; Azoles; Drug Resistance, Fungal; Dermatomycoses; Off-Label Use; Drug Interactions; Arthrodermataceae
PubMed: 38841996
DOI: 10.1080/14787210.2024.2362911 -
Cureus May 2024Onychomycosis, a fungal infection of the nails, presents a significant challenge in clinical management due to its chronic nature and resistance to conventional... (Review)
Review
Onychomycosis, a fungal infection of the nails, presents a significant challenge in clinical management due to its chronic nature and resistance to conventional therapies. This study aims to evaluate the efficacy of laser therapy in treating onychomycosis compared to traditional methods such as terbinafine. A systematic review and meta-analysis were conducted to analyze existing literature on the subject. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram illustrates the selection process of studies. Findings suggest that laser therapy demonstrates promising results in the treatment of onychomycosis, with comparable efficacy to terbinafine and fewer adverse effects. Further large-scale randomized controlled trials are warranted to validate these findings and establish laser therapy as a standard treatment option for onychomycosis.
PubMed: 38841013
DOI: 10.7759/cureus.59720 -
Skin Appendage Disorders Jun 2024Onychomycosis is the most common nail infection, predominantly caused by spp., and is divided into four main types. Confirmatory testing is crucial, but obtaining an...
INTRODUCTION
Onychomycosis is the most common nail infection, predominantly caused by spp., and is divided into four main types. Confirmatory testing is crucial, but obtaining an adequate sample may be challenging. We suggest the use of carbon dioxide (CO) laser for painlessly detaching the nail plate during mycological examination and ensuring a sufficient specimen.
METHODS
We retrospectively enrolled 25 patients with distolateral onychomycosis, treated according to the following protocol: (1) multiple passes of CO laser at 10 W in continuous mode along the proximal border of the affected nail plate; (2) the nail plate was gently cut; (3) the nail bed was curetted; (4) subungual debris and plate fragments were collected for KOH test and culture.
RESULTS
The mean visual analog score (VAS) for pain experienced during the procedure was 0.7 (SD: 2.1), indicating that the sampling was relatively painless for the majority of patients. There were no permanent changes observed in the nail unit of any patients during the follow-up visits as a result of using the CO laser.
CONCLUSION
We firmly believe that the use of lasers offers numerous advantages, including ease of use, reduced pain perception, and the ability to target the proximal margin of fungal infections where viable hyphae are significantly represented.
PubMed: 38835715
DOI: 10.1159/000536289 -
Skin Appendage Disorders Jun 2024Onychomycosis is common among adults with diabetes mellitus (DM). We used two-sample Mendelian randomization to estimate the causal effect of genetic risk for DM on...
INTRODUCTION
Onychomycosis is common among adults with diabetes mellitus (DM). We used two-sample Mendelian randomization to estimate the causal effect of genetic risk for DM on onychomycosis and tinea skin infections in the All of Us Research Program.
METHODS
Onychomycosis and tinea corporis, pedis, manus, and cruris cases were identified using electronic health record data, and genetic instrument variables and summary statistics were collected from a type II DM (T2DM) genome-wide association study (GWAS) meta-analysis.
RESULTS
Inverse variance weighted regression showed positive effect of T2DM genetic risk on onychomycosis (beta = 0.135, = 1.86E-2), and weighted median regression produced a comparable estimate of effect size (beta = 0.148). There was no significant effect of T2DM on skin dermatophytosis.
CONCLUSIONS
Our results suggest that T2DM has a positive causal effect on onychomycosis but not tinea skin infection risk. As onychomycosis may impair occupational function and increase risk for secondary soft tissue infections, patients with diabetes should be screened for onychomycosis and counseled on mitigating infection risk.
PubMed: 38835708
DOI: 10.1159/000535921 -
Annals of Dermatology Jun 2024
PubMed: 38816980
DOI: 10.5021/ad.23.027 -
Dermatology Practical & Conceptual Apr 2024Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors...
INTRODUCTION
Onychomycosis, a fungal nail infection, is associated with significant morbidity and negative impact on quality of life. Therefore, understanding associated risk factors may inform onychomycosis screening guidelines.
OBJECTIVES
This retrospective study investigated common demographic and comorbidity risk factors among hospitalized patients using the National Inpatient Sample.
METHODS
The 2003-2014 National Inpatient Sample (NIS) database was used to identify onychomycosis cases and age and sex matched controls in a 1:2 ratio. Chi-square tests and T-tests for independent samples were utilized to compare categorical and continuous patient factors. Demographic and comorbidity variables significant (P < 0.05) on univariate analysis were analyzed via a multivariate regression model with Bonferroni correction (P < 0.0029).
RESULTS
119,662 onychomycosis cases and 239,324 controls were identified. Compared to controls, onychomycosis patients frequently were White (69.0% versus 68.0%; P < 0.001), Black (17.9% versus 5.8%; P < 0.0001), and insured by Medicare or Medicaid (80.1% versus 71.1%; P < 0.0001). Patients had greater hospital stays (9.69 versus 5.39 days; P < 0.0001) and costs ($39,925 versus $36,720; P < 0.001) compared to controls. On multivariate analysis, onychomycosis was commonly associated with tinea pedis (odds ratio [OR]: 111.993; P < 0.0001), human immunodeficiency virus (OR: 4.372; P < 0.001), venous insufficiency (OR: 6.916; P < 0.0001), and psoriasis (OR: 3.668; P < 0.001).
CONCLUSIONS
Onychomycosis patients had longer hospital stays and greater costs compared to controls. Black patients were disproportionately represented among cases compared to controls. Onychomycosis was associated with tinea pedis, venous insufficiency, human immunodeficiency virus, psoriasis, obesity (body mass index [BMI] ≥ 30 kg/m), peripheral vascular disease, and diabetes with chronic complications, suggesting that inpatients with onychomycosis should be screened for these conditions.
PubMed: 38810060
DOI: 10.5826/dpc.1402a74 -
Dermatology Practical & Conceptual Apr 2024
PubMed: 38810042
DOI: 10.5826/dpc.1402a137 -
Postepy Dermatologii I Alergologii Apr 2024Superficial mycosis is one of the most common diseases worldwide; however, its epidemiology is changing over time.
INTRODUCTION
Superficial mycosis is one of the most common diseases worldwide; however, its epidemiology is changing over time.
AIM
To present the awareness of people using swimming pools about athlete's foot and onychomycosis.
MATERIAL AND METHODS
A total of 690 participants were subjected to an extensive survey administered via Google Documents. The questionnaire consisted of 30 online polling items and aimed to evaluate respondents' knowledge pertaining to fungal infections, encompassing aspects such as prevention strategies, disease trajectory, and therapeutic modalities. The survey sample specifically encompassed students and sports enthusiasts associated with 33 Internet groups, and data collection transpired during the period spanning 12 January to 15 March, 2018, predating the advent of the COVID-19 pandemic.
RESULTS
In the study, 85.2% of participants regularly inspected their feet, with 4.8% seeking podiatric services. While 75.2% demonstrated hygienic behaviour by changing towels after each pool visit, 41.4% acknowledged sharing nail tools. Notably, 75.7% preferred professional assistance for symptoms, with 24.3% opting for home remedies. Gender disparities were evident, with women showing significantly better hygiene practices and pool usage than men ( < 0.001). Women also exhibited a stronger tendency to disinfect grooming tools and prioritise sterility during beautician services ( < 0.001). These findings emphasise the importance of gender-specific health behaviour analysis in promoting preventive measures.
CONCLUSIONS
The study highlights onychomycosis as a significant societal concern. Pre-COVID-19, awareness among municipal swimming pool users regarding prevention, symptoms, and treatment of athlete's foot and onychomycosis was insufficient.
PubMed: 38784926
DOI: 10.5114/ada.2024.136083 -
Actas Dermo-sifiliograficas May 2024
PubMed: 38777225
DOI: 10.1016/j.ad.2024.04.025 -
The Journal of Antibiotics May 2024Onychomycosis, a superficial fungal infection of the nails, is prevalent in many areas of the world. Topical agents for onychomycosis need to reach the subungual layer...
Onychomycosis, a superficial fungal infection of the nails, is prevalent in many areas of the world. Topical agents for onychomycosis need to reach the subungual layer and nail bed to exert antifungal activity in the presence of keratin, the major component of the nail. It is difficult to evaluate the efficacy and pharmacodynamics of topical agents for onychomycosis in a non-clinical evaluation system. No consistent animal model has yet been established to predict the efficacy of topical agents for onychomycosis. In this study, we evaluated the pharmacokinetics and pharmacodynamics of ME1111 in a guinea pig model of tinea corporis designed to predict the efficacy of topical medication for onychomycosis in the vicinity of the nail bed. Trichophyton mentagrophytes TIMM1189 was infected on the back skin of guinea pigs, and ME1111 solution (5%, 10%, or 15%) was administered topically, once daily for 14 consecutive days. Following the completion of dosing, segments of skin from the site of infection were excised and cultured. The concentration of ME1111 in the back skin of guinea pigs increased with formulation concentration and correlated with mycological efficacy. We revealed the concentration required for ME1111 to be effective at the site of infection. Further analysis is needed to predict the efficacy of topical agents for onychomycosis by analyzing the relationship between PK/PD around the nail bed and factors such as subungual penetration and permeability.
PubMed: 38769156
DOI: 10.1038/s41429-024-00738-y