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Recent Patents on Inflammation &... 2020Onychomycosis is a common fungal infection of the nail. (Review)
Review
BACKGROUND
Onychomycosis is a common fungal infection of the nail.
OBJECTIVE
The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis.
METHODS
A PubMed search was completed in Clinical Queries using the key term "onychomycosis". The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term "onychomycosis" in www.freepatentsonline.com.
RESULTS
Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed.
CONCLUSION
Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Foot Dermatoses; Hand Dermatoses; Humans; Onychomycosis; Patents as Topic; Randomized Controlled Trials as Topic
PubMed: 31738146
DOI: 10.2174/1872213X13666191026090713 -
Drugs in Context 2023Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with... (Review)
Review
BACKGROUND
Tinea pedis is one of the most common superficial fungal infections of the skin, with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea pedis.
METHODS
A search was conducted in April 2023 in PubMed Clinical Queries using the key terms 'tinea pedis' OR 'athlete's foot'. The search strategy included all clinical trials, observational studies and reviews published in English within the past 10 years.
RESULTS
Tinea pedis is most often caused by and . It is estimated that approximately 3% of the world population have tinea pedis. The prevalence is higher in adolescents and adults than in children. The peak age incidence is between 16 and 45 years of age. Tinea pedis is more common amongst males than females. Transmission amongst family members is the most common route, and transmission can also occur through indirect contact with contaminated belongings of the affected patient. Three main clinical forms of tinea pedis are recognized: interdigital, hyperkeratotic (moccasin-type) and vesiculobullous (inflammatory). The accuracy of clinical diagnosis of tinea pedis is low. A KOH wet-mount examination of skin scrapings of the active border of the lesion is recommended as a point-of-care testing. The diagnosis can be confirmed, if necessary, by fungal culture or culture-independent molecular tools of skin scrapings. Superficial or localized tinea pedis usually responds to topical antifungal therapy. Oral antifungal therapy should be reserved for severe disease, failed topical antifungal therapy, concomitant presence of onychomycosis or in immunocompromised patients.
CONCLUSION
Topical antifungal therapy (once to twice daily for 1-6 weeks) is the mainstay of treatment for superficial or localized tinea pedis. Examples of topical antifungal agents include allylamines (e.g. terbinafine), azoles (e.g. ketoconazole), benzylamine, ciclopirox, tolnaftate and amorolfine. Oral antifungal agents used for the treatment of tinea pedis include terbinafine, itraconazole and fluconazole. Combined therapy with topical and oral antifungals may increase the cure rate. The prognosis is good with appropriate antifungal treatment. Untreated, the lesions may persist and progress.
PubMed: 37415917
DOI: 10.7573/dic.2023-5-1 -
Journal of Fungi (Basel, Switzerland) Mar 2015Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by and var. . Yeasts, like and , and... (Review)
Review
Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by and var. . Yeasts, like and , and molds, like spp, represent the second cause of onychomycosis. The clinical suspect of onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.
PubMed: 29376897
DOI: 10.3390/jof1010030 -
Infection and Drug Resistance 2018Majocchi's granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is... (Review)
Review
Majocchi's granuloma (MG) is a rare fungal infection of the dermis that is mainly caused by dermatophytes (in ≥95% of cases); the most frequently identified cause is anthropophilic . In the rest of the cases, the causes are non-dermatophytic fungi such as species. This review aimed to provide information about the current perspectives on MG regarding its clinical characteristics, predisposing factors, laboratory diagnosis, and treatment strategies. Although the lower extremities were reported to be the most common site of infection, facial involvement has been predominant in the past 5 years. Our literature research showed that the most common predisposing factor (55%) is the use of topical steroid creams without potassium hydroxide examination during treatment of erythematous squamous dermatoses. A reliable diagnosis of MG is based on histopathological examination, including fungal culture and molecular analyses. MG should be treated not only with topical agents but also with systemic antifungal agents that are continued until the lesions are completely resolved. In systemic treatment, the most preferred drug is terbinafine, because of its efficacy, side effects, and safety.
PubMed: 29861637
DOI: 10.2147/IDR.S145027 -
Journal of Fungi (Basel, Switzerland) Nov 2020Dermatophytoses affect about 25% of the world population, and the filamentous fungus is the main causative agent of this group of diseases. Dermatomycoses are caused by... (Review)
Review
Dermatophytoses affect about 25% of the world population, and the filamentous fungus is the main causative agent of this group of diseases. Dermatomycoses are caused by pathogenic fungi that generally trigger superficial infections and that feed on keratinized substrates such as skin, hair, and nails. However, there are an increasing number of reports describing dermatophytes that invade deep layers such as the dermis and hypodermis and that can cause deep infections in diabetic and immunocompromised patients, as well as in individuals with immunodeficiency. Despite the high incidence and importance of dermatophytes in clinical mycology, the diagnosis of this type of infection is not always accurate. The conventional methods most commonly used for mycological diagnosis are based on the identification of microbiological and biochemical features. However, in view of the limitations of these conventional methods, molecular diagnostic techniques are increasingly being used because of their higher sensitivity, specificity and rapidity and have become more accessible. The most widely used molecular techniques are conventional PCR, quantitative PCR, multiplex PCR, nested, PCR, PCR-RFLP, and PCR-ELISA. Another promising technique for the identification of microorganisms is the analysis of protein profiles by MALDI-TOF MS. Molecular techniques are promising but it is necessary to improve the quality and availability of the information in genomic and proteomic databases in order to streamline the use of bioinformatics in the identification of dermatophytes of clinical interest.
PubMed: 33238603
DOI: 10.3390/jof6040310 -
Current Medical Mycology Jun 2023Tinea incognita (TI), or the other equivalent tinea atypica, is a term used to declare the atypical presentation of dermatophyte infections caused by the administration... (Review)
Review
BACKGROUND AND PURPOSE
Tinea incognita (TI), or the other equivalent tinea atypica, is a term used to declare the atypical presentation of dermatophyte infections caused by the administration of steroids or other immunosuppressive medications which modulate the local and systemic immune response. It can mimic other dermatoses; hence making diagnostic challenges for dermatologists. Tina incognita may be misdiagnosed as many dermatoses. Based on previous studies, corticosteroids may cause different clinical manifestations of dermatophytes that might be very different from those that are commonly described.
MATERIALS AND METHODS
This narrative review was conducted using PubMed and Scopus databases. Search terms included "Tinea incognita" and "Atypical dermatophytosis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews, and case reports. The search was restricted to articles written in the English language from 2006 to Feb 01, 2023. Moreover, duplicate articles and non-available full-text articles were excluded. The extracted data of the search results were retrieved in this study. The morphological patterns, prevalence, sight of infection, and causative agents were also described.
RESULTS
Prevalence of different patterns of TI were recorded as 50% (431 out of 862 cases) for eczema-like lesions followed by psoriasis-like and 6.61% (57 out of 862) for parapsoriasis-like pattern. Moreover, each of the rosacea-like and pyoderma-like lesions equally accounted for 4.98 % of cases (43 out of 862). In addition, the prevalence of causative agents was reported as follows: accounted for 247 isolates (40%) as the most prevalent, followed by (n=152, 24%) and (n=119, 19%).
CONCLUSION
Tinea incognita is a great mimicker; hence, dermatologists should obtain a full medical history of the patients to make correct diagnoses. It is vital to encourage an exact identification of the etiological agent according to the internal transcribed spacer sequencing in some uncertain cases. This review highlights the importance of mycological tests and fast diagnosis of TI, especially in cases of atypical skin lesions, to choose appropriate treatment and avoid the spread of drug-resistant species.
PubMed: 38375520
DOI: 10.22034/cmm.2023.345069.1425 -
Journal of Fungi (Basel, Switzerland) Feb 2019Onychomycosis is mainly caused by two dermatophyte species, and . A study of nail invasion mechanisms revealed that the secreted subtilisin Sub6, which has never been... (Review)
Review
Onychomycosis is mainly caused by two dermatophyte species, and . A study of nail invasion mechanisms revealed that the secreted subtilisin Sub6, which has never been detected under in vitro growth conditions, was the main protease secreted by and during infection. In contrast, most of the proteases secreted during the digestion of keratin in vitro were not detected in infected nails. The hypothesis that proteases isolated from dermatophytes grown in a keratin medium are virulence factors is no longer supported. Non-dermatophyte fungi can also be infectious agents in nails. It is necessary to identify the infectious fungus in onychomycosis to prescribe adequate treatment, as moulds such as spp. and spp. are insensitive to standard treatments with terbinafine or itraconazole, which are usually applied for dermatophytes. In these refractory cases, topical amphotericin B treatment has shown to be effective. Terbinafine treatment failure against dermatophytes is also possible, and is usually due to resistance caused by a missense mutation in the squalene epoxidase enzyme targeted by the drug. resistance to terbinafine treatment is an emerging problem, and a switch to azole-based treatment may be necessary to cure such cases of onychomycosis.
PubMed: 30813287
DOI: 10.3390/jof5010020 -
Journal of Fungi (Basel, Switzerland) Aug 2015Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the... (Review)
Review
Since the early 20th century, onychomycosis originated with the onset of war, the use of occlusive footwear, and the mass migration of people by transportation in the United States. Even though onychomycosis has a high prevalence in the US, other parts of the world including Canada, West Africa, Southeast Asia, Northern Australia, and Europe have been well documented with cases of fungal toenail infection in their environments. () is the major dermatophyte responsible for toenail fungal infection and is typically diagnosed in conjunction with tinea pedis, especially in individuals older than 60 years. Gender roles, age, cultural habits, shoe gear, sports activities, and genetic predisposition all contribute to the different presentation of onychomycosis in these areas where organisms like dermatophytes, candida, and molds were isolated in a variety of cases. Despite the differences in isolated pathogens, treatment outcomes remained consistent. This literature review discusses the influence of tinea pedis, genetics, shoe gear, sports, and age on the development of onychomycosis.
PubMed: 29376909
DOI: 10.3390/jof1020211 -
Scientific Reports Feb 2021Keratin is important and needed for the growth of dermatophytes in the host tissue. In turn, the ability to invade keratinised tissues is defined as a pivotal virulence...
Keratin is important and needed for the growth of dermatophytes in the host tissue. In turn, the ability to invade keratinised tissues is defined as a pivotal virulence attribute of this group of medically important fungi. The host-dermatophyte interaction is accompanied by an adaptation of fungal metabolism that allows them to adhere to the host tissue as well as utilize the available nutrients necessary for their survival and growth. Dermatophyte infections pose a significant epidemiological and clinical problem. Trichophyton rubrum is the most common anthropophilic dermatophyte worldwide and its typical infection areas include skin of hands or feet and nail plate. In turn, Microsporum canis is a zoophilic pathogen, and mostly well known for ringworm in pets, it is also known to infect humans. The aim of the study was to compare the intracellular metabolite content in the T. rubrum and M. canis during keratin degradation using liquid chromatography system coupled with tandem mass spectrometer (LC-MS/MS). The metabolite "fingerprints" revealed compounds associated with amino acids metabolism, carbohydrate metabolism related to the glycolysis and the tricarboxylic acid cycle (TCA), as well as nucleotide and energy metabolism. The metabolites such as kynurenic acid, L-alanine and cysteine in case of T. rubrum as well as cysteine and riboflavin in case of M. canis were detected only during keratin degradation what may suggest that these compounds may play a key role in the interactions of T. rubrum and M. canis with the host tissue. The metabolomic results were completed by qPCR gene expression assay. Our findings suggest that metabolomic analysis of T. rubrum and M. canis growing in culture media that mimic the dermatophyte infection could allow the understanding of processes involved in the pathogenesis of dermatophytes.
Topics: Arthrodermataceae; Chromatography, Liquid; Dermatomycoses; Keratins; Metabolomics; Microsporum; Skin; Tandem Mass Spectrometry; Tinea; Trichophyton
PubMed: 33597693
DOI: 10.1038/s41598-021-83632-z