Onychomycoses represent approximately 50 % of all nail diseases worldwide. In warmer and more humid countries like Brazil, the incidence of onychomycoses caused by non-dermatophyte molds (NDM, ...including
Fusarium
spp.) or yeasts (including
Candida albicans
) has been increasing. Traditional antifungal treatments used for the dermatophyte-borne disease are less effective against onychomycoses caused by NDM. Although some laser and light treatments have demonstrated clinical efficacy against onychomycosis, their US Food and Drug Administration (FDA) approval as “first-line” therapy is pending, partly due to the lack of well-demonstrated fungicidal activity in a reliable in vitro model. Here, we describe a reliable new in vitro model to determine the fungicidal activity of laser and light therapies against onychomycosis caused by
Fusarium oxysporum
and
C. albicans
. Biofilms formed in vitro on sterile human nail fragments were treated with 1064 nm neodymium-doped yttrium aluminum garnet laser (Nd:YAG), 420 nm intense pulsed light (IPL) IPL 420, followed by Nd:YAG, or near-infrared light ((NIR) 700–1400 nm). Light and laser antibiofilm effects were evaluated using cell viability assay and scanning electron microscopy (SEM). All treatments were highly effective against
C. albicans
and
F. oxysporum
biofilms, resulting in decreases in cell viability of 45–60 % for
C. albicans
and 92–100 % for
F. oxysporum
. The model described here yielded fungicidal activities that matched more closely to those observed in the clinic, when compared to published in vitro models for laser and light therapies. Thus, our model might represent an important tool for the initial testing, validation, and “fine-tuning” of laser and light therapies against onychomycosis.
Trichophyton rubrum (T.rubrum) caused onychomycosis is the most common nail fungal disease. The common diagnostic methods are direct microscopic examination and fungal culture. In this study we used ...scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to study the subungual ultrastructural changes in T. rubrum induced onychomycosis.
Six outpatients with onychomycosis were recruited and T.rubrum infection was confirmed by fungal culture. Six toenail samples were collected and prepared for SEM characterization. The cultured fugal colonies were prepared for SEM and TEM characterization.
1) SEM showed significant structural damages and the formation of a thin layer or a single layer of keratinocytes in all infected nail plates. Hyphae (piercing or penetrating keratinocytes layers), arthrospores and local bacterial aggregation were observed on the ventral surface of the nail plates. 2) SEM of the cultured fungal colony showed relatively straight, highly branched hyphae and microconidias; TEM showed branching hyphae that were composed of double-layer cell walls. Hyphae had nucleus, mitochondria, liposomes, lysosomes, scattered rough endoplasmic reticulum, myeloid bodies and aggregated ribosomes. There were high-density particles outside the hyphae.
SEM showed a large number of hyphae penetrated the keratinocytes layer, suggesting that T. rubrum can cause severe damage to the stratum corneum. TEM showed the ultrastructural features of T. rubrum-induced infection before treatment.
Primary care physicians provide a wide variety of treatments and conditions affecting the foot. This article discusses the removal of toenails, both full and partial removal. Subungual ...hematoma/Subungual blistering evacuation as well as wart, corn, callus, and blister management will also be discussed.
Dermoscopy is a non-invasive tool mainly used to clarify pigmented and nonpigmented skin lesions. Based on its physical properties, dermoscopy is divided into non-polarized and polarized. Dermoscopy ...examination is a diagnostic technique that is often performed on skin disorders, including skin disorders due to fungal infections. Some of the fungal diseases that are examined by dermoscopy are tinea capitis, pityriasis versicolor and onychomycosis. The dermoscopy features found in tinea capitis are comma hair, corkscrew hair, black dots and short hair. Onychomycosis found dermoscopy chromonychia, white longitudinal stripes and opaque nails (cloudy). The dermoscopy in pityriasis versicolor shows hypopigmented and hyperpigmented patterns.
Prognostic factors for cure following treatment of onychomycosis Sigurgeirsson, B
JEADV. Journal of the European Academy of Dermatology and Venereology/Journal of the European Academy of Dermatology and Venereology,
June 2010, Letnik:
24, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objective To examine if host baseline factors and week 24 mycology results are associated with mycological and clinical cure in patients with onychomycosis treated with oral terbinafine.
Design ...Open pilot study to determine prognostic factors in the treatment of onychomycosis.
Setting Outpatient dermatology clinic.
Patients A total of 199 patients from the Icelandic arm of a trial comparing continuous terbinafine with intermittent terbinafine in onychomycosis were recruited for additional observation.
Main outcome measures Mycological, clinical and complete cure of the target toenail 72 weeks after treatment was initiated.
Results Patients with matrix involvement or slow nail growth were less likely to reach mycological, clinical and complete cure. Lateral involvement affected complete and mycological cure rates negatively. Patients with a dermatophytoma were less likely to reach mycological cure. Patients with a history of prior infection, men and older patients were less likely to reach clinical cure. Positive culture at 24 weeks affected mycological and clinical cure at 72 weeks negatively.
Limitations Only patients treated with terbinafine were considered.
Conclusions Several host‐related factors at baseline and positive culture at 24 weeks had negative effects on cure of onychomycosis 72 weeks after treatment was initiated. This finding merits a large study on prognostic outcome factors in onychomycosis.
Onychomycosis is a fungal nail infection caused primarily by dermatophytes. Several other nail disorders, including psoriasis, can simulate onychomycosis. Accurate diagnosis is therefore vital for ...the ongoing treatment and management of onychomycosis and to avoid misdiagnosis and treatment delay, which can be both lengthy and costly. Often, a combination of histologic and laboratory techniques is used to obtain an accurate diagnosis. The potential diagnostic challenges associated with the differential diagnosis of onychomycosis caused by dermatophytes and the most common techniques used to confirm the diagnosis are discussed.
Summary
Background: Laser treatment of onychomycosis is the object of considerable interest. Laser therapy could be a safe and cost‐effective treatment modality without the disadvantages of drugs. ...Some studies have described the inhibitory effects of lasers on the growth of fungal colonies. We therefore examined the effects of various laser wavelengths, which have previously shown inhibitory potential, on the fungal isolate Trichophyton rubrum.
Patients and Methods: Isolates of fungal colonies were placed clockwise on culture plates. Each culture plate was irradiated on one half with one of the following treatment regimens: 1064 nm‐Q‐switched Nd:YAG laser at 4 J/cm2 and 8 J/cm2; 532 nm‐Q‐switched Nd:YAG laser at 8 J/cm2; 1064 nm‐long‐pulsed Nd:YAG laser at 45 J/cm2 or 100 J/cm2. The other half remained untreated. Standardized photographs were taken and areas of treated and untreated colonies were compared for growth inhibition.
Results: There was no inhibition of fungal growth in any of the treated plates. Differences in size between treated and untreated colonies were not significant (p > 0.10).
Conclusions: In this in vitro study Nd:YAG laser treatment of Trichophyton rubrum colonies failed to inhibit fungal growth. Nevertheless there might be an effectiveness in vivo which has to be clarified by clinical studies.
Summary
The genera Acremonium and Sarocladium comprise a high diversity of morphologically and genetically related fungi generally found in the environment, although a few species, mainly Sarocladium ...kiliense and Acremonium egyptiacum, can also be involved in many human infections. Clinical management of opportunistic infections caused by these fungi is very complex, since their correct identification is unreliable, and they generally show poor antifungal response. More than 300 clinical cases involving a broad range of Acremonium/Sarocladium infections have so far been published, and with this review we aim to compile and provide a detailed overview of the current knowledge on Acremonium/Sarocladium human infections in terms of presentation, diagnosis, treatments and prognoses. We also aim to summarise and discuss the data currently available on their antifungal susceptibility, emphasising the promising results obtained with voriconazole as well as their impact in terms of animal infections.
Confocal microscopy for healthy and pathological nail Cinotti, E.; Fouilloux, B.; Perrot, J. L. ...
Journal of the European Academy of Dermatology and Venereology,
July 2014, Letnik:
28, Številka:
7
Journal Article
Recenzirano
Nail diseases are often annoying for the patient and diagnostically challenging for dermatologists. New imaging techniques are of high interest in the diagnosis of nail disorders to reduce the number ...of nail biopsies. Confocal microscopy is a high‐resolution emerging imaging technique that can be used to explore the entire body surface, including skin, mucosa, hair and nails. A systematic review of the literature concerning the use of confocal microscopy for the study of either healthy or pathological nail has been performed to evaluate the current use of this technique and possible future applications. Confocal microscopy is particularly suitable for nails because it allows a non‐invasive in vivo examination of this sensitive body area, and nail plate transparency permits to image up to the nail bed with an easy identification of corneocytes. Confocal microscopy can play a role in the diagnosis of onychomycosis and melanonichia, and in the study of drug penetration through the nail plate. It could be used in the future as a non‐invasive procedure for the investigation of different nail diseases, such as psoriasis and lichen planus. Further application could be the intra‐operative ex vivo examination of nail specimens to outline tumour margins to assist surgery.
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