| White
Onychomycosis. / Onicomicosis Blanca. ***********************************
****** DATA-MEDICOS *********
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ONICOMICOSIS BLANCA
WHITE ONYCHOMYCOSIS
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***** DERMAGIC-EXPRESS No 17 *********
****** 16 NOVIEMBRE 1.998 *******
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1.) EDITORIAL //ESPANOL
=======================
Hola amigos de la red, DERMAGIC, de nuevo con ustedes, el tema de hoy la
onicomicosis, haciendo enfasis en la onicomicosis blanca de la cual hay poca literatura. Encontre unas 19 referencias sobre tan interesante patologia y las
complemente con otros 13 articulos muy buenos sobre el tema.
Esta edición esta dedicada a TODOS los micologos de nuestro mundo
Dermatológico que nos rodea, especialmente a la lista FUNGI, del Dr. Paulo
Taborda (Brasil),, saludos.
Dr. Roberto Pribyl, Rolando Hernadez,, tuve inconvenientes, justo el dia antes del Congreso, y lamentablemente no pude ir, gracias por los comentarios. Espero que se repitan esos eventos y pueda participar. El tiempo ?? la verdad es que no se de donde lo saco,, tengo 14 años de vuelo en informática,,,sera eso ??
Dr. Raul Fachin, me encanto que todo salio bien, DERMAGIC, siempre divulgará información Dermatológica de interes para todos. Felicitaciones a la Residente Arminda Acuña por su premio,,,
Hasta una próxima edicion,,, saludos
Proximas ediciones: * EL SOLARASE,,,, * LEISHMANIASIS, PENTAMIDINA E ITRACONAZOLE
1.) EDITORIAL// ENGLISH
=======================
Hello friends of the net, DERMAGIC, again with you, today's topic the
onychomycosis, making emphasis in the white onychomycosis of which there is little literature. I found some 19 references on so interesting pathology and it
supplements them with other 13 very good articles on the topic.
This edition is dedicated to ALL the mycologist of our Dermatologic world that surrounds us, especially to the list FUNGI, of the Dr. Paulo Taborda
(Brazil), greetings.
Dr. Marcus Meinardi your e-mail starting from this date is in DERMAGIC,
greetings Amsterdam from Venezuela.
I Remind the colleagues Dermatologist from USA and Europe that DERMAGIC is
being Liberated through the LIST ACADERM-L, of the Dr. Art C. Huntley.
Until a next edition, greetings
Next editions: * THE SOLARASE,,, * LEISHMANIASIS, PENTAMIDINE AND ITRACONAZOLE
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DERMAGIC/EXPRESS(17)
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ONICOMICOSIS BLANCA // WHITE ONYCHOMYCOSIS
======================================================================
1.) Superficial white onychomycosis.
2.) Childhood white superficial onychomycosis caused by Trichophyton
rubrum: report of seven cases and review of the literature.
3.) Proximal white subungual onychomycosis in AIDS.
4.) Proximal white subungual onychomycosis in a kidney transplant patient
[letter]
5.) Onychomycosis associated with Onychocola canadensis: ten case reports
and a review of the literature.
6.) Proximal subungual onychomycosis due to Microsporum canis.
7.) Unusual clinical features of fingernail infection by Fusarium oxysporum.
8.) Nondermatophyte causes of onychomycosis and superficial mycoses.
9.) The spectrum of nail disease in patients with human immunodeficiency
virus infection.
10.) White superficial onychomycosis caused by Trichophyton rubrum.
11.) Proximal white subungual onychomycosis: a sign of immunodeficiency.
12.) Clinical pearl: proximal white subungual onychomycosis in AIDS.
13.) Onychomycosis in graft versus host disease.
14.) Proximal white subungual onychomycosis in a patient with acquired
immune deficiency syndrome.
15.) The spectrum of nail disease in patients with human immunodeficiency
virus infection.
16.) Onychomycosis and AIDS. Clinical and laboratory findings in 62 patients.
17.) White nails in AIDS/ARC due to Trichophyton rubrum infection.
18.) Fungal infection as a cause of skin disease in the eastern province of
Saudi Arabia: prevailing fungi and pattern of infection.
19.) Fungal infections of the nails in Western Australia.
20.) A higher prevalence of onychomycosis in psoriatics compared with
non-psoriatics: a multicentre study.
21.) Onychomycosis in children: prevalence and treatment strategies.
22.) Pharmacoeconomic analysis of oral therapies for onychomycosis: a US
model.
23.) Update on the management of onychomycosis: highlights of the Third
Annual International Summit on Cutaneous Antifungal Therapy [see comments]
24.) Prevalence of dermatophyte onychomycosis in Spain: a cross-sectional
study.
25.) Economic evaluation of antifungal agents in the treatment of toenail
onychomycosis in Germany.
26.) Onychomycosis. Going for cure.
27.) Itraconazole therapy is effective for pedal onychomycosis caused by some
nondermatophyte molds and in mixed infection with dermatophytes and molds:
a multicenter study with 36 patients.
28.) A questionnaire study on the management of onychomycosis: a Canadian
perspective.
29.) Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of
distal subungual onychomycosis of the fingernail.
30.) Antifungal pulse therapy for onychomycosis. A pharmacokinetic and
pharmacodynamic investigation of monthly cycles of 1-week pulse therapy
with itraconazole.
31.) Measuring health-related quality of life in onychomycosis.
32.) Prevalence and epidemiology of unsuspected onychomycosis in patients
visitingdermatologists' offices in Ontario, Canada--a multicenter survey of 2001
patients.
======================================================================
1.) Superficial white onychomycosis.
======================================================================
Author
Bodman MA; Brlan MR
Address
Cleveland Foot and Ankle Clinic, Ohio College of Podiatric Medicine
44106, USA.
Source
J Am Podiatr Med Assoc, 85(4):205-8 1995 Apr
Abstract
A study on the incidence and causative organisms of pedal superficial
white onychomycosis
within several patient populations is presented. Early recognition,
debridement, and topical
antifungal therapy for several weeks with attention to biomechanical
factors should resolve
the infection and prevent progression to a more destructive form of
onychomycosis.
======================================================================
2.) Childhood white superficial onychomycosis caused by Trichophyton
rubrum: report of seven cases and review of the literature.
======================================================================
Author
Ploysangam T; Lucky AW
Address
Department of Dermatology, University of Cincinnati Medical Center,
OH, USA.
Source
J Am Acad Dermatol, 36(1):29-32 1997 Jan
Abstract
BACKGROUND: Although white superficial onychomycosis (WSO) is well
recognized in
adults and considered to be mainly caused by Trichophyton
mentagrophytes, childhood
WSO is rare. WSO caused by Trichophyton rubrum in prepubertal children
has never been
reported. OBJECTIVE: Our purpose was to describe the existence of WSO
in children and
to emphasize that T. rubrum may be its main cause. METHODS: Seven
children with WSO
seen between 1988 and 1993 were examined. Only patients who had a
positive potassium
hydroxide preparation and a positive fungal culture were included.
RESULTS: Seven healthy
prepubertal children, 2 to 9 years of age, were identified with WSO.
All cases were proved
to be caused by T. rubrum. Six patients had associated tinea pedis,
and five had a family
history of tinea pedis. Topical antifungal therapy was partially
effective in some cases.
CONCLUSION: This report documents the existence of WSO in prepubertal
children. All
cultures grew T. rubrum. Although onychomycosis is not as common in
prepubertal children
as in adults, it may be underrecognized.
======================================================================
3.) Proximal white subungual onychomycosis in AIDS.
======================================================================
Author
Silva-Lizama E; Logemann H
Address
Department of Dermatology and Mycology, Guatemalan Social Security
Institute, Central
America.
Source
Int J Dermatol, 35(4):290-1 1996 Apr
======================================================================
4.) Proximal white subungual onychomycosis in a kidney transplant patient
[letter]
======================================================================
Author
Chang P; Arenas R
Source
Int J Dermatol, 34(8):591 1995 Aug
======================================================================
5.) Onychomycosis associated with Onychocola canadensis: ten case reports
and a review of the literature.
======================================================================
Author
Gupta AK; Horgan-Bell CB; Summerbell RC
Address
Department of Medicine, Sunnybrook Health Science Center and the
University of Toronto,
Ontario, Canada. [email protected]
Source
J Am Acad Dermatol, 39(3):410-7 1998 Sep
Abstract
BACKGROUND: Onychocola canadensis is a nondermatophyte mold associated
with
onychomycosis particularly in temperate climates (eg, Canada, New
Zealand, and France).
The slow growth rate of O canadensis and lack of resemblance to any
other known
nail-infecting fungus may have delayed its discovery. We are aware of
23 mycologically
confirmed cases of O canadensis in the literature. OBJECTIVE: We
describe 10 previously
unreported Canadian patients, specimens from whom grew O canadensis.
We also review
the literature on infections associated with this organism. METHODS:
Cases of O canadensis
onychomycosis were diagnosed on the basis of (1) the finding of
compatible filaments on
direct microscopy of nail and (2) consistent culture from repeated
specimens. All patients
from whom O canadensis was isolated were followed up, but those in
whom outgrowth was
not consistent were not accepted as having "authentic" infections.
RESULTS: In 10 patients
O canadensis was found to be associated with distal lateral subungual
onychomycosis (6
patients), white superficial onychomycosis (1 patient), and as an
insignificant contaminant in
the nails of 3 patients. Less commonly the organism may cause tinea
manuum or tinea pedis
interdigitalis. O canadensis appears to be more frequent in the
elderly, especially females. It is
not unusual for a patient with onychomycosis caused by O canadensis to
be a gardener or
farmer, suggesting that the infectious inoculum may originate from the
soil. The optimal
therapy for onychomycosis caused by this organism remains unclear.
CONCLUSION: O
canadensis may be the etiologic agent of distal and lateral subungual
or white superficial
onychomycosis; however, it may sometimes be present in an
abnormal-appearing nail as an
insignificant finding, not acting as a pathogen.
======================================================================
6.) Proximal subungual onychomycosis due to Microsporum canis.
======================================================================
Author
Piraccini BM; Morelli R; Stinchi C; Tosti A
Address
Department of Dermatology, University of Bologna, Cesena, Italy.
Source
Br J Dermatol, 134(1):175-7 1996 Jan
Abstract
A case of proximal subungual onychomycosis due to Microsporum canis in
a 36-year-old
woman is presented. The onychomycosis involved the left thumb and the
little fingernails,
with thinning of the nail plate and crumbling of the nail plate
surface. A milky-white
discoloration of the proximal portion of the left thumbnail was also
evident. A 2-mm
longitudinal nail biopsy showed a large number of fungal elements in
the whole length of the
nail plate. Fungal hyphae were more numerous in the ventral nail plate
and produced
detachment of the superficial nail plate. The nail bed was not invaded
by fungal elements and
was devoid of inflammatory changes. Proximal subungual onychomycosis
is uncommon in
immunocompetent individuals but has frequently been described in
patients with AIDS. In our
patient, in whom the proximal subungual onychomycosis was due to M.
canis, there were no
clinical or biochemical signs of immunodeficiency. Oral treatment with
terbinafine, 250
mg/daily for 2 months, produced clinical and mycological cure.
======================================================================
7.) Unusual clinical features of fingernail infection by Fusarium oxysporum.
======================================================================
Author
Gianni C; Cerri A; Crosti C
Address
Universit`a degli Studi di Milano, Clinica Dermatologica IV, Italy.
Source
Mycoses, 40(11-12):455-9 1997 Dec
Abstract
Four cases of invasion of fingernails caused by Fusarium oxysporum are
described. The
typical picture of onychomycosis by this non-dermatophytic mould is a
'white superficial
onychomycosis' which usually affects the great toenail. Only few cases
of fingernail infections
by this organism have been described in the literature and, to our
knowledge, there are no
reported cases on the pustulous and eczema-like aspect of paronychia
by Fusarium
oxysporum. We report different and unusual clinical features of this
infection successfully
treated with systemic antifungals. Two patients were treated with
terbinafine, 250 mg daily for
3 months, and two patients with itraconazole, 200 mg daily for 3 months.
======================================================================
8.) Nondermatophyte causes of onychomycosis and superficial mycoses.
======================================================================
Author
Gupta AK; Elewski BE
Address
Department of Medicine, Sunnybrook Health Science Center, Toronto,
Canada.
Source
Curr Top Med Mycol, 7(1):87-97 1996 Dec
Abstract
Compared to dermatophytes, nondermatophytes that may cause distal and
lateral subungual
onychomycoses are Aspergillus species, Acremonium species, Fusarium
oxysporum and
Scopulariopsis brevicaulis. White superficial onychomycosis may be
caused by
nondermatophyte species, for example, Acremonium species, Aspergillus
terreus, other
Aspergillus species and Fusarium oxysporum. Nondermatophyte molds such as
Scopulariopsis brevicaulis may uncommonly result in cutaneous
infections. Scytalidium
dimidiatum (Scytalidium anamorph of Hendersonula toruloidea) and
Scytalidium hyalinum
may cause interdigital tinea pedis, and less frequently "moccasin
foot" or plantar tinea pedis.
Nondermatophytes have generally responded poorly to griseofulvin and
ketoconazole. There
have been reports of some nondermatophyte fungi responding to
itraconazole and terbinafine.
======================================================================
9.) The spectrum of nail disease in patients with human immunodeficiency
virus infection.
======================================================================
AUTHOR(S): Daniel CR 3d; Norton LA; Scher RK.
SOURCE: Journal of the American Academy of Dermatology 1992 Jul;27(1):93-7
There are no known pathognomonic nail signs of human immunodeficiency virus
(HIV) infection. However, several presentations should increase the index
of suspicion. (1) Proximal white subungual onychomycosis or superficial
white onychomycosis, especially of the fingernails, is present.
Trichophyton rubrum appears to cause both most commonly in HIV-infected
patients. Periungual dermatophyte involvement and involvement of all 10
fingernails is unusual in non-HIV-infected persons. (2) Candida is a
primary pathogen of the nail bed and nail plate especially if many nails
are involved. (3) A destructive, almost granulomatous-like psoriatic
involvement of the nails is present. (4) Squamous cell carcinoma of the
nail bed in a young adult. There are no clinical trails to confirm the
efficacy of therapy mentioned in this article. The treatment suggestions
are empirical and are the personal views of the authors.
======================================================================
10.) White superficial onychomycosis caused by Trichophyton rubrum.
======================================================================
SO - Cutis 1984 Apr;33(4):384, 386
AU - Sweren RJ
MJ - Onychomycosis [etiology]
MN - Adult; Foot Dermatoses [etiology] [microbiology] [pathology]; Nails
[pathology]; Onychomycosis [microbiology] [pathology]; Trichophyton
[isolation & purification]
MT - Case Report; Female; Human
PT - JOURNAL ARTICLE
AB - A patient with T. rubrum WSO is reported. The presence of this
pathogen, a rare cause of this condition, can be confirmed by examination
of smears and cultures taken from scrapings of the white spots on the nail
plate.
======================================================================
11.) Proximal white subungual onychomycosis: a sign of immunodeficiency.
======================================================================
SO - J Am Acad Dermatol 1994 Jan;30(1):129-30
AU - Rongioletti F; Persi A; Tripodi S; Rebora A
AD - Department of Dermatology, University of Genoa, Italy.
======================================================================
12.) Clinical pearl: proximal white subungual onychomycosis in AIDS.
======================================================================
SO - J Am Acad Dermatol 1993 Oct;29(4):631-2
AU - Elewski BE
AD - Department of Dermatology, University Hospitals of Cleveland, OH 44106.
======================================================================
13.) Onychomycosis in graft versus host disease.
======================================================================
SO - Cutis 1987 Sep;40(3):237-41
AU - Basuk PJ; Scher RK
AD - Department of Medicine, Brown University Program in Medicine,
Providence, Rhode Island.
MJ - Graft vs Host Disease [complications]; Onychomycosis [etiology]
MN - Adult; Mouth Diseases [etiology]; Nail Diseases [etiology]
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE; REVIEW (30 references); REVIEW, MULTICASE
AB - Graft versus host disease is associated with a myriad of cutaneous
signs and few nail manifestations. A case of documented chronic graft
versus host disease with the initial cutaneous presentation of white
superficial onychomycosis is presented. The patient developed a lichenoid
eruption in an unusual distribution and a reticulated hyperpigmentation of
the face. Culture of the nails was positive for Trichophyton rubrum, an
uncommon cause of white superficial onychomycosis, this being the third
known reported case. Histopathologic examination revealed fungal elements
in the superficial nail plate with an absence of fungus in the ventral
aspect of the nail plate. A summary of cutaneous skin and nail
manifestations in graft versus host disease is presented.
======================================================================
14.) Proximal white subungual onychomycosis in a patient with acquired
immune deficiency syndrome.
======================================================================
SO - Int J Dermatol 1986 Nov;25(9):586-7
AU - Noppakun N; Head ES
======================================================================
15.) The spectrum of nail disease in patients with human immunodeficiency
virus infection.
======================================================================
SO - J Am Acad Dermatol 1992 Jul;27(1):93-7
AU - Daniel CR 3d; Norton LA; Scher RK
AD - Department of Medicine (Dermatology), University of Mississippi
Medical Center, Jackson.
MJ - HIV Infections [complications]; Nail Diseases [complications];
Opportunistic Infections [complications]
MN - Candidiasis, Cutaneous [complications]; Dermatomycoses
[complications]; Nail Diseases [diagnosis]
MT - Human
PT - JOURNAL ARTICLE
AB - There are no known pathognomonic nail signs of human immunodeficiency
virus (HIV) infection. However, several presentations should increase the
index of suspicion. (1) Proximal white subungual onychomycosis or
superficial white onychomycosis, especially of the fingernails, is present.
Trichophyton rubrum appears to cause both most commonly in HIV-infected
patients. Periungual dermatophyte involvement and involvement of all 10
fingernails is unusual in non-HIV-infected persons. (2) Candida is a
primary pathogen of the nail bed and nail plate especially if many nails
are involved. (3) A destructive, almost granulomatous-like psoriatic
involvement of the nails is present. (4) Squamous cell carcinoma of the
nail bed in a young adult. There are no clinical trails to confirm the
efficacy of therapy mentioned in this article. The treatment suggestions
are empirical and are the personal views of the authors.
======================================================================
16.) Fungal infections of the nail.
======================================================================
SO - Semin Dermatol 1991 Mar;10(1):41-53
AU - Haneke E
AD - Department of Dermatology, Ferdinand-Sauerbruch-Klinikum, Elberfeld,
Germany.
MJ - Dermatomycoses [microbiology]; Nail Diseases [etiology]
MN - Antifungal Agents [therapeutic use]; Dermatomycoses [drug therapy]
[pathology]; Nail Diseases [drug therapy] [pathology]
MT - Human
PT - JOURNAL ARTICLE; REVIEW (75 references); REVIEW, TUTORIAL
AB - Onychomycoses represent the most frequently seen nail diseases and
are the most difficult to treat of all skin mycoses. They are rare in
children and increase in incidence with age. Most cases are caused by
dermatophytes, in particular by Trichophyton rubrum, less frequently by T
mentagrophytes and Epidermophyton floccosum. Molds may secondarily infect
nails already diseased; however, some are probably capable of primary
invasion of nail tissues. Yeasts, particularly Candida albicans, are mainly
isolated from fingernails in chronic paronychia and onycholysis, and from
nails in chronic mucocutaneous candidosis. Mixed infections by
dermatophytes, molds, and/or yeasts are not uncommon. Probably, most fungi
cannot infect a healthy nail organ, and only predisposing factors such as
impaired blood circulation, peripheral neuropathy, diabetes mellitus,
damage from repeated minor trauma, and limited immune defects as well as
AIDS make the nail susceptible to fungal infection. Most onychomycoses are
secondary to a mycosis of the adjacent skin. Distallateral subungual
onychomycosis starts at the hyponychium spreading proximally to the nail
bed and matrix. In proximal subungual onychomycosis, the fungus infects the
cuticle and eponychium to reach the matrix where it becomes enclosed into
the nail plate substance. Total dystrophic onychomycosis may result from
either form or develop in chronic mucocutaneous candidosis. Superficial
white onychomycosis is commonly a culture of T mentagrophytes on the
surface of a toenail. Mycotic paronychia and onycholysis are usually due to
C albicans. Clinically, onychomycoses have to be differentiated from
noninfectious onychodystrophy, nail psoriasis, lichen planus unguium, and
chronic nail eczema. Despite a considerable number of effective antifungal
drugs, treatment has remained difficult because the predisposing factors
are usually not amendable to therapy.
======================================================================
16.) Onychomycosis and AIDS. Clinical and laboratory findings in 62 patients.
======================================================================
SO - Int J Dermatol 1990 Jun;29(5):337-9
AU - Dompmartin D; Dompmartin A; Deluol AM; Grosshans E; Coulaud JP
AD - Department of Dermatology, Hospital Claude Bernard, Paris, France.
PT - JOURNAL ARTICLE
AB - The results of a study on onychomycosis in AIDS related complex and
AIDS patients presenting for dermatology consultation at an infectious
diseases department are reported. The clinical results showed that most
patients presented a proximal white superficial onychomycosis. The
association with a clinical interdigital involvement was rare, but the
association with a mycotic plantar keratoderma was more frequent. The
laboratory results showed that dermatophytes were the most frequent
etiologic agents, especially Trichophyton rubrum (58%). Although most of
these patients presented an oral candidiasis, Candida albicans was isolated
only in seven patients' nails. Surprisingly, Pityrosporum ovale was the
only etiologic organism that was found in two patients. This result was
confirmed with a histologic examination.
======================================================================
17.) White nails in AIDS/ARC due to Trichophyton rubrum infection.
======================================================================
SO - Clin Exp Dermatol 1988 Jan;13(1):24-5
AU - Weismann K; Knudsen EA; Pedersen C
======================================================================
18.) Onychomycosis.
======================================================================
SO - Dermatol Clin 1985 Jul;3(3):445-60
AU - Zaias N
MJ - Onychomycosis [pathology]
PT - JOURNAL ARTICLE
AB - This article summarizes the diseases of the nail caused by fungi. The
clinical appearance of the diseases are the key to understanding their
causes. Therapy is updated. Specifically discussed are distal subungual
onychomycosis, white superficial onychomycosis, proximal subungual
onychomycosis, and onychomycosis in chronic mucocutaneous candidiasis.
======================================================================
18.) Fungal infection as a cause of skin disease in the eastern province of
Saudi
Arabia: prevailing fungi and pattern of infection.
======================================================================
SO - Mycoses 1991 Jul-Aug;34(7-8):333-7
AU - al-Sogair SM; Moawad MK; al-Humaidan YM
AD - Directorate of Health Affairs, Ministry of Health, Dammam, Kingdom of
Saudi Arabia.
MJ - Dermatomycoses [epidemiology]
MN - Adult; Child; Dermatomycoses [ethnology] [microbiology]; Incidence;
Prevalence; Saudi Arabia [epidemiology]; Tinea Versicolor [epidemiology]
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - A total of 4,294 clinically suspected cases of dermatomycoses
belonging to 26 different nationalities were examined between April 1984
and April 1988. Fungi were demonstrated in routine potassium
hydroxide/dimethyl sulfoxide mount in 3,814 cases (88.8%) and the etiology
was determined by culture in 2,458 cases (57.2%). Tinea versicolor was the
predominant fungal infection (30.9% of all infections). Onychomycosis and
paronychia ranked second in prevalence (16.8%). Candidal onychomycosis was
the most common type of infection. Scalp ringworm among children ranked
third (15.3%), Microsporum canis was the main etiologic agent. Tinea pedis
and tinea manuum ranked fourth in prevalence (13.2%). Tinea corporis
represented 10.7% of infections and M. canis was the main agent. Tinea
cruris accounted for 8.7% of infections and Epidermophyton floccosum was
the most common agent. Cutaneous candidosis constituted 4.3% of infections.
White piedra was seen in 6 cases (0.16%). Yeasts were proved not to be
unimportant as a cause of disease of skin and nail in our study.
======================================================================
19.) Fungal infections of the nails in Western Australia.
======================================================================
SO - Mycopathologia 1981 Feb 13;73(2):115-20
AU - McAleer R
PT - JOURNAL ARTICLE
AB - Between 1963 and 1972, 986 fungi were isolated from the nails of
patients in Western Australia. Three clinical types of infections in both
finger and toe nails were studied. All 3 types occurred more commonly in
adults over the age of 20. Multiple infections were relatively frequent.
Two hundred and fourteen of the nail infections were caused by dermatophyte
fungi. Trichophyton rubrum was the predominant aetiologic agent isolated
from both finger and toe nails, T. mentagrophytes and other dermatophytes
were involved to a lesser degree. Paronychia of the finger nails was common
and mainly caused by C. albicans. Aspergillus species were the most
frequent fungi grown from superficial white onychomycosis.
======================================================================
20.) A higher prevalence of onychomycosis in psoriatics compared with
non-psoriatics: a multicentre study.
======================================================================
Author
Gupta AK; Lynde CW; Jain HC; Sibbald RG; Elewski BE; Daniel CR 3rd;
Watteel GN;
Summerbell RC
Address
Department of Medicine, Sunnybrook Health Science Center, Toronto,
Canada.
Source
Br J Dermatol, 136(5):786-9 1997 May
Abstract
There is some controversy about the prevalence of onychomycosis in
patients with psoriasis
compared to non-psoriatics. We therefore measured the prevalence of
toenail
onychomycosis in psoriatics and non-psoriatics attending
dermatologists' offices. None of
the patients had a referring diagnosis of onychomycosis. The
prevalence of pedal
onychomycosis in psoriatics (n = 561) was 13%. The odds of patients
with psoriasis having
onychomycosis was 56% greater than non-psoriatics of the same age and
sex (P = 0.02). In
the psoriatics, when the toenails were clinically abnormal, the
prevalence of onychomycosis
was 27%. The odds of developing onychomycosis increased with age (P <
0.0001) and the
odds of men developing onychomycosis was 2.5 times that of women (P =
0.0001). The
duration of psoriasis did not significantly affect the odds of
developing onychomycosis. The
fungal organisms recovered from psoriasis subjects with onychomycosis
were similar to
those in the normal population with onychomycosis (P = 0.58).
======================================================================
21.) Onychomycosis in children: prevalence and treatment strategies.
======================================================================
Author
Gupta AK; Sibbald RG; Lynde CW; Hull PR; Prussick R; Shear NH; De
Doncker P; Daniel
CR 3rd; Elewski BE
Address
Department of Medicine, Sunnybrook Health Science Center, Toronto,
Canada.
Source
J Am Acad Dermatol, 36(3 Pt 1):395-402 1997 Mar
Abstract
BACKGROUND: Onychomycosis is observed less frequently in children than
adults. Until
recently management of onychomycosis in children included topical
formulations, oral
griseofulvin, and in some cases deferral of treatment. OBJECTIVE: We
attempted to
determine the prevalence of onychomycosis in North American children
18 years old or
younger attending our dermatology offices (three Canadian, two U.S.)
and to report the
group's experience using fluconazole, itraconazole, and terbinafine
for onychomycosis.
METHODS: We undertook a prospective, multicenter survey in which all
children,
regardless of presenting complaint, were examined for onychomycosis by
a dermatologist.
In instances of clinical suspicion appropriate nail samples were
obtained for light microscopy
and culture. RESULTS: A total of 2500 children under age 18 were
examined in the
five-center survey (1117 males and 1383 females, mean +/- S.E. age:
11.2 +/- 0.1 years).
There was one child with fingernail and ten with mycologically
confirmed toenail
dermatophyte onychomycosis. The overall prevalence of onychomycosis
was 0.44%.
Considering those children whose primary or referring diagnosis was
not onychomycosis or
tinea pedis, the prevalence of onychomycosis was 0.16%. Outside the
survey we have seen
six other children with dermatophyte onychomycosis; these 17 cases
form the basis for the
remainder of the report. Of the 17 children, eight (47%) had
concomitant tinea pedis
infection, and in 11 (65%) a sibling, parent, or grandparent had
onychomycosis or tinea
pedis. Management included topical terbinafine (two patients: one
cured, one failed therapy),
topical ketoconazole (one patient: clinical improvement), oral
fluconazole (two patients: one
cured, one had Down's syndrome and was noncompliant), oral
itraconazole (four patients:
three cured with subsequent recurrence at follow-up in one patient,
one lost to follow-up),
oral terbinafine (five patients: four cured with subsequent recurrence
at follow-up in one
patient, one failed therapy). One child received no therapy following
discussion with the
parents, one was lost to follow-up and one was found to have
asymptomatic hepatic
dysfunction with hepatitis C at pretherapy bloodwork. CONCLUSION: The
prevalence of
onychomycosis in our sample of North American children 18 years old or
younger was
0.44% (n = 2500). In the subset of children whose primary or referring
diagnosis was not
onychomycosis, the prevalence of onychomycosis was 0.16%. Children with
onychomycosis should be carefully examined for concomitant tinea
pedis, and their parents
and siblings checked for onychomycosis and tinea pedis. The newer oral
antifungal agents
fluconazole, itraconazole, and terbinafine may be effective and
well-tolerated in the treatment
of onychomycosis in this age group. These drugs should be carefully
evaluated in a larger
cohort of children with onychomycosis.
======================================================================
22.) Pharmacoeconomic analysis of oral therapies for onychomycosis: a US
model.
======================================================================
Author
Marchetti A; Piech CT; McGhan WF; Neugut AI; Smith BT
Address
Sandoz Pharmaceuticals Corporation, East Hanover, New Jersey, USA.
Source
Clin Ther, 18(4):757-77; discussion 702 1996 Jul-Aug
Abstract
An evaluation of treatment practices in 13 countries, not including
the United States, has
shown oral terbinafine to be more cost-effective (from a government
payer perspective) than
griseofulvin, itraconazole, and ketoconazole in the treatment of
onychomycosis of toenails and
fingernails. The purpose of this study was to evaluate the clinical
and economic effects of oral
griseofulvin, itraconazole, ketoconazole, and terbinafine in the
treatment of onychomycosis
from the perspective of a third-party payer in the United States. A
previously constructed
decision-analytic model evaluating the costs of onychomycosis in 13
countries outside the
United States was updated to determine the costs of treating
onychomycosis in the United
States. Clinical management patterns were assessed to identify and
quantify physician visits,
laboratory tests, and adverse drug reaction treatment components for
patients with toenail
and fingernail onychomycosis. A random-effects model meta-analysis of
treatment efficacy
(mycologic cure) and New York Metropolitan Medicare charge data for
physician fees were
used in the treatment model. A sensitivity analysis assessing
alternative dosing regimens and a
rank order stability analysis investigating the effects of length of
treatment, success rates,
relapse rates, and drug acquisition costs on overall results were also
conducted. Terbinafine
had the lowest cost per mycologic cure after one treatment regimen for
onychomycosis in
both toenail and fingernail infections ($791.00 and $454.00,
respectively). The costs of
treating toenail and fingernail infections were comparatively higher
for therapy with
itraconazole ($1535.00 and $767.00, respectively), griseofulvin
($2385.00 and $837.00,
respectively), and ketoconazole ($10,025.00 and $1512.00,
respectively). As a primary
treatment choice, terbinafine also had the lowest overall expected
cost per patient for both
toenail and fingernail infections ($977.00 and $550.00, respectively).
Griseofulvin had
expected costs ($1543.00 and $822.00, respectively) similar to
itraconazole ($1588.00 and
$894.00, respectively), whereas ketoconazole was the most expensive
primary treatment
choice ($2359.00 and $1287.00, respectively). This study demonstrates
that terbinafine is an
economical and cost-effective treatment for patients with
dermatophytic onychomycosis,
supporting European and Canadian studies. Except for the rank order of
griseofulvin and
itraconazole, sensitivity analyses show that these results are fairly
stable.
======================================================================
23.) Update on the management of onychomycosis: highlights of the Third
Annual International Summit on Cutaneous Antifungal Therapy [see comments]
======================================================================
Author
Elewski BE; Hay RJ
Address
University Hospitals of Cleveland, Ohio, USA.
Source
Clin Infect Dis, 23(2):305-13 1996 Aug
Abstract
Onychomycosis is an increasingly common fungal infection of the nail,
which has traditionally
been difficult to diagnose and treat and has physical and
psychological consequences for the
patient. Onychomycosis can be caused by dermatophytes,
nondermatophytic filamentous
fungi, and yeasts. The relative percentages of cases due to these
etiologic agents vary with
geographic location; however, in the United States, dermatophytes are
the most common
pathogens. Toenails are affected four times as often as fingernails.
Microscopy and culture
are the diagnostic "gold standards" for onychomycosis, although biopsy
of the nail may be
required to obtain a definitive diagnosis when conditions that mimic
onychomycosis, such as
psoriasis, are suspected. The treatment of onychomycosis includes a
combination of topical
therapy, surgical or chemical nail avulsion, and systemic therapy. The
new generation of
systemic agents (itraconazole, fluconazole, and terbinafine) is
associated with a higher cure
rate and shorter courses of treatment than are the older systemic
antifungal drugs (i.e.,
griseofulvin and ketoconazole); these characteristics have sparked new
interest in
onychomycosis. Of these newer antifungals, itraconazole and
terbinafine are the only agents
currently approved by the U.S. Food and Drug Administration for the
treatment of
onychomycosis.
======================================================================
24.) Prevalence of dermatophyte onychomycosis in Spain: a cross-sectional
study.
======================================================================
Author
Sais G; Jucgl`a A; Peyr´i J
Address
Department of Dermatology, Hospital Pr´inceps d'Espanya, Universitat
de Barcelona, Spain.
Source
Br J Dermatol, 132(5):758-61 1995 May
Abstract
To evaluate the prevalence of dermatophyte onychomycosis in Spain, a
cross-sectional
study was conducted between 1992 and 1993. A total of 10,007 subjects
over the age of 15
years were interviewed (using the computer-assisted telephone
interview system), completed
a directed questionnaire, and reviewed a series of photographs of
diverse nail disorders. The
period prevalence of onychomycosis was 2.6% and the point prevalence
1.7%. The
prevalence of onychomycosis was higher in women (1.8%) than in men
(0.8%). Age group
distribution showed a higher onychomycosis prevalence (1.2%) in the
oldest age group (>
55 years). With regard to localization, the prevalence of toenail
onychomycosis was higher
than that of fingernail onychomycosis and of concurrent infection in
both sites. The results of
this study suggest that 802,893 inhabitants of Spain have, or have
previously suffered from
dermatophyte onychomycosis. Only 38.6% have sought medical advice, and
only 14% of
those who did so consulted a dermatologist.
======================================================================
25.) Economic evaluation of antifungal agents in the treatment of toenail
onychomycosis in Germany.
======================================================================
Author
Van Doorslaer EK; Tormans G; Gupta AK; Van Rossem K; Eggleston A;
Dubois DJ; De
Doncker P; Haneke E
Address
Institute for Medical Technology Assessment, Erasmus University,
Rotterdam, The
Netherlands.
Source
Dermatology, 193(3):239-44 1996
Abstract
BACKGROUND: The strategies for the management of onychomycosis have
changed
since the availability of the newer generation of antifungal agents,
particularly, itraconazole
and terbinafine. Itraconazole (1-week pulse) therapy may have higher
efficacy and an
improved adverse-effects profile compared to the continuous therapy
regimen. OBJECTIVE:
We performed a pharmacoeconomic evaluation of the most commonly used
treatments in
Germany for toenail onychomycosis from a health care payer
perspective. METHODS: A
5-step approach was used. Firstly, the purpose of the study, the
comparator drugs, their
dosage regimens and the time frame of the analysis were defined. Next,
the medical practice
and resource consumption patterns associated with the treatment of
onychomycosis were
identified. In step III, a meta-analysis was used to determine the
relative efficacy of the
comparator drugs. In step IV, a decision tree of the treatment
algorithms was constructed for
each comparator. The expected cost analysis and cost-effectiveness
analysis were also
performed. Finally, a sensitivity analysis was carried out. RESULTS:
For the four main
comparator drugs used to treat toenail onychomycosis in Germany, the
clinical response
rates (clinical cure plus marked improvement) at the end of the
follow-up period (month 12
after starting therapy) were, for itraconazole (1-week pulse dosing):
89.8 +/- 3% (mean +/-
SE), terbinafine: 79.4 +/- 10%, itraconazole (continuous dosing): 77.5
+/- 9%, and
ciclopirox nail varnish: 55 +/- 5%. Itraconazole (1-week pulse dosing)
was most
cost-effective at DM 1,107 per successful treatment, followed by oral
terbinafine at DM
1,224, ciclopirox nail varnish and itraconazole (continuous dosing).
Sensitivity analyses
indicated that itraconazole (1-week pulse dosing) and terbinafine had
similar
cost-effectiveness ratios. CONCLUSION: Itraconazole is an effective,
broad-spectrum
triazole used as continuous or pulse therapy in the treatment of
onychomycosis. Itraconazole
(1-week pulse) and terbinafine are the most cost-effective therapies
for toenail
onychomycosis.
======================================================================
26.) Onychomycosis. Going for cure.
======================================================================
Author
Gupta AK; Shear NH
Address
Department of Medicine, Sunnybrook Health Science Centre.
Source
Can Fam Physician, 43():299-305 1997 Feb
Abstract
OBJECTIVE: To review onychomycosis with an emphasis on the traditional
and newer
antifungal agents available to treat onychomycosis. QUALITY OF
EVIDENCE: We
searched MEDLINE for the years 1966 to 1995. We excluded case reports
from our
analysis. MAIN FINDINGS: For treating onychomycosis, newer antifungal
agents (such as
terbinafine, itraconazole, and fluconazole) are more cost-effective
than the traditional agents
griseofulvin and ketoconazole. Of the newer agents, only terbinafine
is currently approved in
Canada for treating onychomycosis. CONCLUSIONS: The new generation of
drugs is an
important addition to the armamentarium of therapies available for
treating onychomycosis.
At the moment, in Canada, terbinafine is the drug of choice and more
cost-effective than
griseofulvin for treating dermatophyte-induced onychomycosis.
======================================================================
27.) Itraconazole therapy is effective for pedal onychomycosis caused by some
nondermatophyte molds and in mixed infection with dermatophytes and molds:
a multicenter study with 36 patients.
======================================================================
Author
De Doncker PR; Scher RK; Baran RL; Decroix J; Degreef HJ; Roseeuw DI;
Havu V;
Rosen T; Gupta AK; Pi´erard GE
Address
Clinical Research Department, Janssen Research Foundation, Beerse,
Belgium.
Source
J Am Acad Dermatol, 36(2 Pt 1):173-7 1997 Feb
Abstract
BACKGROUND: Onychomycosis of the toenail caused by nondermatophyte
molds alone
or in combination with dermatophytes is difficult to eradicate with
standard antifungal therapy.
OBJECTIVE: Our purpose was to determine the effectiveness of
itraconazole in the
treatment of toenail onychomycosis caused by molds alone or in
combination with
dermatophytes. METHODS: We treated 36 patients with this drug given as
continuous
dosing (100 or 200 mg/ day) for 6 to 20 weeks or as a 1-week pulse
dosing (200 mg twice
daily for 1 week per month) for two to four pulses. RESULTS: Patients
with toenail
onychomycosis with the following organisms were treated: Aspergillus
spp. (eight patients),
Fusarium spp. (four patients), Scopulariopsis brevicaulis (23
patients), and Alternaria spp.
(one patient). Nineteen patients had onychomycosis with a mixed
origin. At follow-up, 12
months after therapy was initiated, clinical and mycologic cure was
achieved in 15 of 17
patients (88%) with onychomycosis caused by a single mold. In patients
with mixed
infection, a clinical cure was obtained in 16 of 19 patients (84%) and
a mycologic cure in 13
of 19 patients (68%). CONCLUSION: Itraconazole appears to be effective
and safe for the
treatment of toenail onychomycosis caused by some nondermatophyte
molds alone or in
combination with dermatophytes.
======================================================================
28.) A questionnaire study on the management of onychomycosis: a Canadian
perspective.
======================================================================
Author
Gupta AK; Shear NH
Address
Department of Medicine, Sunnybrook Health Science Center, Toronto,
Canada.
[email protected]
Source
Int J Dermatol, 37(6):457-60 1998 Jun
Abstract
BACKGROUND: Onychomycosis of the toenails is a condition that responds
poorly to
griseofulvin. The introduction of terbinafine in Canada in May 1993
resulted in a marked shift
in the choice of treatment for pedal onychomycosis. METHODS: A
questionnaire survey
was carried out in 1996 among Canadian dermatologists regarding the
management of
onychomycosis. RESULTS: There were 160 respondents from the roughly
350 practicing
dermatologists. The dermatologists saw 8 +/- 0.6 patients per week
(average +/- standard
error (SE) with suspected or diagnosed onychomycosis, with 5 +/- 0.5
patients per week
consulting the dermatologists for the first time. Most dermatologists
performed mycological
testing prior to starting treatment for onychomycosis. The management
options for
onychomycosis (mean +/- SE) were oral systemic antifungal therapy 51
+/- 3%, no therapy
31 +/- 3%, and nondrug therapy 9 +/- 2%. The majority of
dermatologists (83%) used
terbinafine as first-line therapy if, indeed, they used oral
antifungal agents. In contrast,
griseofulvin and ketoconazole were used as first-line therapy in 5%
and 1% of cases,
respectively. In Canada, there are no monitoring requirements when
using oral terbinafine for
onychomycosis. Therefore, it is not surprising that only 30% of
dermatologists performed
monitoring with terbinafine. In contrast, the frequency of monitoring
with griseofulvin and
ketoconazole was 40% and 80%, respectively. The subset of
dermatologists who reported
monitoring carried it out in only a fraction of their patients: 47%,
53% and 83% for
terbinafine, griseofulvin, and ketoconazole, respectively. Therefore,
the overall number of
patients in whom regular monitoring was performed was 14.1% 21.2%, and
71.4% for
terbinafine, griseofulvin, and ketoconazole, respectively. The
perceived cure rates with
terbinafine and griseofulvin (mean +/- SE) were 83.7 +/- 1% and 41 +/-
3.1%, respectively.
CONCLUSIONS: In May 1996, within three years of the introduction of
terbinafine to
Canada, this agent has become the drug of choice for the treatment of
pedal onychomycosis
(at the time of the survey neither itraconazole or fluconazole were
approved for
onychomycosis). Terbinafine has been found to be very effective and
safe, and only a
minority of dermatologists perform regular monitoring with this drug.
======================================================================
29.) Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of
distal subungual onychomycosis of the fingernail.
======================================================================
Author
Drake L; Babel D; Stewart DM; Rich P; Ling MR; Breneman D; Scher RK;
Martin AG;
Pariser DM; Pariser RJ; Ellis CN; Kang S; Katz HI; McDonald CJ; Muglia
J; Savin RC;
Webster G; Elewski BE; Leyden JJ; Bucko AD; Tschen EH; Hanifin JM;
Morman MR;
Shupack JL; Greer DL; et al
Address
Dermatology Clinical Investigations Unit, Massachusetts General
Hospital, Boston
02114-2698, USA.
Source
J Am Acad Dermatol, 38(6 Pt 2):S87-94 1998 Jun
Abstract
BACKGROUND: Onychomycosis is a prevalent infection of the nail caused
primarily by
dermatophytes. Fluconazole is active in vitro against the most common
pathogens, penetrates
into the nail bed, and is clinically effective in the treatment of a
wide variety of fungal
infections. OBJECTIVE: The purpose of this study was to assess the
safety and efficacy of
oral fluconazole 150, 300, and 450 mg administered once weekly
compared with placebo in
the treatment of distal subungual onychomycosis of the fingernail
caused by dermatophytes.
METHODS: This was a multicenter, randomized, double-blind,
placebo-controlled study
enrolling 349 patients with onychomycosis of the fingernails. Clinical
and mycologic efficacy
as well as measures of safety were assessed monthly for a maximum of 9
months of
treatment, with additional safety visits occurring at weeks 2 and 6.
For inclusion, patients
were required to have clinically and mycologically documented
onychomycosis of the
fingernail caused by dermatophytes with at least 25% involvement of
the target fingernail.
After end of therapy, patients with improved or cured fingernails
entered a blinded 6-month
follow-up without drug treatment during which efficacy was assessed
every 2 months.
Efficacy was assessed by clinical (visual) and mycologic (microscopic
and culture) measures.
Clinical measures included assessments of the percentage of target
nail involvement,
measurement of the distance from the nail fold to the proximal
onychomycotic border, and
signs and symptoms of onychomycosis. RESULTS: Fluconazole was
significantly superior to
placebo in eradicating clinical and mycologic symptoms of
onychomycosis, both at the end
of active treatment and at 6 months after treatment (p=0.0001 for all
efficacy measures). At
the end of therapy, 91% to 100% of patients in the fluconazole groups
were judged clinical
successes, defined as reduction of the affected area of the target
nail to less than 25% or
cure, compared with 8% for placebo. Clinical cure rates at end of
therapy were 76%, 85%,
and 90% for fluconazole 150, 300, and 450 mg, respectively, compared
with 3% for
placebo. These clinical success and cure rates were largely maintained
or improved during
follow-up. Clinical relapse in cured patients during the follow-up
period was very low (1.5%
to 3.3%). Fluconazole demonstrated mycologic eradication rates of 89%
to 100% at the end
of treatment and 90% to 99% at the end of follow-up; for placebo the
rates were 8% and
12%, respectively. CONCLUSION: Fluconazole administered once weekly is
safe and
effective in eradicating distal subungual onychomycosis of the
fingernail caused by
dermatophytes.
======================================================================
30.) Antifungal pulse therapy for onychomycosis. A pharmacokinetic and
pharmacodynamic investigation of monthly cycles of 1-week pulse therapy
with itraconazole.
======================================================================
Author
De Doncker P; Decroix J; Pi´erard GE; Roelant D; Woestenborghs R;
Jacqmin P; Odds F;
Heremans A; Dockx P; Roseeuw D
Address
Department of Dermatology, University of Antwerp, Wilrijk, Belgium.
Source
Arch Dermatol, 132(1):34-41 1996 Jan
Abstract
BACKGROUND AND DESIGN: In the treatment of onychomycosis, oral
therapies have
generally been given as a continuous-dosing regimen. For example, the
suggested dose of
itraconazole for the treatment of onychomycosis has thus far been 200
mg/d for 3 months.
Based on the advances in our understanding of the pharmacokinetics of
itraconazole, we
investigated the efficacy and nail kinetics of intermittent
pulse-dosing therapy with oral
itraconazole in patients who were suffering from onychomycosis. Fifty
patients with
confirmed onychomycosis of the toenails, predominantly Trichophyton
rubrum, were
recruited and randomly assigned to three (n = 25) or four (n = 25)
pulses of 1-week
itraconazole therapy (200 mg twice daily for each month). Clinical and
mycological evaluation
of the infected toenails, and determination of the drug levels in the
distal nail ends of the
fingernails and toenails, were performed at the end of each month up
to month 6 and then
every 2 months up to 1 year. RESULTS: In the three-pulse treatment
group, the mean
concentration of itraconazole in the distal ends of the toenails
ranged from 67 (month 1) to
471 (month 6) ng/g, and in the distal ends of the fingernails, it
ranged from 103 (month 1) to
424 (month 6) ng/g. At month 11, the drug was still present in the
distal ends of the toenails
at an average concentration of 186 ng/g. The highest individual
concentrations of 1064 and
1166 ng/g were reached at month 6 for toenails and fingernails,
respectively. At end-point
follow-up, toenails in 84% of the patients were clinically cured with
a negative potassium
hydroxide preparation and culture in 72% and 80% of the patients,
respectively. In the
four-pulse treatment group, the mean concentration of itraconazole in
the distal ends of the
toenails ranged from 32 (month 1) to 623 (month 8) ng/g, and in the
distal ends of the
fingernails, it ranged from 42 (month 1) to 380 (month 6) ng/g. The
highest individual
concentrations of 1549 and 946 ng/g were reached at month 7 for
toenails and at month 9
for fingernails, respectively. At month 12, the drug was still present
in the distal ends of the
toenails at an average concentration of 196 ng/g. At end-point
follow-up, toenails in 76% of
the patients were clinically cured with a negative potassium hydroxide
preparation and culture
in 72% and 80% of the patients, respectively. There were no
significant intergroup
differences between the three- and four-pulse treatment groups for the
primary efficacy
parameters. The drug was well tolerated with no significant side
effects in either patient
group. CONCLUSIONS: Following pulse therapy with itraconazole (400
mg/d given for 1
week each month for 3 to 4 months), the drug has been detected in the
distal ends of nails
after the first pulse, and it has reached therapeutic concentrations
with further therapy. After
stopping the last pulse, the drug remains in the nail plate at levels
above 300 ng/g for several
months. Clinical cure rates between 76% and 84% and negative
mycological examination
findings between 72% and 80%, respectively, were observed in toenail
onychomycosis. The
data suggest that pulse therapy with itraconazole is an effective and
safe treatment option for
onychomycosis.
======================================================================
31.) Measuring health-related quality of life in onychomycosis.
======================================================================
Author
Lubeck DP
Address
Technology Assessment Group, San Francisco, CA 94107, USA.
Source
J Am Acad Dermatol, 38(5 Pt 3):S64-8 1998 May
Abstract
BACKGROUND: Patients with onychomycosis may experience physical
impairment and
psychological and social limitations related to their infection.
OBJECTIVE: The object of this
study was to compare health-related quality-of-life scores of patients
with onychomycosis
with those of a control group. METHODS: The interview instrument
included scales of
general measures, disease-specific factors, and issues specifically
related to onychomycosis
symptoms; the onychomycosis group also was questioned about past
treatment and attitude
towards treatment. RESULTS: A total of 299 persons with onychomycosis
and 381
controls were interviewed. Demographic factors were similar except for
gender and age.
Analyses adjusted for these differences. All general quality-of-life
scores but one were
significantly lower in the onychomycosis group. For responses to
questions related
specifically to nails, the onychomycosis group reported significantly
more problems with
physical appearance than did controls (p < 0.001); the greatest
absolute differences were for
physical activities involving the feet. The majority (88%) of the
onychomycosis group
indicated they would take oral medication even if it had short-term
side effects.
CONCLUSION: Onychomycosis affects generic health-related
quality-of-life measures less
than other variables. The greatest impact is on onychomycosis-specific
measures. Because
patients are willing to try treatment, many of these quality-of-life
concerns can be addressed
by newer oral treatments.
======================================================================
32.) Prevalence and epidemiology of unsuspected onychomycosis in patients
visiting
dermatologists' offices in Ontario, Canada--a multicenter survey of 2001
patients.
======================================================================
Author
Gupta AK; Jain HC; Lynde CW; Watteel GN; Summerbell RC
Address
Department of Medicine, Sunnybrook Health Sciences Center, Toronto,
Canada.
Source
Int J Dermatol, 36(10):783-7 1997 Oct
Abstract
BACKGROUND: Questionnaire studies have been used to determine the
prevalence of
onychomycosis in the United Kingdom and Europe. One disadvantage of
this methodology
is that the patient self-diagnoses the onychomycosis. There have been
very few large studies
involving clinical examination of the nails of subjects, followed by
mycological confirmation of
the onychomycosis. We therefore determined the prevalence of
onychomycosis in patients
visiting dermatologists' offices in Ontario, Canada. METHODS: In a
prospective, multicenter
study, the finger- and toenails of all new patients presenting to
dermatologists' offices were
examined by a board-certified dermatologist. If there was clinical
suspicion of
onychomycosis, then nail samples were obtained for mycological
examination at a central
laboratory. Patients referred specifically for the management of
onychomycosis were
excluded. RESULTS: Toenails appeared abnormal in 455 (22.7%) of 2001
patients.
Mycologically-confirmed pedal onychomycosis was present in 182 (9.1%)
of the 2001
patients. The estimated value of the prevalence of onychomycosis in
Ontario is 6.86% (95%
confidence interval (CI): 5.8-8.0%), when corrected for age and sex of
the general
population using census data. Onychomycosis increased with age (P <
0.0001). The odds
of males having onychomycosis was 84.3% greater than females of the
same age (P =
0.0003). The distribution of organisms in the 141 patients with pedal
onychomycosis who
were culture positive was: dermatophytes 131 (92.9%), Candida species
4 (2.8%) and
non-dermatophyte molds 6 (4.3%). CONCLUSIONS: The prevalence of
mycologically-confirmed toenail onychomycosis was 9.1%, with the
estimated prevalence in
Ontario being 6.86%. The majority of patients with abnormal-appearing
nails were unaware
they might have onychomycosis, that it is infectious and potentially
treatable, suggesting that
there is potential for increased public awareness and education.
======================================================================
DATA-MEDICOS/DERMAGIC-EXPRESS No (16) 12/11/98 DR. JOSE LAPENTA R. DERMATOLOGO
======================================================================
Dr. Jose Lapenta R.
Maracay, Venezuela
[email protected]
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