****** DATA-MÉDICOS *********

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ONICOMICOSIS BLANCA

WHITE ONYCHOMYCOSIS

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***** DERMAGIC-EXPRESS No 17 ********* 

****** 16 NOVIEMBRE 1.998 ******* 

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 EDITORIAL ESPANOL:

====================

Hola amigos de la red, DERMAGIC, de nuevo con ustedes, el tema de hoy la onicomicosis, haciendo énfasis en la onicomicosis blanca de la cual hay poca literatura. Encontre unas 19 referencias sobre tan interesante patología y las complemente con otros 13 artículos muy buenos sobre el tema. 

Esta edición esta dedicada a TODOS los micólogos de nuestro mundo Dermatológico que nos rodea, especialmente a la lista FUNGI, del Dr. Paulo Taborda (Brasil),, saludos. 

Dr. Roberto Pribyl, Rolando Hernandez,, 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,,,será eso ?? 

La onicomicosis blanca se ha notificado principalmente en pacientes inmunodeprimidos, especialmente aquellos con infección por el virus de la inmunodeficiencia humana (VIH) y otros pacientes inmunodeprimidos. En los últimos años también se han diagnosticado casos de esta patología en pacientes inmunocompetentes. Pero Una onicomicosis blanca o superficial de la lámina ungueal no significa necesariamente que el paciente este inmunodeprimido.

Dr. Raul Fachin, me encanto que todo salio bien, DERMAGIC, siempre divulgará información Dermatológica de interés para todos. Felicitaciones a la Residente Arminda Acuña por su premio,,,

Hasta una próxima edicion,,, saludos

Próximas ediciones: * EL SOLARASE,,,, * LEISHMANIASIS, PENTAMIDINA E ITRACONAZOLE 

 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. 

White onychomycosis has been reported mainly in immunocompromised patients, especially those with human immunodeficiency virus (HIV) infection and other immunocompromised patients. In recent years, cases of this pathology have also been diagnosed in immunocompetent patients. But a white superficial onychomycosis of the nail plate does not necessarily mean that the patient is immunosuppressed.

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. agupta@execulink.com 

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.

agupta@execulink.com 

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-MÉDICOS/DERMAGIC-EXPRESS No (16) 16/11/98 DR. JOSE LAPENTA R. DERMATÓLOGO

======================================================================

Produced by Dr. José Lapenta R. Dermatologist
Venezuela 1.998-2.024

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.0024

Tlf: 0414-2976087 - 04127766810