-
[show abstract]
[hide abstract]
ABSTRACT: Background:The influence of dosing regimens on the recurrence rates of onychomycosis has not been investigated.Objective:To compare recurrence rates for toenail dermatophyte onychomycosis between four dosing regimens.Methods:A prospective, investigator-blinded, long-term follow-up (1.25 to 7 years postenrolment) study of the following regimens was undertaken with or without booster therapy at week 36: overlapping continuous itraconazole and terbinafine (COMBO), continuous terbinafine (CTERB), intermittent terbinafine (TOT), and pulsed itraconazole (III).Results:One hundred six mycologically and 43 completely cured participants at week 48 were included. Recurrence rates (RR) for mycologically and completely cured participants were respectively termed mycologic recurrence (MRR) and complete cure recurrence (CRR) rates. No statistically significant difference was detected between the four regimens for the two rates. However, lower MRRs were obtained for CTERB (32%) and TOT (36%) compared to III (59%) and COMBO (57%). When participants who received booster therapy were excluded from the analysis, the MRR was lower for CTERB (21%) compared to TOT (39%).Conclusions:Itraconazole therapy was associated with higher RRs than terbinafine therapy. Combined therapy did not reduce the RRs compared to monotherapies. A difference might exist between continuous and intermittent antifungal regimens, but additional randomized clinical trials are needed for confirmation.
Journal of Cutaneous Maedicine and Surgery 06/2013; 17(3):201-206. · 0.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Nondermatophyte mold (NDM) onychomycosis is difficult to diagnose given that NDMs are common contaminants of the nails and of the mycology laboratory. Diagnostic criteria and definition of cure are inconsistent between studies, which may affect the quality of published data. We identified 6 major criteria used in the literature: identification of the NDM in the nail by microscopy (using potassium hydroxide preparation), isolation in culture, repeated isolation in culture, inoculum counting, failure to isolate a dermatophyte in culture, and histology. Most studies used 3 or more of these (range = 1-5). We recommend using at least 3 of the criteria to rule out contamination; these should include potassium hydroxide preparation for direct microscopy and isolation of the organism in culture. We review geographic distribution and clinical presentations associated with different NDMs. The treatment with the greatest quantity of data and highest reported cure rates is terbinafine, for the treatment of Scopulariopsis brevicaulis and Aspergillus species infections. Topicals such as ciclopirox nail lacquer may also be effective (data originating from Scopulariopsis brevicaulis and Acremonium species infections), especially when combined with chemical or surgical avulsion of the nail. We recommend that future studies use (and clearly indicate) at least 3 of the main criteria for diagnosis, and report the clinical type of onychomycosis and the isolated organism. When evaluating different treatments, we suggest that authors clearly define their efficacy outcomes.
Journal of the American Academy of Dermatology 08/2011; 66(3):494-502. · 3.99 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Methods to treat onychomycosis are varied, using therapies that can be categorized as topical, oral or device-related. Since their development, oral therapies have represented the gold standard for treatment over other methods. However, efficacy with oral therapies remains limited, and safety may be an issue, leaving many patients requiring alternative treatments. With research advances, topical therapies as alternatives for onychomycosis are being investigated with greater interest as new technologies are overcoming previous limitations of topical treatments, such as lack of nail penetration. New device-related topical therapy methods are particularly noteworthy, as they may allow for shorter, more convenient treatments for patients, reducing issues with topical compliance, and, in cases of non-drug light-based therapies, they will avoid potential for drug reactions. Research in these fields is preliminary, and the impact these methods may have on the future of onychomycosis remains to be seen.
Journal of drugs in dermatology: JDD 09/2010; 9(9):1109-13. · 1.57 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Despite its long history in clinical use, reported efficacy rates of griseofulvin remain highly variable. A meta-analysis of clinical trials of griseofulvin use in tinea capitis was performed to determine mean griseofulvin efficacy. A review of the literature identified 7 studies. When all 7 studies were pooled, the overall mean effective cure (negative KOH and culture) of griseofulvin at 4 to 6 weeks posttreatment was 73.4% +/- 7% (7 studies, n = 438 patients). Higher efficacy rates appeared to be reported with the use of higher dosages of griseofulvin (> 18 mg/kg/d). When broken down by species, the mean efficacy for Trichophyton and Microsporum were 67.6% +/- 9% (5 studies, n = 396) and 88.1% +/- 5% (2 studies, n = 42 patients), respectively. Based on these studies, griseofulvin efficacy has remained consistently high over the past decade. Both genera showed good efficacy with griseofulvin therapy given from 6 to 8 weeks. Griseofulvin remains an effective therapy for tinea capitis.
Journal of drugs in dermatology: JDD 05/2008; 7(4):369-72. · 1.57 Impact Factor
-
12/2007: pages 355-381;
-
[show abstract]
[hide abstract]
ABSTRACT: Ciclopirox is an antifungal agent and is effective against both Gram-positive and Gram-negative bacteria. These properties may give ciclopirox an advantage over other antifungal agents in the treatment of interdigital tinea pedis with secondary bacterial infection (dermatophytosis complex).
To evaluate the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis interdigitalis with secondary bacterial infection in a prospective, randomized, double-blind, placebo-controlled clinical study.
One hundred subjects were enrolled in this 8-week study (twice-daily ciclopirox, 40 subjects; once-daily ciclopirox, 40 subjects; twice-daily vehicle, 20 subjects). Mycologic sampling, bacterial swabs, and evaluations for symptoms and signs of tinea pedis were performed on a target webspace at baseline and at weeks 2, 4, and 8. Global evaluations were made by both investigator and subject at each visit.
Ciclopirox gel applied once or twice daily significantly reduced the signs and symptoms at week 8, compared with vehicle (P<0.0036). The mycologic cure and complete cure rates were much higher for the ciclopirox regimens than for the vehicle regimen. Early reduction of bacterial counts was noted with the ciclopirox regimens. There was no significant difference in the adverse event rate between the ciclopirox groups and the placebo group.
Ciclopirox 0.77% gel, applied once or twice daily, is effective and safe in the treatment of tinea pedis interdigitalis with concomitant bacterial infection (dermatophytosis complex).
International Journal of Dermatology 07/2005; 44(7):590-3. · 1.14 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Background Ciclopirox is an antifungal agent and is effective against both Gram-positive and Gram-negative bacteria. These properties may give ciclopirox an advantage over other antifungal agents in the treatment of interdigital tinea pedis with secondary bacterial infection (dermatophytosis complex).Objective To evaluate the efficacy of ciclopirox 0.77% gel in the treatment of tinea pedis interdigitalis with secondary bacterial infection in a prospective, randomized, double-blind, placebo-controlled clinical study.Subjects and methods One hundred subjects were enrolled in this 8-week study (twice-daily ciclopirox, 40 subjects; once-daily ciclopirox, 40 subjects; twice-daily vehicle, 20 subjects). Mycologic sampling, bacterial swabs, and evaluations for symptoms and signs of tinea pedis were performed on a target webspace at baseline and at weeks 2, 4, and 8. Global evaluations were made by both investigator and subject at each visit.Results Ciclopirox gel applied once or twice daily significantly reduced the signs and symptoms at week 8, compared with vehicle (P < 0.0036). The mycologic cure and complete cure rates were much higher for the ciclopirox regimens than for the vehicle regimen. Early reduction of bacterial counts was noted with the ciclopirox regimens. There was no significant difference in the adverse event rate between the ciclopirox groups and the placebo group.Conclusion Ciclopirox 0.77% gel, applied once or twice daily, is effective and safe in the treatment of tinea pedis interdigitalis with concomitant bacterial infection (dermatophytosis complex).
International journal of dermatology 06/2005; 44(7):590 - 593. · 1.18 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Superficial fungal infections are chronic and recurring conditions. Tinea capitis is a scalp infection, primarily affecting prepubescent children. Ringworm infections, such as tinea corporis and tinea cruris, involve the glabrous skin. Tinea nigra is a rare mycotic infection that may be related to travel abroad. Piedra, black or white, is limited to the hair shaft without involvement of the adjacent skin. Pityriasis (tinea) versicolor and seborrheic dermatitis are dermatoses associated with yeasts of the genus Malassezia that affect the lipid-rich areas of the body. The taxonomy of the Malassezia yeasts has been revised to include nine species, eight of which have been recovered from humans. Tinea pedis, an infection of the feet and toes, is one of the most common forms of dermatophytosis. Onychomycosis is a fungal infection affecting the nail bed and nail plate; it may be chronic and can be difficult to treat. In instances where the superficial fungal infection is severe or chronic, an oral antifungal agent should be considered. Terbinafine, itraconazole, and fluconazole are oral antifungals that are effective in the treatment of superficial mycoses.
American Journal of Clinical Dermatology 12/2003; 5(4):225-237. · 1.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The most common presentation of tinea pedis (athlete's foot) is that involving the interdigital spaces. Tinea pedis interdigitalis may present as asymptomatic dermatophytosis simplex or dermatophytosis complex, which is symptomatic, with secondary bacterial infection. In the dermatophytosis complex presentation there may be inflammation, maceration and odor, with bacterial involvement. Ciclopirox gel offers advantages in the treatment of tinea pedis, especially in the dermatophytosis complex presentation, with antifungal, antibacterial, and anti-inflammatory activity; furthermore, the gel formulation is fast drying, which is an advantage when the toe web area is moist.
International Journal of Dermatology 10/2003; 42 Suppl 1:23-7. · 1.14 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To estimate the incidence of, and the variables affecting, illegible drug prescriptions in the United States.
Illegible notations of medications (ie, drug mentions) on the patient record form used for data collection in the National Ambulatory Medical Care Survey from 1990 to 1998 were used as a proxy for the incidence of illegible prescriptions in the United States.
The average incidence of illegible mentions was 1.44%. Increased age of patient, female sex, urban practice setting, increased number of diagnoses and prescriptions written during the visit and seeing a family physician or internist were associated with an increased probability of at least 1 illegible drug mention.
Distinct characteristics are associated with a higher incidence of illegible prescriptions. Multiple diagnoses and an increased number of prescriptions, both of which contribute to the complexity of a patient visit, are especially likely to be associated with at least 1 illegible prescription per visit. Physicians need to recognize factors contributing to illegible prescriptions to maintain high standards of care.
The American journal of managed care 09/2003; 9(8):548-52. · 2.46 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In summary, terbinafine is a broad-spectrum allylamine, which has been used to treat superficial fungal infections including onychomycosis, and some systemic mycoses in adults. With a fungicidal activity, low minimum inhibitory concentration value, and high selectivity for fungal squalene epoxidase, terbinafine has demonstrated good efficacy in superficial fungal infections. Its lipophilic nature provides excellent, widespread absorption into hair, skin, and nails where it can eradicate fungal infection. Terbinafine has been shown to be effective and safe in several studies of the treatment of tinea capitis and onychomycosis in children. When treating Trichophyton tinea capitis the length of therapy may be 2 or 4 weeks. Microsporum tinea capitis may require somewhat higher or longer doses of terbinafine for adequate efficacy. These regimens still tend to be shorter than treatment with griseofulvin, and terbinafine may provide a higher compliance and a more cost-effective means of managing tinea capitis. It is possible that even higher cure rates and a shorter duration of therapy may be achieved following further optimization of treatment regimens that use a higher daily dosage of terbinafine than is currently recommended. The evidence is strongly in favor of using terbinafine to treat superficial fungal infections in children.
Dermatologic Clinics 08/2003; 21(3):511-20. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Seborrheic dermatitis is present in 1% to 3% of immunocompetent adults, and is more prevalent in men than in women. Seborrheic dermatitis may be seen in conjunction with other skin diseases, such as rosacea, blepharitis or ocular rosacea, and acne vulgaris. Malassezia yeasts have been associated with seborrheic dermatitis. Abnormal or inflammatory immune system reactions to these yeasts may be related to development of seborrheic dermatitis. Treatment modalities for seborrheic dermatitis include keratolytic agents, corticosteroids, and more recently, antifungal agents. Antifungal agents do not carry a risk of skin atrophy or telangiectasia with prolonged use, and it is more prudent to consider antifungals than corticosteroid preparations. The wide range of antifungal formulations available (creams, shampoos, or oral) provides safe, effective, and flexible treatment options for seborrheic dermatitis.
Dermatologic Clinics 08/2003; 21(3):401-12. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Fluconazole has excellent absorption and good persistence in tissues that suggests it may be useful in superficial fungal infections. The predominant use in pediatric superficial fungal infection has been for tinea capitis, and successful treatment has been shown with both daily and weekly fluconazole regimens. The data regarding fluconazole use in superficial fungal infections in children are somewhat limited; however, it seems that there is good potential for the safe use of fluconazole to treat tinea capitis in children. Further studies need to be conducted, particularly in cases of tinea capitis (both T. tonsurans and M. canis), to determine the optimal treatment regimens using fluconazole.
Dermatologic Clinics 08/2003; 21(3):537-42. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Current dosing regimens for itraconazole are effective, safe, and versatile for use in superficial fungal infections in children, particularly tinea capitis. Good efficacy rates have been noted in both Trichophyton and Microsporum tinea capitis infections. Itraconazole has a high affinity for keratin, and accumulates to high levels at the site of superficial fungal infections. A pulse regimen may be chosen over continuous dosing, because the accumulation persists after dosing of itraconazole has been stopped. An oral solution of itraconazole is available, and may be more convenient for children who cannot swallow capsules. The oral solution also produces good rates of efficacy, but may be associated with a somewhat higher potential for gastrointestinal adverse events than the capsules. The range of adverse events noted with itraconazole capsules or oral solution use in children is similar to the range in adults. Events are generally mild and transient. Attention must be taken to note any medications that the child is using, because itraconazole is associated with a range of potential drug interactions. This safety of use, in combination with itraconazole's wide antifungal spectrum and pharmacokinetic properties, which allow for shorter dosing regimens, may make itraconazole a suitable alternative to griseofulvin for pediatric superficial fungal infections.
Dermatologic Clinics 08/2003; 21(3):521-35. · 2.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Although actinic keratosis (AK) has been linked to the development of nonmelanoma skin cancer (NMSC), particularly squamous cell carcinoma (SCC), increased awareness regarding diagnosis and treatment may be an important component for reducing morbidity and even mortality from AK and NMSC. We used the National Ambulatory Medical Care Survey (NAMCS) data from 1990 to 1999 to evaluate the diagnosis and treatment of AKs among a wide variety of patients by physicians across the United States. To our knowledge, no widespread surveys of North American populations have been performed recently to determine the epidemiology of AK. AK was diagnosed in more than 47 million visits over the 10-year period surveyed and was found to occur in 14% of patients visiting dermatologists. The diagnosis of AK as determined by NAMCS does not reflect the true prevalence of AK because only patients seeking physician diagnosis were surveyed. This suggests that the actual number of patients in the United States with AK is much higher than 14%. Rates of AK diagnosis in the standard metropolitan statistical areas (SMSAs) and non-standard metropolitan statistical areas (non-SMSAs) of the West states are higher than in other states, but geographic location may not be a direct risk factor for the development of AKs. Procedures were undertaken at 70% of visits where AK was the primary diagnosis. Destruction of lesions was the most frequently performed procedure found in the survey considering only the 1993 and 1994 NAMCS data. Biopsy was the second most frequently performed procedure.
Cutis; cutaneous medicine for the practitioner 09/2002; 70(2 Suppl):8-13. · 0.81 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Naftifine is a topical allylamine that is effective and safe in the management of superficial dermatomycoses. Naftifine is fungicidal in vitro against a broad spectrum of dermatophyte fungi and provides good activity against Candida and Aspergillus species. It is also effective against gram-negative and gram-positive bacteria.
To provide a review of the pharmacologic properties and clinical efficacy of topical naftifine preparations.
A review of the medical literature was performed using PubMed (1965-2006) using the search term "naftifine." All available English-language articles discussing the pharmacology and clinical use of naftifine were reviewed for the article.
Naftifine causes interruption of fungal ergosterol synthesis and accumulation of squalene in fungal organisms. Naftifine also has demonstrated anti-inflammatory properties such as a reduction in superoxide production and a reduction in polymorphonuclear leukocyte chemotaxis/endothelial adhesion. Naftifine has shown good efficacy and safety for a variety of conditions and is a useful treatment that provides both antifungal action and relief of inflammatory signs and symptoms. Few adverse events have been noted with naftifine use, the most frequent being mild and transient burning, stinging, or itching in the application area.
Naftifine remains a reliable multifunctional agent for a variety of superficial infections.
Journal of Cutaneous Maedicine and Surgery 12(2):51-8. · 0.98 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The recent advances in pityriasis versicolor, seborrheic dermatitis, tinea capitis and onychomycosis are reviewed. Some highlighted points include the new classification of Malassezia species, and the association of Malassezia species with seborrheic dermatitis. The use of terbinafine, fluconazole, and itraconazole for the treatment of tinea capitis is discussed. The management of onychomycosis, highlighting the high efficacy rates obtained with terbinafine when used to treat dermatophyte toenail onychomycosis, is discussed. The use of combination therapies in some circumstances to maximize cure rates is reviewed.
Clinics in Dermatology 21(5):417-25. · 2.33 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Dermatophytosis is an infection of the hair, skin, or nails caused by a dermatophyte, which is most commonly of the Trichophyton genus and less commonly of the Microsporum or Epidermophyton genera. Tinea capitis, tinea pedis, and onychomycosis are common dermatologic diseases that may result from such an infection. The treatment of fungal infections caused by a dermatophyte has been successful when treated with oral or topical antifungal agents. Terbinafine, itraconazole, and fluconazole are oral antimycotics that are effective in the treatment of superficial mycoses, although, depending on the severity of the infection, a topical antifungal may be sufficient.
SKINmed 4(5):305-10.
-
SKINmed 8(4):227-9.
-
[show abstract]
[hide abstract]
ABSTRACT: Nail psoriasis is common among patients with plaque psoriasis or psoriatic arthritis and has a detrimental effect on quality of life. However, there are currently no standardized therapeutic regimens for nail psoriasis. Traditional treatments for nail psoriasis, which include topical, intralesional, and oral therapies, may be time-consuming, painful, or unsafe when administered long term. Biologic therapies have demonstrated efficacy for plaque psoriasis and psoriatic arthritis; these therapies may be particularly promising for the treatment of nail psoriasis as both groups of patients have an elevated incidence of nail dystrophy. The biologic therapies adalimumab, alefacept, efalizumab, etanercept, and infliximab have demonstrated clinically important nail psoriasis improvements using the Nail Psoriasis Severity Index, a helpful tool that, upon validation, will allow comparison across treatments and trials. Large-scale, long-term trials using standardized outcome measures are needed to further evaluate biologic therapies for the treatment of nail psoriasis.
Journal of Cutaneous Maedicine and Surgery 13 Suppl 2:S102-6. · 0.98 Impact Factor
