Fractional CO laser-assisted drug delivery is an effective and safe treatment option for onychomycosis.

No abstract

Onychomycosis is an important medical disorder affecting both health and quality of life of patients. This study was done to compare the efficacy of CO 2 laser in combination with topical tioconazole versus CO 2 laser only versus topical tioconazole alone in onychomycosis. A total of 120 patients with onychomycosis were randomly assigned to three groups. Group A patients were treated with fractional CO 2 laser followed by topical tioconazole 28% for five sessions with 3 weeks interval. Group B patients were treated with only fractional CO 2 laser for five sessions with 3 weeks interval. Group C patients were treated with only topical tioconazole 28% for 16 weeks. The clinical effect, KOH examination, and culture for the affected nails in the three groups were analyzed.One month after the last session, regarding clinical response, 55% showed complete clinical improvement in Group A versus 30% in Group B versus 25% in Group C with a significant difference in between. There was a significant difference between the three studied groups as regard KOH test and culture after treatment. Fractional CO 2 laser combined with topical antifungal is a safe and effective treatment for onychomycosis. K E Y W O R D Sfractional CO 2 laser, onychomycosis, tioconazole

Pityriasis versicolor (PV) is a chronic superficial fungal infection. Management using azole drugs leads to drug resistance. The present study aimed to compare the clinical outcome of 0.1% adapalene gel vs 2% ketoconazole cream and their combination in PV. This randomized double‐blinded study was conducted on 90 PV patients divided into three equal groups. GI was treated with topical ketoconazole 2% cream twice daily and placebo, GII was treated with topical 0.1% adapalene gel twice daily and placebo and GIII was treated with topical combination of 0.1% adapalene gel (at night) and ketoconazole 2% cream (in the morning). All patients received medications for 4 weeks. Evaluation was done at 2 and 4 weeks and included clinical assessment, laboratory assessment, and patient satisfaction. We found that after 4 weeks of treatment, all groups showed significant improvement. There was better response in GIII in terms of lower rate of positive potassium hydroxide staining, higher rate of significantly improved cases and higher rate of well‐satisfied patients. However, the difference fell short of statistical significance. We concluded that a combination of adapalene gel and ketoconazole cream is very effective in treatment of PV with no or mild side effects.

Introduction: Granulocyte-macrophage colony-stimulating factor (GM-CSF) is an essential factor in the growth and maturation of blood cells as well as modulation of the immune system. Few studies have investigated its involvement in the development of vitiligo, and no studies have been performed on Egyptian patients. Aim: To assess GM-CSF serum level among non-segmental Egyptian vitiligo patients and to determine its possible role in the etiopathogenesis of the disease. Methods: Forty patients with non-segmental vitiligo and 40 age-and sex-matched subjects were assessed for levels of GM-CSF in serum using the ELISA technique. Results: The patients in this study showed lower levels of GM-CSF in serum compared to controls (mean ± SD was 33.4 ± 5.7 pg/ml versus 63.4 ± 7.4 pg/ml, respectively, p = 0.0001). No appreciable relation was detected between levels of GM-CSF in serum and age, sex, family history, and stressful events or disease activity, type, and extent, p > 0.05. Conclusions: GM-CSF serum level may be one of the determinants of the autoimmune hypothesis in the etiopathogenesis of nonsegmental vitiligo.

Onychotillomania is a psychodermatosis that results from self-induced repeated trauma to the nail unit. It is characterized by the neurotic and irresistible urge to pick at, pull out, or harmfully bite or injure the nail(s). Multiple psychological factors can be involved. It can be difficult to diagnose, as patients mostly deny the self-destructive behavior, and the clinical features may mimic other inflammatory conditions of the nail apparatus. It presents with typical, usually bizarre morphologies of the nail plate. There is no evidence-based treatment for the condition, and it can be highly resistant to both dermatological and psychological interventions. Based on history and classical nail changes, a case of onychotillomania in a 19-year-old woman successfully treated with local steroid injection plus topical calcipotriol/betamethasone dipropionate combination is presented. An injection of a local steroid (0.2 mL of 5 mg/mL triamcinolone acetonide) was given monthly for 3 months and was then decreased to a bimonthly interval. In addition, topical calcipotriol/betamethasone dipropionate combination was applied daily for 3 months and was then decreased to every other day. Clinical improvement was noted after the third month, while complete resolution of the condition was achieved after 8 months. This treatment regimen can be advocated for similar nail dystrophies after excluding infective etiology.

Background. The etiology of foot intertrigo is varied. Several pathogens and skin conditions might play a role in toe web space lesions. Objective. To identify the possible etiological causes of toe web space lesions. Methods. 100 Egyptian patients were enrolled in this study (72 females and 28 males). Their ages ranged from 18 to 79 years. For every patient, detailed history taking, general and skin examinations, and investigations including Wood's light examination, skin scraping for potassium hydroxide test, skin swabs for bacterial isolation, and skin biopsy all were done. Results. Among the 100 patients, positive Wood's light fluorescence was observed in 24 and positive bacterial growth was observed in 85. With skin biopsy, 52 patients showed features characteristic for eczema, 25 showed features characteristic for fungus, 19 showed features characteristic for callosity, and 3 showed features characteristic for wart while in only 1 patient the features were characteristic for lichen planus. Conclusion. Toe web space lesions are caused by different etiological factors. The most common was interdigital eczema (52%) followed by fungal infection (25%). We suggest that patients who do not respond to antifungals should be reexamined for another primary or secondary dermatologic condition that may resemble interdigital fungal infection.

Onychomycosis often presents as thickened, discolored nails. Usually, one or both great toenails are affected. Eventually, the nail plate becomes friable and may split and break up, often due to trauma or invasion of the plate by dermatophytes that have keratolytic properties. Dermatophytoma is a unique feature of onychomycosis that occurred by abundant fungal filaments and spores forming a fungal ball under the nail plate. It is often refractory to traditional therapy. Based on the clinical and mycological examination, a case of onychomycosis in a 45-year-old woman presented as dermatophytoma with longitudinal nail splitting caused by <i>Trichophyton rubrum</i> is presented. The case was successfully treated with nail plate debridement plus topical ciclopirox olamine 1% solution. Nail debridement was performed using a 15-scalpel blade to remove the affected nail portion with the underlying subungual debris to enhance the effect of topical ciclopirox 1% solution which was then applied 3 times daily to the debrided area. Follow-up visits with nail photography were planned every 2 weeks after the procedure to check treatment progress. A complete clinical resolution was achieved after 5 months. This treatment option can be advocated for similar nail conditions avoiding unnecessary and expensive lines of treatment.