Itraconazole is a broad spectrum triazole antifungal agent. It has favourable pharmacodynamic and pharmacokinetic profiles and is available as both oral and i.v. formulations. Over the last two decades, clinical and animal infection studies have demonstrated the efficacy of itraconazole in a wide range of superficial fungal infections including difficult-to-treat dermatophytoses and onychomycoses. Furthermore, shortened treatment regimens have proven to be effective, ranging from 1-day treatment for vaginal candidosis to 1-week pulse therapy per month, for 2-4 months, in onychomycosis and follicular dermatophytosis. Clinical experience with itraconazole in the treatment of deep mycoses is less comprehensive. However, results in systemic candidosis, sporotrichosis, blastomycosis, paracoccidioiodomycosis, certain types of histoplasmosis and aspergillosis are extremely encouraging. Itraconazole is less effective in the treatment of chromomycosis and coccidioidomycosis. Nevertheless, considering the refractory nature of these diseases, itraconazole has proven to be a valuable addition to the antifungal drugs currently available for treatment. Itraconazole has been well-tolerated with doses of up to 400 mg/day being generally free of serious adverse effects. However, a potential for drug interactions exists, mediated through the cytochrome P450 enzyme 3A4 system, which should be considered when itraconazole is used as part of a multi-drug regimen.

Despite promising pharmacodynamic and pharmacokinetic pro les, modern antifungals exhibit limited ef cacy in the treatment of onychomycoses. The clinical and mycological data are far from reaching a complete cure even after long-course treatments extending over many months. After reviewing the histological presentation of onychomycoses, one of the main reasons for treatment failure and disease recurrence appears to be the presence of dormant chlamydospores and arthroconidia inside the infected nail plate. Accordingly, we present a novel concept in onychomycosis treatment. It consists of the combination of an antifungal with a device boosting germination of fungal propagules in order to render these cells more responsive to treatment. Preliminary results of a pilot study support such a concept.

Data show that PVP-I limits fungal growth on stratum corneum. Different species and strains of fungi are not similarly affected. There also exists a diversity of individual susceptibility of the stratum corneum to promote germination of yeasts and arthroconidia.

Aim To specify that different types of fungi attack the nails, and that they have different pathogenetic influences. Background There is still debate about the different pathogenicities of the different types of fungi which cause onychomycosis. Materials and Methods Histology, immunohistochemistry and dual flow cytometry were used to identify distinct fungi, including dermatophytes, yeasts and molds, in nail clippings. Results Various distinct fugi were confirmed responsible for nail infection, and these microorganisms were found morphologically indistinguishable from the pathogenic forms that invade other tissues and organs. Conclusion The term onychomycosis comprises a group of diseases of the nails caused by various distinct fungi.

Acquired persistent atypical lentigines are pigmentary lesions that are unusual both clinically and microscopically. They occur in young adults with photosensitive skin using 5-methoxypsoralen-containing sunscreens during sunbathing. Their biologic behavior is benign, but there are grounds for concern regarding the carcinogenic risk in these patients.