Onychomycosis is a fungal infection of the nail unit including the nail matrix, the nail bed and the nail plate by both dermatophyte and non-dermatophyte agents. It is disturbs not only cosmetic disfigurement, but also it may have an impact on patients’ emotional, social and occupational functioning, finally affecting the overall quality of life. The incidence rate tends to increase, management of onychomycosis is still challenging. Important problems regarding antifungal monotherapy have experienced many failures and recurrences. In general, pharmacological approaches for onychomycosis can be topical or oral antifungal. Antifungal monotherapies often lead to failure treatment, also high incidence of recurrence. One strategy for this problem is a combination antifungal therapy. In vitro studies show the synergistic effect of using combination two antifungals (both oral antifungal or combination topical and oral antifungal), hence it is mycologically or clinically expected to increase the success rate of onychomycosis therapy. This review tries to evaluate the previous study exploring the effectiveness of antifungal combination therapies on onychomycosis. Two oral antifungals usually used are terbinafine as fungicidal agent and itraconazole as fungistatic agent. There is combination between topical and oral antifungal such as itraconazole or terbinafine with amorolfine or ciclopirox, also other combination like griseofulvin and amorolfone or tioconazole. All the combination therapies show better result than monotherapy alone, but it is still difficult to conclude whether antifungal combinations in onychomycosis will increase effectiveness due to variations in therapeutic duration, result definition, and statistical evaluation on existing studies. Further research is required with longer duration of observation, uniform patient criteria and definition of success, random control and blinding to minimize bias.
Atopic dermatitis is chronic pruritic inflammatory skin disease affects one third of children in the world, and the highest number of child`s skin problems in Indonesia. The complex role of the skin microbiome in the pathogenesis of atopic dermatitis is being elucidated. Interaction between skin barrier defects, and immunological factors can change the skin microbiome, and increased Staphylococcus aureus colonization. The aim of this study was to compare the colony of Staphylococcus aureus from antecubital fossa of non-exacerbated atopic dermatitis children to healthy children without history of atopic dermatitis. A comparative observational analytic with cross sectional design, examined antecubital swab culture from 17 non-exacerbated atopic dermatitis patients and 17 controls to investigate the presence of Staphylococcus aureus and density of the colonization. Staphylococcus aureus skin colonization was seen in 5 patients (29.41%) in non-exacerbated atopic dermatitis patients but none in control group (statistically significant with p=0.044), relative risk 2.417. All of positive colonization revealed moderate and heavy bacterial growth (104->105 cfu/cm2). This finding supports previous study that atopic dermatitis prone to colonized with Staphylococcus aureus.
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