Ajoene and 5-fluorouracil in the topical treatment ofCladophialophoracarrioniichromoblastomycosis in humans: a comparative open study

Abstract

Ajoene and 5-fluorouracil (5-FU) are compounds that have shown in-vitro activity against Cladophialophora carrionii, an important etiologic agent of chromoblastomycosis. An open comparative trial was conducted to assess safety and effectiveness of topical ajoene and 5-FU in the treatment of localized chromoblastomycosis. Thirty-seven patients with a clinically and mycologically confirmed diagnosis were randomly distributed into two groups allocated to ajoene (0.5% gel; n = 19) or 5-FU (1% cream; n = 18). Topical treatment was applied to localized lesions (< or = 2.5-cm diameter) once a day, with occlusion, for 12-16 weeks. Complete clinical and mycological remission was achieved in 14/19 patients (74%) treated with ajoene and 14/18 patients (78%) treated with 5-FU. All 5-FU-treated patients developed a post-treatment scar at the site of the lesion, while ajoene-treated patients showed only a slight depigmentation of the skin. The differences observed in cure rate between ajoene and 5-FU are not statistically significant. Follow-up of all patients for 4 years revealed no relapses in the ajoene-treated group, while one patient in the 5-FU-treated group had a relapse 6 months after the end of therapy. This trial represents the first clinical use of ajoene in the control of a deep mycosis.

Management of chromoblastomycosis: novel perspectives

“…There is thus no 'gold standard' therapy for this mycosis but several treatment options including systemic antifungals used alone or combined with physical methods such surgery, local heat, or topical liquid nitrogen. Recently, topical ajoene was shown to result in the same response as topic 5-flucytosine in patients with mild forms of chromoblastomycosis caused by C. carrionii [20]. A comprehensive review of the principal therapeutic choices in chromoblastomycosis was published by Bonifaz et al [21 ].…”

Early State Research on Antifungal Natural Products

“…It had the ability to block the transition from the mycelial phase to the yeast-like phase (an important mechanism in the pathogenicity of paracoccidioidomycosis) and efficiently controlled this disease in mouse experiments [127,128]. Furthermore, studies have shown that ajoene is effective for the topical treatment of superficial mycoses [129,130,131] and subcutaneous disease [132]. Thus, ajoene extract is an alternative for the treatment of the tested fungus and especially for onychomycosis caused by Fusarium spp.…”

Treatment of Refractory Chromomycosis by Isolated Limb Infusion with Melphalan and Actinomycin D

“…Melphalan and actinomycin D are also likely to have direct cytotoxic effects on the causative fungus, similar to those observed in vitro and in vivo with 5-fluorouracil. 17 Melphalan and actinomycin D are the standard agents used for ILI at our institution, and we have used this technique to treat refractory and extensive bilateral hand warts. 18 Although complete eradication of warts was not achieved, the procedure rapidly restored functional use of the hands, and the patient had prolonged improvement, with only minimal recurrence of his warts.…”