Efficacy of Itraconazole, Terbinafine, Fluconazole, Griseofulvin and Ketoconazole in the Treatment of <i>Scopulariopsis brevicaulis</i> Causing Onychomycosis of the Toes

Abstract

Background:Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis. Objective: To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis.Patients and Methods: In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks. Results: There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25–53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment. Conclusions: Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.

Chronic Mycotic-Associated Surgical Nail Pathology Complicated With Ingrown Nail (Nail Incarnation): The Analyses of Clinical Cases and Complex Treatment

“…Index of open capillaries was reduced by 31%. Patients in both groups mainly were affected with hallucis on left foot -in 188 people, the other -on right foot (133 patients), the presence of pathological ingrown nail plates of hallucis of both feet [12,15,17] and otherfingers were examined in other patients.…”

“…Systemic adjuvant pulse therapy with 400 mg itraconazole was applied during two days before the initial surgical treatment and during the first three days of postoperative period [19]. Remediation of other affected nails in order to prevent from mycosis reinfection was carried out with antimycotic amorolfine 5% lacquer and ciclopirox 8% nail lacquer solution [2,[11][12][13]22]. Removal of other nails affected by hyperkeratosis with trichophytosis was performed through onycholysis by separate successive stages, where certain 'pulses' of therapy were supported with itraconazole [19,21].…”

“…the analysis justifies the feasibility of establishing predictive relationships between clinical variants of chronic purulent necrotic infections and combined comorbidity [1,25]. System therapy by itraconazole in operative treatment (basic onychial defeats sanation) and in a postoperative period was carried out [12,25]. The applied types of operative treatment of surgical nail pathology may be divided into five main groups: 1 -EmmertSchmiden type surgeries (marginal excision of nail plate and eponychia with marginal removal of the growing part via partial matricectomy); 2 -Dupuytren's type surgeries (onychectomy -complete removal of nail plate); 3 -Bartlett type surgeries (local tissue plastic re construction); 4 -marginal resection of marginal section of nail plate; 5 -Meleshevych surgery; 6 -our modifications (with previous block-type eponychectomy).…”

“…the results of determining of vitamins В 1 , В 2 , РР, В 6 and С in blood and their derivatives are analysed [22]. Some 50-year-old patients, who have high mycotic surgical nail pathology, have the endothelial dysfunctions and polyvitamin disturbances that are some factors from clinical corrections [10, 12,22].…”

Forty-Eight-Hour Diagnosis of Onychomycosis with Subtyping ofTrichophyton rubrumStrains

“…The most commonly used oral antifungals include itraconazole, terbinafine, and fluconazole; these drugs have superseded the traditional therapies based on the use of griseofulvin and ketoconazole. While terbinafine and itraconazole demonstrate efficacy against T. rubrum and T. interdigitale, griseofulvin and fluconazole are ineffective against T. interdigitale and against molds, e.g., S. brevicaulis, that may cause the infection (19,45).…”