Efficacy of topical vs combined oral and topical antifungals in white piedra of the scalp

Abstract

White piedra (WP) of the scalp is a superficial mycotic infection of the hairs frequently reported in tropical humid regions as Southeast Asia, South America, and Middle East. 1 The majority of cases occur in children and young adult females. 2 It is characterized clinically by the presence of multiple whitish soft nodules along the hair shafts. The patients may also present with dry lusterless hair, hair breakage, and frayed ends. 3 Direct microscopic examination and culture of infected hair enable a definitive diagnosis to be made. 4 Treatment of scalp WP is challenging as eliminating the fungus through cutting the hair is not always acceptable by the patients. Moreover, lack of response and post-treatment relapse is frequently encountered after topical antifungal therapy. 3 Persistent infection is more common in patients with long hair and those who reutilize their infected hairbrushes. 5 It was also hypothesized that the organism may cause penetration of the hair cuticle by its keratolytic activity, which

Familial White Piedra Caused by <i>Trichosporon inkin</i>

“…The patients were treated with topical azoles and/or systemic triazoles. There is no consensus on the treatment of this mycosis, El Attar et al [15] compared three therapy modalities: 1) topical azoles, 2) topical and oral azole; and 3) topical azole and oral terbinafine. The percentages of cure were in 1) 50% in 12 weeks; 2) 75% in four weeks; 3) 60% in eight weeks, the combination of topical and oral azolic drugs showed to be the best therapy.…”

Modelo experimental in vitro de piedra branca e avaliação do perfil de susceptibilidade de Trichosporon frente a derivados de tiofeno-tiosemicarbazona (L10)

“…Os índices de casos de infecções invasivas causadas por patógenos fúngicos, em especial, o Trichosporon, tem aumentado consideravelmente devido a limitação da sensibilidade a diversas classes de antifúngicos, assim como a ausência de novos fármacos eficazes (Iturrieta-González et al, 2014;Padovan et al, 2019;Kuo et al, 2020). Atualmente, os polienos, azóis e triazóis são classificados como principais classes de antifúngicos, em especial, a Anfotericina B (polieno), Voriconazol (azol) e Fluconazol (azol), que se destacam como fármacos de primeira escolha para o tratamento destes patógenos fúngicos (Padovan et al, 2019;El Attar et al, 2020). Neste contexto, uma possível alternativa para ultrapassar a resistência e a alta mortalidade relacionada a doenças severas causadas por Trichosporon spp.…”

“…Neste contexto, uma possível alternativa para ultrapassar a resistência e a alta mortalidade relacionada a doenças severas causadas por Trichosporon spp. seria a combinação de duas ou três classes de antifúngicos, especialmente se estes medicamentos apresentarem mecanismos de ação diferentes (Cawley et al, 2000;Moretti-Branchini et al, 2001;Mooty et al, 2001;Li et al, 2005;El Attar et al, 2020;Lan et al, 2020). (Lan et al, 2020).…”