Image Gallery: Molluscum contagiosum-like facial lesions in a patient with a renal transplant: deep dermatophytosis due to <i>Trichophyton rubrum</i>

Ergen, Elizabeth N.; Donaldson, Stephanie L.; Stratton, Michael Slade; Pavlidakey, Peter; Elewski, Boni E.

doi:10.1111/bjd.16432

Cited by 6 publications

(1 citation statement)

References 2 publications

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“…Dermatophytes, such as Trichophyton rubrum and T interdigitale , are the most common fungal species implicated in onychomycosis. This superficial infection is usually benign, impairing social interactions because of cosmetic impact 2 or causing local pain, but it can also be the origin of severe dermatophytosis 3 and deep infections in patients receiving immunosuppression therapies 4‐7 . Clear guidelines for onychomycosis management have been established in immunocompetent individuals 8 .…”

Section: Introductionmentioning

confidence: 99%

Severe onychomycosis management with oral terbinafine in a kidney transplantation setting: Clinical follow‐up by image analysis

Moreno-Sabater

Ouali

Chasset

et al. 2020

Mycoses

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Background Severe onychomycosis treatment in kidney transplant recipients (KTR) is challenging because of drug interactions and adverse events. Tacrolimus remains the antirejection treatment (ART) of choice in kidney transplantation but tolerance with systemic terbinafine for the management of severe onychomycosis has not been studied. Objective This study illustrates severe onychomycosis management in a kidney transplantation setting and investigates systemic terbinafine tolerance profile in KTR. Patients/Methods We retrospective analysed clinical data of KTR with a confirmed diagnosis of severe onychomycosis. Results We retrieved a total of 29 KTR with severe onychomycosis needing an oral treatment to manage onychomycosis. In 55.1% (16/29) KTR, altered renal biological parameters or lack of guidelines to manage severe onychomycosis were the main reasons to deterring clinicians from prescribing oral treatments. 13 patients received an oral terbinafine treatment (9, 3 and 1 with a tacrolimus, cyclosporine and everolimus‐based ART, respectively). Clinical and biological follow‐up did not reveal severe drug interactions. ART blood levels showed significant variations in 2 patients without clinical consequences in renal graft. Two patients reported mild adverse events but after only one dose of terbinafine. Using an open‐source image analysis program, clinical evolution of onychomycosis could be retrospectively quantified and followed up. Conclusions The results presented here suggest that oral terbinafine can be proposed to treat severe onychomycosis with an acceptable tolerance profile in KTR with different ART such as tacrolimus and highlight the need of multicentric studies to establish guidelines for onychomycosis treatment in KTR.

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Section: Introductionmentioning

confidence: 99%