&lt;i&gt;Trichophyton&lt;/i&gt;-&lt;i&gt;rubrum&lt;/i&gt;-lnfected Toenails Treated with Ketoconazole and Partial Nail Avulsion

Kavli, G; Midelfart, K.; Moseng, Dagfinn; Se, Stenvold; Es, Falk; Jw, Nilssen; Volden, G

doi:10.1159/000249602

Cited by 4 publications

(2 citation statements)

References 5 publications

(7 reference statements)

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“…For tinea unguium, the most resistant of dermatophytoses, topical therapy is seldom efficaceous and spontaneous resolution is rare. One long-standing strategy is avulsion or chemical ablation of the nail, followed by treatment of the nail bed with fungistatic agents (137,149). Chemical ablation is often accomplished with urea paste under occlusion.…”

Section: Tinea Unguiummentioning

confidence: 99%

“…Poor penetration is the most likely reason for this unresponsiveness, not the development of resistance in the fungus involved. Ketoconazole, once used as an alternative, is now seldom used because of rare instances of hepatotoxicity (137,149,156,189). Recently, the much greater success rates of terbinafine and itraconazole in toenail infection have made a strong impact (13,78,189,257).…”

Section: Tinea Unguiummentioning

confidence: 99%

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The dermatophytes

1995

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The etiologic agents of the dermatophytoses (ringworm) are classified in three anamorphic (asexual or imperfect) genera, Epidermophyton, Microsporum, and Trichophyton. Species capable of reproducing sexually belong in the teleomorphic genus, Arthroderma, of the Ascomycota. On the basis of primary habitat association, they may be grouped as geophilic (soil associated), zoophilic, and anthropophilic. Adaptation to growth on humans by most geophilic species resulted in diminished loss of sporulation, sexuality, and other soil-associated characteristics. The dermatophytes have the ability to invade keratinized tissue (skin, hair, and nails) but are usually restricted to the nonliving cornified layer of the epidermis because of their inability to penetrate viable tissue of an immunocompetent host. However, invasion does elicit a host response ranging from mild to severe. Acid proteinases, elastase, keratinases, and other proteinases reportedly act as virulence factors. The development of cell-mediated immunity correlated with delayed hypersensitivity and an inflammatory response is associated with clinical cure, whereas the lack of or a defective cell-mediated immunity predisposes the host to chronic or recurrent dermatophyte infection. Chronic dermatophytosis is mostly caused by Trichophyton rubrum, and there is some evidence that mannan produced by this fungus suppresses or diminishes the inflammatory response. Since dermatophytes cause a communicable disease, modes of transmission and control are discussed as well as a survey of recent trends in therapy. Collection of specimens, culture media, and tests for identification are also presented. Genetic studies have led to an understanding of incompatibility mechanisms, pleomorphism and variation, resistance to griseofulvin, and virulence. Molecular biology has contributed to our knowledge of the taxonomy and phylogenetic relationships of dermatophytes.

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Section: Tinea Unguiummentioning

confidence: 99%