Subungual dermatophytoma complicating dermatophyte onychomycosis

Roberts, David T.; Evans, E. G. V.

doi:10.1046/j.1365-2133.1998.02050.x

Cited by 109 publications

(90 citation statements)

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“…In our patients, a variety of clinical characteristics may have contributed to the poor outcome [19, 20, 21, 22, 23, 24](table 1). None of our patients were diabetic, immunocompromised or noncompliant with therapy [19, 20, 25].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of in vitro Resistance in Patients with Onychomycosis Who Fail Antifungal Therapy

Gupta

Kohli

2003

Dermatology

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Background: With the increased awareness of onychomycosis and the increasing use of antifungals for this indication, it is prudent to be concerned about the possible emergence of resistant strains. There has been substantial work on the development of standardized methods for testing the in vitro resistance of various fungi and yeasts to the currently available antifungal agents. However, relatively little research has been published concerning the resistance of dermatophyte species. Objective: We report the results of a retrospective study analyzing the relationship between in vitro and clinical resistance in strains of Trichophyton rubrum cultured from patients with recalcitrant dermatophyte toe onychomycosis. Materials and Methods: We analyzed the in vitro resistance of dermatophyte strains obtained from 18 patients with chronic onychomycosis who failed antifungal therapy with itraconazole or terbinafine. Multiple-sequential strains from 11 patients were included in the study. Susceptibility testing of these strains was performed against 4 antifungals, itraconazole, ketoconazole, terbinafine and ciclopirox, using the broth microdilution method as per the NCCLS M27-A guidelines. A record of clinical characteristics that may relate to patient treatment and therapy was maintained. Results: All of the strains were susceptible to 3 of the 4 antifungal agents tested. Although there was no direct correlation between clinical resistance and in vitro resistance, increased minimum inhibitory concentration values for ketoconazole were observed in strains obtained after treatment from 3 of 18 patients evaluated in the study. In all but 1 patient, we were able to identify other factors that may have been responsible for treatment failure. Conclusions: With the more common use of antifungals to treat various fungal infections, development of increased resistance in the causative organisms remains a possibility. However, factors other than fungal resistance may also be implicated in treatment failure.

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Section: Discussionmentioning

confidence: 99%

Evaluation of in vitro Resistance in Patients with Onychomycosis Who Fail Antifungal Therapy

Gupta

Kohli

2003

Dermatology

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“…A patch is a round area that is not contiguous with the free edge of the nail. This clinical finding has important prognostic value, as it is unlikely for even systemic antifungals to penetrate this fungal mass [14,32]. For example, in one study, patients with the presence of a dermatophytoma who were treated with oral terbinafine were less likely to achieve a mycological cure than patients without it [17].…”

Section: Nail Featuresmentioning

confidence: 99%

Prognostic Factors in Onychomycosis Treatment

Lipner

Scher

2014

J Infect Dis Ther

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Onychomycosis is a common fungal disease of the nail unit with a prevalence of 10% to 12% in the United States. Despite therapeutic innovations in the last few decades, as many as 20-25% of patients do not achieve a complete cure, and 10-53% are reported to relapse after successful treatment. Some of the factors associated with a poor response to onychomycosis have been well studied. They include patient characteristics and morbidities, nail characteristics, and the infecting organism. Therefore, the goal of therapy is to identify these specific prognostic features for each patient and devise an appropriate treatment plan that will allow for the best chance for cure. Scoring systems may be helpful for grading the severity of onychomycosis and predicting the therapeutic outcome.

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“…Among these fungal pathogens, Trichophyton rubrum was the most common etiological agent of tinea unguium and the second causative agent of tinea corporis and tinea cruris from clinical isolation during 2010 to 2014 in Tehran, Iran (3), in addition to the most common isolated dermatophytes in other European countries (4)(5)(6). Trichophyton rubrum infections are often intractable and associated with relapses after discontinuation of antifungal therapy (7). Another dermatophyte agent is Microsporum canis, which was the earnest epidemiologic problem in Europe and Australia, with increased incidence observed recently (8).…”

Section: Introductionmentioning

confidence: 99%

In-Vitro Evaluation of Antifungal Activity of Terbinafine and Terbinafine Nano-Drug Against Clinical Isolates of Dermatophytes

Motedayen

Hashemi

Rezaei

et al. 2018

Jundishapur J Microbiol

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Background: Due to long-term treatment of dermatophytic lesions, such as tinea unguium and using antifungal drugs, which cause side effects, it is essential to investigate new antifungal drugs with greater absorption and fewer side effects, such as nanodrugs. Trichophyton rubrum and Microsporum canis are important dermatophyte species. To investigate new strategy treatment, researchers have tried to find a new drug with extensive therapeutic effects and short-duration treatment. In this context, nano-drugs have gained great interest in improving the efficacy of antifungal properties compared to commercial drugs.

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Subungual dermatophytoma complicating dermatophyte onychomycosis

Cited by 109 publications

References 0 publications

Evaluation of in vitro Resistance in Patients with Onychomycosis Who Fail Antifungal Therapy

Evaluation of in vitro Resistance in Patients with Onychomycosis Who Fail Antifungal Therapy

Prognostic Factors in Onychomycosis Treatment

In-Vitro Evaluation of Antifungal Activity of Terbinafine and Terbinafine Nano-Drug Against Clinical Isolates of Dermatophytes

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