Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream

Lim, Eun-Hwa; Kim, Hyeong-rae; Park, Young-Ok; Lee, Young; Seo, Young‐Joon; Kim, Chang Deok; Lee, Jeung‐Hoon; Im, Myung

doi:10.1016/j.jaad.2014.01.893

Cited by 102 publications

(108 citation statements)

References 14 publications

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“…However, oral antifungals may cause adverse effects. The topical formulation with antifungal agents may have low therapeutic efficacy because of their limited ability to penetrate the nail plate and reach the affected area [3].These factors and the high incidence of this infection are important parameters for the analyses of Corresponding author: Natalia M. Inada, Ph.D., doctor of medical pathophysiology, post-doctorate by the physics institute of USP in São Carlos (IFSC), researcher, research fields: biology, medicine, pharmacy, chemistry and physics, with a background in biochemistry (metabolism and bioenergetics), operates mainly in: mitochondrial bioenergetics, tumor cells, reactive oxygen species, cell death mechanisms, basic photodynamic therapy (in vitro and in vivo) and applied (clinical research), optical devices applied in health. E-mail: nataliainada@gmail.com.…”

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confidence: 99%

A Promising Strategy for the Treatment of Onychomycosis with Curcumin and Photodynamic Therapy

Silva¹,

Carbinatto²,

Bagnato³

et al. 2015

JPP

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Abstract:Onychomycosis is a disease of high incidence in the nail plate and responsible for approximately half of the cases of nail infections. Conventionally, dermatologists prescribe antibiotics and antifungals for long periods for its treatment. The high incidence of this type of infection and the increase of microbial strains resistant to the available drugs have justified the importance of the development of new technologies and treatments. This paper presents the photodynamic therapy as an alternative treatment of onychomycosis. New strategies for the use of curcumin as a photosensitizer and its therapeutic response were investigated in different formulations (gel and emulsion). Photodynamic therapy is a promising technique by which microorganisms are eliminated by a photosensitizing compound , light and oxygen. It was evaluated in two patients who had developed lesions in the fingernails caused by onychomycosis for approximately 10 years. The lesions were treated by photodynamic therapy with curcumin. The therapeutic efficacy was observed after a maximum of six photodynamic therapy sessions without any other adjuvant therapy. Curcumin has become more promising than the therapeutic standard as it is a natural and versatible drug for incorporation in different formulations, at low cost and low probability of side effects.

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confidence: 99%

A Promising Strategy for the Treatment of Onychomycosis with Curcumin and Photodynamic Therapy

Silva¹,

Carbinatto²,

Bagnato³

et al. 2015

JPP

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“…Current studies support the theory that topical therapies alone cannot effectively treat onychomycosis because of low-penetration rates of antifungal drugs through the nail plate (Baran & Kaoukhov, 2005;Lim et al, 2014); therefore, oral antifungal medications remain a mainstay in onychomycosis treatment because of the deep-seated and persistent nature of this type of infection. However, systemic treatment of onychomycosis is undesirable owing to the reported side effects of antifungal medications, the general immune-compromised nature of patients suffering from onychomycosis with higher incidence of drug interaction and hepatotoxicity, in addition to the limited blood circulation into the affected nail bed which necessitates the presence of large amount of the drug in the blood circulation (Repka et al, 2002;Miron et al, 2014).…”

Section: Introductionmentioning

confidence: 85%

Novel nail penetration enhancer containing vesicles “nPEVs” for treatment of onychomycosis

et al. 2015

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Context: The systemic treatment of onychomycosis has been hampered by the reported side effects of antifungals in addition to the limited blood circulation to the affected nails. Topical ungual treatment would circumvent the limitations of systemic onychomycosis treatment. Objective: Preparation and characterization of nail penetration enhancer containing nanovesicles (nPEVs) loaded with sertaconazole for topical treatment of onychomycosis. Materials and methods: nPEVs were prepared using different nail penetration enhancers (N-acetyl-L-cysteine, thioglycolic acid, thiourea and ethanol) by the thin film hydration method, and characterized for their particle size, zeta potential, entrapment efficiency (EE%), elasticity, viscosity, physical stability and morphology. The selected nPEVs formula and the marketed Dermofix Õ cream were compared in terms of nail hydration, transungual drug uptake and antifungal activity against Trichophyton rubrum. Results: N-acetyl-L-cysteine was the optimum nail penetration enhancer for incorporation within vesicles. nPEVs showed high EE% of sertaconazole ranging from 77 to 95%, a size ranging from 38-538 nm and a zeta potential ranging from +48 to +72 mV. The selected nPEVs formula displayed spherical morphology and good storage stability. Compared to the conventional marketed cream, the selected nPEVs formula showed 1.4-folds higher hydration and drug uptake enhancement into nail clippings. Furthermore, it showed significantly higher zone of inhibition for Trichophyton rubrum (20.9 ± 0.25 mm) than the marketed cream (11.6 ± 0.44 mm). Conclusion: Nail penetration enhancer containing nanovesicles (nPEVs) present a very promising option, worthy of clinical experimentation on onychomycotic patients.

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“…Interesujące jest badanie Lim i wsp. [37] dotyczące wykorzystania lasera CO 2 w celu wytworzenia kolumnowego zniszczenia płyt-ki paznokciowej, co poprawia przenikanie preparatu, a następnie miejscowego stosowania leku przeciwgrzybiczego (amorolfina w postaci kremu). Wykonano 3 zabiegi co 4 tygodnie w znieczuleniu z wykorzystaniem kremu Emla.…”

Section: Promieniowanie Laserowe W Leczeniu Grzybicy Paznokciunclassified

“…Po 12-tygodniowej obserwacji statystycznie istotnie zmniejszyła się powierzchnia paznokci zajęta przez zmiany grzybicze. U 92% pacjentów zauważono poprawę kliniczną, a u 50% badanie mikologiczne było ujemne [37].…”

Section: Promieniowanie Laserowe W Leczeniu Grzybicy Paznokciunclassified

Novel light therapies in treatment of onychomycosis

Erkiert‐Polguj¹,

Algiert²,

Rotsztejn³

2016

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Przegląd Dermatologiczny 2016/3 246 STRESZCZENIE Grzybica paznokci jest częstą chorobą dotyczącą aparatu paznokciowego, a jej leczenie wg obecnie obowiązujących standardów nie zawsze przynosi zadowalające efekty. Celem pracy jest zwrócenie uwagi na nowe możliwości terapii z wykorzystaniem promieniowania laserowego, promieniowania ultrafioletowego typu C, a także terapii fotodynamicznej. Najwięcej danych piśmiennictwa dotyczy wykorzystania lasera neodymowo-yagowego, a także laserów diodowych lub ablacyjnego lasera dwutlenkowo-węglowego. Niektórzy autorzy, aby poprawić skuteczność leczenia, stosowali przed zabiegiem usuwanie mas grzybiczych lub dołączali miejscowe leczenie preparatami przeciwgrzybiczymi. Ponadto przedstawiono metodę fotodynamiczną wykorzystywaną w leczeniu stanów przednowotworowych i powierzchownych nowotworów skóry, która daje obiecujące wyniki w terapii grzybicy paznokci z zastosowaniem tych samych lub innych fotouczulaczy. Uzyskane przez autorów efekty leczenia i brak poważnych działań ubocznych zachęcają do stosowania tego typu terapii, ale żadna z metod do tej pory nie została porównana z leczeniem farmakologicznym wg aktualnych wytycznych. ABSTRACTOnychomycosis is a frequent nail disease. Standard treatment is not sufficient in some patients. The aim of the study is to provide an overview of laser, UVC and photodynamic therapy of onychomycosis. The use of Nd:YAG laser is described in many articles, and also diode lasers and ablative CO 2 are used. Some authors, in order to improve the efficiency of treatment, also administered topical antifungal therapy or removed a part of the nail. Also photodynamic therapy usually used in precancerous diseases or superficial skin tumors is also employed in onychomycosis with the same or new photosensitizers. The results and the lack of serious side effects encourage the use of these methods, although none has been compared to standard oral therapy. SŁOWA KLUCZOWE:terapia fotodynamiczna, laser, grzybica paznokci, UVC.

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Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream

Cited by 102 publications

References 14 publications

A Promising Strategy for the Treatment of Onychomycosis with Curcumin and Photodynamic Therapy

A Promising Strategy for the Treatment of Onychomycosis with Curcumin and Photodynamic Therapy

Novel nail penetration enhancer containing vesicles “nPEVs” for treatment of onychomycosis

Novel light therapies in treatment of onychomycosis

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