Treatment of Onychomycosis by Partial Nail Avulsion and Topical Miconazole

Rollman, Ola

doi:10.1159/000249920

Cited by 37 publications

(11 citation statements)

References 5 publications

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“…The azoles miconazole and ketoconazole were the most sensitive antifungals and this is in conformity with other studies [30, 31] that have proven desirable cure rates and even prevention of reoccurrence obtainable through the use of these drugs. In addition isolates of T. rubrum and T. metagraphyte were also sensitive to amphotericin B.…”

Section: Discussionsupporting

confidence: 90%

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns

et al. 2016

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BackgroundOnychomycosis is an infection of the nail unit by a fungus. This is a very common infection amongst diabetics. Its occurrence among diabetics in Fako division is unknown. In this study we provide information on the characteristics of onychomycosis in diabetics in Fako division, Cameroon.MethodsA cross-sectional descriptive and analytical hospital-based study was conducted in two diabetic clinics in the Buea and Limbe regional hospitals. We recruited 152 consenting diabetics into the study. Demographic, behavioural, and clinical data of patients were obtained through the use of structured questionnaires. Toenail, finger nail, skin scrapings and nail clippings were collected from participants, KOH mounts were prepared and observed under the microscope and cultured on Sabouraud Dextrose Agar supplemented with chloramphenicol to isolate causative fungi. Identification of isolates was done to species level using the cello tape flag method and slide culture. The presence of a dermatophyte by either microscopy or culture or both methods was considered positive for onychomycosis. Antifungal susceptibility testing was carried out using selected antifungals by the Kirby–Bauer disk diffusion method on Sabouraud Dextrose Agar.ResultsClinical onychomycosis was found in 77 of the 152 diabetics tested giving a prevalence of 50.7% (95% CI 42.4–58.9) in diabetics in Fako. No socio-demographic or clinical factor studied was significantly associated with onychomycosis. Trichophyton rubrum was the most common isolate (62%). Other isolates included Trichophyton metagraphyte (22%) and Trichophyton tonsurans (16%). Dermatophytes were sensitive to miconazole (66%), amphotericin B (19%) and ketoconazole (14%).ConclusionOnychomycosis is common in diabetics in Fako signifying the need for regular screening by either microscopy or culture. Infected nails could be treated with miconazole.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-2302-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns

et al. 2016

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“…This treatment modality could be a valuable alternative to other remedies for the treatment of onychomycosis limited to a few nails. [10] Total nail avulsion has been found to be effective, especially for patients with single-or oligo-onychomycosis [ Figure 2] and in those with a dubious diagnosis. [11] In contrast, another randomized trial comprising 40 subjects with single-nail onychomycosis recorded a high drop-out rate.…”

mentioning

confidence: 99%

Nail avulsion: Indications and methods (surgical nail avulsion)

Pandhi¹,

Verma²

2012

Indian J Dermatol Venereol Leprol

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The nail is a subject of global importance for dermatologists, podiatrists and surgeons. Nail avulsion is a frequently undertaken, yet simple, intriguing procedure. It may either be surgical or chemical, using 40% urea. The former is most often undertaken using the distal approach. Nail avulsion may either be useful for diagnostic purposes like exploration of the nail bed, nail matrix and the nail folds and before contemplating a biopsy on the nail bed or for therapeutic purposes like onychocryptosis, warts, onychomycosis, chronic paronychia, nail tumors, matricectomy and retronychia. The procedure is carried out mostly under local anesthesia with or without epinephrine (1:2,00,000 dilution). Besides the above-mentioned indications, the contraindications and complications of nail avulsion are briefly outlined.

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“…Among these were clotrimazole [6], tolnaftate [7], miconazole [8], and recently bifonazole [9]. Ciclopirox has proved to be effective since 1979 [10]; also cow horn penetration experiments with ciclopiroxolamine cream were performed.…”

Section: Discussionmentioning

confidence: 99%

Ciclopirox Nail Lacquer 8%: In vivo Penetration into and through Nails and in vitro Effect on Pig Skin

Ceschin-Roques

Hänel²,

Pruja-Bougaret

et al. 1991

Skin Pharmacol Physiol

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This report presents original methods to assess the bioavailability of an antifungal drug from a varnish preparation in finger nails. For the studies with human volunteers a ciclopirox 8 % nail lacquer was used to determine its efficacy in the treatment of onychomycoses. In vivo studies were performed on the fingernails of healthy volunteers by determining the total amount of ciclopirox penetrated per milligram of nail and the partition of the drug in the plate of the nails (technically divided into four layers). Ciclopirox concentrations were evaluated by measuring the inhibition of Candida pseudotropicalis growth in vitro. The ciclopirox concentration after 30 days treatment was determined as 3.35 ± 0.82 µg/mg nail material. This is a sufficient amount to kill the fungal pathogens. In addition, in vitro penetration experiments were carried out with excised pig skin. Lacquer formulations from 0.5 to 8 % were used to inhibit the growth of Trichophyton mentagrophytes. Formulations from 2 to 8% led to a strong to total inhibition of the dermatophyte after 30 min treatment time.

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Treatment of Onychomycosis by Partial Nail Avulsion and Topical Miconazole

Cited by 37 publications

References 5 publications

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns

Onychomycosis in diabetic patients in Fako Division of Cameroon: prevalence, causative agents, associated factors and antifungal sensitivity patterns

Nail avulsion: Indications and methods (surgical nail avulsion)

Ciclopirox Nail Lacquer 8%: In vivo Penetration into and through Nails and in vitro Effect on Pig Skin

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