Oral Antifungals Effective for Toenail Onychomycosis

Total Page：16

File Type：pdf, Size：1020Kb

PEARLS Practical Evidence About Real Life Situations Oral antifungals effective for toenail onychomycosis Clinical Question How effective are oral antifungal treatments for toenail onychomycosis? Bottom Line There was high-quality evidence that oral azole and terbinafine treatments were more effective for achieving mycological cure and clinical cure for onychomycosis compared to placebo. When compared directly, terbinafine was probably more effective than azoles and likely not associated with excess adverse events (both moderate-quality evidence). Low-certainty evidence showed griseofulvin to be less effective than terbinafine in terms of both mycological and clinical cure, while griseofulvin and azole probably had similar efficacy (moderate-quality evidence). Griseofulvin was associated with more adverse reactions than azoles (moderate-quality) and terbinafine (low-quality). No study addressed quality of life. The evidence in this review applied for treatments of at least 12 weeks in duration. Caveat Only a limited number of studies reported adverse events, and the severity of the events was not taken into account, which limited the direct application to clinical practice. Not all comparisons measured recurrence rate, and the available evidence was based on low- to very low-quality evidence. Context Toenail onychomycosis is common, and treatment is taken orally or applied topically. Oral treatments appear to have shorter treatment times and better cure rates. Cochrane Systematic Review Kreijkamp-Kaspers S et al. Oral antifungal medication for toenail onychomycosis. Cochrane Reviews, 2017, Issue 7. Art. No.: CD010031.DOI: 10.1002/14651858. CD010031.pub2. This review contains 48 studies PEARLS Practical Evidence About Real Life Situations involving 10,200 participants. Pearls No. 574, March 2018, written by Brian R McAvoy. C49 .

Copy Link

Recommended publications

Fungal Infections from Human and Animal Contact
Journal of Patient-Centered Research and Reviews Volume 4 Issue 2 Article 4 4-25-2017 Fungal Infections From Human and Animal Contact Dennis J. Baumgardner Follow this and additional works at: https://aurora.org/jpcrr Part of the Bacterial Infections and Mycoses Commons, Infectious Disease Commons, and the Skin and Connective Tissue Diseases Commons Recommended Citation Baumgardner DJ. Fungal infections from human and animal contact. J Patient Cent Res Rev. 2017;4:78-89. doi: 10.17294/2330-0698.1418 Published quarterly by Midwest-based health system Advocate Aurora Health and indexed in PubMed Central, the Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. REVIEW Fungal Infections From Human and Animal Contact Dennis J. Baumgardner, MD Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI; Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI; Center for Urban Population Health, Milwaukee, WI Abstract Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America.
[Show full text]
Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol
Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail
[Show full text]
Dermatologic Nuances in Children with Skin of Color
5/21/2019 Dermatologic Nuances in Children with Skin of Color Candrice R. Heath, MD, FAAP, FAAD Director, Pediatric Dermatology LKSOM Temple University @DrCandriceHeath Advisory Board – Pfizer, Regeneron-Sanofi Consultant –Marketing – Unilever, Proctor & Gamble Speaker’s Bureau - Pfizer I do not intend to discuss on-FDA approved or investigational use of products in my presentation. • Recognize common hair, scalp and skin disorders that may present differently in children with skin of color • Select appropriate treatment options based upon common cultural preferences to increase adherence • Establish treatment algorithm for challenging cases 1 5/21/2019 • 2050 : Over half of the United States population will be people of color • 2050 : 1 in 3 US residents will be Hispanic • 2023 : Over half of the children in the US will be people of color • Focuses on ethnic and racial groups who have – similar skin characteristics – similar skin diseases – similar reaction patterns to those skin diseases Taylor SC et al. (2016) Defining Skin of Color. In Taylor & Kelly’s Dermatology for Skin of Color. 2016 Type I always burns, never tans (palest) Type II usually burns, tans minimally Type III sometimes mild burn, tans uniformly Type IV burns minimally, always tans well (moderate brown) Type V very rarely burns, tans very easily (dark brown) Type VI Never burns (deeply pigmented dark brown to darkest brown) 2 5/21/2019 • Black • Asian • Hispanic • Other Not so fast… • Darker skin hues • The term “race” is faulty – Race may not equal biological or genetic inheritance – There is not one gene or characteristic that separates every person of one race from another Taylor SC et al.
[Show full text]
Hair and Nail Disorders
Hair and Nail Disorders E.J. Mayeaux, Jr., M.D., FAAFP Professor of Family Medicine Professor of Obstetrics/Gynecology Louisiana State University Health Sciences Center Shreveport, LA Hair Classification • Terminal (large) hairs – Found on the head and beard – Larger diameters and roots that extend into sub q fat LSUCourtesy Health of SciencesDr. E.J. Mayeaux, Center Jr., – M.D.USA Hair Classification • Vellus hairs are smaller in length and diameter and have less pigment • Intermediate hairs have mixed characteristics CourtesyLSU Health of E.J. Sciences Mayeaux, Jr.,Center M.D. – USA Life cycle of a hair • Hair grows at 0.35 mm/day • Cycle is typically as follows: – Anagen phase (active growth) - 3 years – Catagen (transitional) - 2-3 weeks – Telogen (preshedding or rest) about 3 Mon. • > 85% of hairs of the scalp are in Anagen – Lose 75 – 100 hairs a day • Each hair follicle’s cycle is usually asynchronous with others around it LSU Health Sciences Center – USA Alopecia Definition • Defined as partial or complete loss of hair from where it would normally grow • Can be total, diffuse, patchy, or localized Courtesy of E.J. Mayeaux, Jr., M.D. CourtesyLSU of Healththe Color Sciences Atlas of Family Center Medicine – USA Classification of Alopecia Scarring Nonscarring Neoplastic Medications Nevoid Congenital Injury such as burns Infectious Systemic illnesses Genetic (male pattern) (LE) Toxic (arsenic) Congenital Nutritional Traumatic Endocrine Immunologic PhysiologicLSU Health Sciences Center – USA General Evaluation of Hair Loss • Hx is
[Show full text]
Trachyonychia Associated with Alopecia Areata and Secondary Onychomycosis
TRACHYONYCHIA ASSOCIATED WITH ALOPECIA AREATA AND SECONDARY ONYCHOMYCOSIS Jose L. Anggowarsito Renate T. Kandou Department of Dermatovenereology Medical Faculty of Sam Ratulangi University Prof. Dr. R. D. Kandou Hospital Manado Email: [email protected] Abstract: Trachyonychia is an idiopathic nail inflammatory disorder that causes nail matrix keratinization abnormality, often found in children, and associated with alopecia areata, psoriasis, atopic dermatitis, or nail lichen planus. Trachyonychia could be a manifestation of associated pleomorphic or idiopathic disorders; therefore, it may occur without skin or other systemic disorders. There is no specific diagnostic criteria for tracyonychia. A biopsy is needed to determine the definite pathologic diagnosis for nail matrix disorder; albeit, in a trachyonychia case it is not entirely necessary. Trachyonychia assessment is often unsatisfactory and its management is focused primarily on the underlying disease. We reported an 8-year-old girl with twenty dystrophic nails associated with alopecia areata. Cultures of nail base scrapings were performed two times and the final impression was trichophyton rubrum. Conclusion: Based on the clinical examination and all the tests performed the diagnosis of this case was trachyonychia with twenty dystrophic nails associated with alopecia areata and secondary onychomycosis.The majority of trachyonychia cases undergo spontaneous improvement; therefore, a specific therapy seems unnecessary. Onychomycosis is often difficult to be treated. Eradication of the fungi is not always followed by nail restructure, especially if there has been dystrophy before the infection. Keywords: trachyonychia, alopecia areata, onychomycosis. Abstrak: Trakionikia adalah inflamasi kuku idiopatik yang menyebabkan gangguan keratinisasi matriks kuku, sering terjadi pada anak, dan terkait dengan alopesia areata, psoriasis, dermatitis atopik atau lichen planus kuku.
[Show full text]
Folliculitis
Folliculitis Common Cutaneous • Inflammation of hair follicle(s) Bacterial Infections • Symptoms: Often pruritic (itchy) Pseudomonas folliculitis Eosinophilic Folliculitis (HIV) Folliculitis: Causes • Bacteria: – Gram positives (Staph): most common – Gram negatives: Pseudomonas – “hot tub” folliculitis • Fungal: Pityrosporum aka Malassezia • HIV: eosinophilic folliculitis (not bacterial) • Renal Failure: perforating folliculitis (not bacterial) Treatment of Folliculitis 21 year old female with controlled Crohn’s disease and history of • Bacterial hidradenitis suppuritiva presents stating – culture pustule she has recurrent flares of her HS – topical clindamycin or oral cephalexin / doxycycline – shower and change shirt after exercise – keep skin dry; loose clothing • Fungal: topical antifungals (e.g., ketoconazole) • Eosinophilic folliculitis – Phototherapy – Treat the HIV MRSA MRSA Eradication • Swab nares mupirocin ointment bid x 5 days • GI noted Crohn’s was controlled but increased – Swab axillae, perineum, pharynx infliximab intensity, but that was not controlling • Chlorhexidine 4% bodywash qd x 1 week recurrent “flares” • Chlorhexidine mouthwash qd x 1 week; soak toothbrush (or disposable) •I & D MRSA on three occasions • Bleach bath: 1/3 cup to tub, soak x 10 min tiw x 1 week, then prn (perhaps weekly) • THIS WAS INFLIXIMAB-RELATED • Oral antibiotics x 14 days: Bactrim, Doxycycline, depends FURUNCULOSIS FROM MRSA COLONIZATION on sensitivities – D/C infliximab • Swab partners – Anti-MRSA regimen • Hand sanitizer frequently – Patient is better • Bleach wipes to surfaces (doorknobs, faucet handles) • Towels use once then wash; paper towels when possible Pointing abscess (furuncle) --pointing requires I & D-- Acute Paronychia Furuncle Treatment Impetigo • Incise & Drain (I & D) Culture pus • Warm soaks • Antibiotics – e.g., cephalexin orally AND mupirocin topically • If recurrent, suspect nasal carriage of Staph aureus swab culture and mupirocin to nares b.i.d.
[Show full text]
Evidence-Based Danish Guidelines for the Treatment of Malassezia- Related Skin Diseases
Acta Derm Venereol 2015; 95: 12–19 SPECIAL REPORT Evidence-based Danish Guidelines for the Treatment of Malassezia- related Skin Diseases Marianne HALD1, Maiken C. ARENDRUP2, Else L. SVEJGAARD1, Rune LINDSKOV3, Erik K. FOGED4 and Ditte Marie L. SAUNTE5; On behalf of the Danish Society of Dermatology 1Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, 2 Unit for Mycology, Statens Serum Institut, 3The Dermatology Clinic, Copen- hagen, 4The Dermatology Clinic, Holstebro, and 5Department of Dermatology, Roskilde Hospital, University of Copenhagen, Denmark Internationally approved guidelines for the diagnosis including those involving Malassezia (2), guidelines and management of Malassezia-related skin diseases concerning the far more common skin diseases are are lacking. Therefore, a panel of experts consisting of lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspi- dermatologists and a microbiologist appointed by the ces of the Danish Society of Dermatology undertook a Danish Society of Dermatology undertook a data review data review and compiled guidelines for the diagnostic and compiled guidelines on the diagnostic procedures procedures and management of pityriasis versicolor, se- and management of Malassezia-related skin diseases. borrhoeic dermatitis and Malassezia folliculitis. Main The ’head and neck dermatitis’, in which hypersensi- recommendations in most cases of pityriasis versicolor tivity to Malassezia is considered to be of pathogenic and seborrhoeic dermatitis include topical treatment importance, is not included in this review as it is restric- which has been shown to be sufficient. As first choice, ted to a small group of patients with atopic dermatitis. treatment should be based on topical antifungal medica- tion.
[Show full text]
Beyond Onychomycosis: Other Nail Dystrophies
BEYOND ONYCHOMYCOSIS: OTHER NAIL DYSTROPHIES Tracey C. Vlahovic, DPM FFPM RCPS (Glasg) Clinical Professor, J Stanley and Pearl Landau Faculty Fellow Temple University School of Podiatric Medicine, Phila, PA CONFLICTS OF INTEREST: ORTHO DERM, BAKO EVALUATION AND TREATMENT ALGORITHM OSI severe: orals (multiple courses), with/without OSI adjunctive topical treatment Onychomycosis Comorbid Conditions? OSI moderate: orals and/or topical OSI mild: Abnormal topical monotherapy Nail Not Differential Appropriate Treatment Onychomycosis Diagnosis OSI, onychomycosis severity index. HOW TO COLLECT NAIL SPECIMEN • Dermatophytes in DSO invade the nail bed rather than the nail plate, the specimen MUST BE OBTAINED from the NAIL BED, which is the greatest concentration of viable fungi • First, Wipe the area with an alcohol pad • Second, debride the nail as usual • Third, take specimen from the nail bed as proximally to the cuticle as possible with a small curette or a #15 scalpel • “If debris is insufficient, material should be obtained from the nail bed. Material should also be obtained from the underside of the nail plate, with emphasis placed on sampling from the advancing infected edge most proximal to the cuticle. This is the area most likely to contain viable hyphae and least likely to contain contaminants” Elewski B E. Clinical pearl: diagnosis of onychomycosis. J Am Acad Dermatol. 1995;32:500–501 NAIL DYSTROPHY • Generalized term • Roughness, Beau’s lines, onychorrhexis, ridging • Acrocyanosis • Alopecia areata • Congenital • Lichen planus • Occupational
[Show full text]
Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment
Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment Saunte, Ditte M.L.; Gaitanis, George; Hay, Roderick James Published in: Frontiers in Cellular and Infection Microbiology DOI: 10.3389/fcimb.2020.00112 Publication date: 2020 Document version Publisher's PDF, also known as Version of record Document license: CC BY Citation for published version (APA): Saunte, D. M. L., Gaitanis, G., & Hay, R. J. (2020). Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment. Frontiers in Cellular and Infection Microbiology, 10, [112]. https://doi.org/10.3389/fcimb.2020.00112 Download date: 24. sep.. 2021 REVIEW published: 20 March 2020 doi: 10.3389/fcimb.2020.00112 Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment Ditte M. L. Saunte 1,2*†, George Gaitanis 3,4†‡ and Roderick James Hay 5† 1 Department of Dermatology, Zealand University Hospital, Roskilde, Denmark, 2 Department of Clinical Medicine, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark, 3 Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece, 4 DELC Clinic, Biel/Bienne, Switzerland, 5 St. Johns Institute of Dermatology, Kings College London, London, United Kingdom Edited by: Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, Salomé LeibundGut-Landmann, which are a part of the normal skin ﬂora (microbiome). Malassezia colonize the human University of Zurich, Switzerland skin after birth and must therefore, as commensals, be normally tolerated by the Reviewed by: Peter Mayser, human immune system. The Malassezia yeasts also have a pathogenic potential where University of Giessen, Germany they can, under appropriate conditions, invade the stratum corneum and interact with Philipp Peter Bosshard, the host immune system, both directly but also through chemical mediators.
[Show full text]
ECORFAN Journal Folliculitis by Malassezia Sp., an Epidemiological Study in Dominican Republic
14 Article ECORFAN Journal December 2015 Vol.1 No.1 14-19 Folliculitis by Malassezia sp., An epidemiological study in Dominican Republic PORRAS-LÓPEZ, Carlos*†, COMPRES-ESPINAL, Adriana, CRUZ, Cecilia and ISA-ISA, Rafael Institute of Dermatology and Skin Surgery "Dr. Fernando Cordero C. Unit of Medical Mycology, "Guatemala City. Dominican Dermatology Institute and Skin Surgery "Prof. Dr. Hubert Bogaert Diaz. Department of Mycology, "Dominican Republic. Received April 15, 2015; Accepted November 16, 2015 Abstract Malassezia´s folliculitis is a pathology characterized by the presence of papules and pustules in which Malassezia sp. can be isolated. This is indistinguishable from Candida sp. folliculitis, acne vulgaris, acneiform reaction, and some bacterial folliculitis so it may be underdiagnosed. The objective of this study was to characterize the epidemiology of Malassezia folliculitis through a retrospective cross- sectional study from 2009 to 2012 at the Institute Dermatological and Skin Surgery "Prof. Dr. Hubert Bogaert ", Dominican Republic. It was observed that the disease is more common in women, the most prevalent age group is 21 to 30 years, concomitant pathology is more often associated with tinea versicolor, the evolution time is less than 1 year, the most often associated site is the back. The use of Gram stain and culture is recommended to fully establish the diagnosis. Malassezia sp., Gram stain, folliculitis. Citation: PORRAS-PORRAS, Carlos, Adriana, CRUZ, Cecilia and ISA-ISA, Rafael. Folliculitis by Malassezia sp., An epidemiological study in Dominican Republic. ECORFAN Journal-Republic of Guatemala 2015, 1-1: 14-19 * Correspondence to Author (email: [email protected]) † Researcher contributing first author. © ECORFAN Journal - Republic of Guatemala www.ecorfan.org/republicofguatemala 15 Article ECORFAN Journal December 2015 Vol.1 No.1 14-19 Introduction The presence of Malassezia in pustular lesions can be demonstrated using KOH 10% of Malassezia folliculitis is a pathology chlorazol black, white calcoflour or Gram stain.
[Show full text]
Hawaii Dermatology Seminar™
HIGHLIGHTS OF A CME/CE CERTIFIED SUPPLEMENT TO SKIN DISEASE EDUCATION FOUNDATION’S 40th Annual Hawaii Faculty Joseph F. Fowler, Jr, MD Clinical Professor of Dermatology University of Louisville Dermatology Louisville, Kentucky Theodore Rosen, MD ™ Professor of Dermatology Baylor College of Medicine Seminar A CONTINUING MEDICAL EDUCATION CONFERENCE Houston, Texas Jeffrey M. Sobell, MD Assistant Professor of Dermatology Tufts University School of Medicine Introduction Director, Psoriasis Treatment Center SkinCare Physicians Chestnut Hill, Massachusetts Update on TNF Inhibitors Nowell Solish, MD, FRCP(C) in Dermatology Assistant Professor University of Toronto Facial Dermatitis and Rosacea Toronto, Ontario, Canada Linda F. Stein Gold, MD Tinea and Onychomycosis Director of Dermatology Research Henry Ford Health System Acne: What’s New Detroit, Michigan Christopher B. Zachary, MBBS, FRCP Fillers: What’s Here and What’s Ahead Professor and Chair Department of Dermatology University of California, Irvine The Aging Face: Global Approach Irvine, California With Fillers and Neuromodulators Facial Rejuvenation: 40th Anniversary Review Post-Test and Evaluation Form Original Release Date: June 2016 • Expiration Date: June 30, 2017 Estimated Time to Complete Activity: Update to 2.33 hours Jointly provided by Supported by educational grants from AbbVie Inc., Bayer Healthcare, Merz North America Inc., and Valeant Pharmaceuticals North America LLC A CME/CE CERTIFIED SUPPLEMENT TO HIGHLIGHTS OF SKIN DISEASE EDUCATION FOUNDATION’S 40th Annual Hawaii Dermatology ™ Seminar Reprinted from A CONTINUING MEDICAL EDUCATION CONFERENCE Seminars in Cutaneous Medicine and Surgery The manuscript was originally published as a supplement to Seminars in Cutaneous Medicine and Surgery, Vol. 35, No. 4S, June 2016. It has been reviewed and approved by the faculty as well as the Editors Table of Contents of Seminars in Cutaneous Medicine and Surgery.
[Show full text]
Candida Onychomycosis: Indian Scenario
International Journal of Advances in Medicine Narain U et al. Int J Adv Med. 2016 Aug;3(3):638-642 http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933 DOI: http://dx.doi.org/10.18203/2349-3933.ijam20162509 Research Article Candida onychomycosis: Indian scenario Upma Narain1*, Ashok Kumar Bajaj2 1Department of Microbiology and Immunology, Tejas Microdiagnostics, Allahabad, Uttar Pradesh, India 2Department of Dermatology, Moti Lal Nehru Medical College, Allahabad, Uttar Pradesh, India Received: 05 May 2016 Accepted: 04 June 2016 *Correspondence: Dr. Upma Narain, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Onychomycosis, a fungal infection of nails, may be caused by dermatophytes, nondermatophytes and yeast. Its incidence is progressively increasing, and now it is no more considered merely a cosmetic problem and the figures represent only the tip of the iceberg. Methods: The retrospective study was carried out from January, 2000 to March, 2014 at Allahabad. KOH examination and culture were carried out in 3321 cases and species identification of Candida was done by Vitek-2 system. Results: Out of 3321 cases, 2906 cases were culture positive. Candida onychomycosis was found in 284 (10.1%) cases. When data was further analyzed Candida albicans were isolated in 96 (33.81%) cases while non albicans Candida species were identified in 188 (66.19%) cases.
[Show full text]