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Terbinafine resistance in Trichophyton species has emerged and appears to be increasing. A new EUCAST susceptibility testing method and tentative ECOFFs were recently proposed for Trichophyton. Terbinafine resistance and target gene mutations were detected in 16 Danish isolates in 2013–2018. In this study, samples/isolates submitted for dermatophyte susceptibility testing 2019– 2020 were examined. Species identification (ITS sequencing for T. mentagrophytes/T. interdigitale species complex (SC) isolates), EUCAST MICs and squalene epoxidase (SQLE) profiles were obtained. Sixty-three isolates from 59 patients were included. T. rubrum accounted for 81% and T. men-tagrophytes/T. interdigitale SC for 19%. Approximately 60% of T. rubrum and T. mentagrophytes/inter-digitale SC isolates were terbinafine non-wildtype and/or had known/novel SQLE mutations with possible implications for terbinafine MICs. All infections with terbinafine-resistant T. men-tagrophytes/interdigitale SC isolates were caused by Trichophyton indotineae. Compared to 2013–2018, the number of patients with terbinafine-resistant Trichophyton isolates increased. For T. rubrum, this is partly explained by an increase in number of requests for susceptibility testing. Terbinafine-re-sistant T. indotineae was first detected in 2018, but accounted for 19% of resistance (4 of 21 patients) in 2020. In conclusion, terbinafine resistance is an emerging problem in Denmark. Population based studies are warranted and susceptibility testing is highly relevant in non-responding cases.

Terbinafine resistance in Trichophyton species has emerged and appears to be increasing. A new EUCAST susceptibility testing method and tentative ECOFFs were recently proposed for Trichophyton. Terbinafine resistance and target gene mutations were detected in 16 Danish isolates in 2013–2018. In this study, samples/isolates submitted for dermatophyte susceptibility testing 2019– 2020 were examined. Species identification (ITS sequencing for T. mentagrophytes/T. interdigitale species complex (SC) isolates), EUCAST MICs and squalene epoxidase (SQLE) profiles were obtained. Sixty-three isolates from 59 patients were included. T. rubrum accounted for 81% and T. men-tagrophytes/T. interdigitale SC for 19%. Approximately 60% of T. rubrum and T. mentagrophytes/inter-digitale SC isolates were terbinafine non-wildtype and/or had known/novel SQLE mutations with possible implications for terbinafine MICs. All infections with terbinafine-resistant T. men-tagrophytes/interdigitale SC isolates were caused by Trichophyton indotineae. Compared to 2013–2018, the number of patients with terbinafine-resistant Trichophyton isolates increased. For T. rubrum, this is partly explained by an increase in number of requests for susceptibility testing. Terbinafine-re-sistant T. indotineae was first detected in 2018, but accounted for 19% of resistance (4 of 21 patients) in 2020. In conclusion, terbinafine resistance is an emerging problem in Denmark. Population based studies are warranted and susceptibility testing is highly relevant in non-responding cases.

Background: Dermatophytosis is commonly encountered in the dermatological clinics. The main aetiological agents in dermatophytosis of skin and nails in humans are Trichophyton (T.) rubrum, T. mentagrophytes and T. interdigitale (former T. mentagrophytes-complex). Terbinafine therapy is usually effective in eradicating infections due to these species by inhibiting their squalene epoxidase (SQLE) enzyme, but increasing numbers of clinically resistant cases and mutations in the SQLE gene have been documented recently. Resistance to antimycotics is phenotypically determined by antifungal susceptibility testing (AFST). However, AFST is not routinely performed for dermatophytes and no breakpoints classifying isolates as susceptible or resistant are available, making it difficult to interpret the clinical impact of a minimal inhibitory concentration (MIC). Summary: PubMed was systematically searched for terbinafine susceptibility testing of dermatophytes on October 20, 2020, by two individual researchers. The inclusion criteria were in vitro terbinafine susceptibility testing of Trichophyton (T.) rubrum, T. mentagrophytes and T. interdigitale with the broth microdilution technique. The exclusion criteria were non-English written papers. Outcomes were reported as MIC range, geometric mean, modal MIC and MIC50 and MIC90 in which 50 or 90% of isolates were inhibited, respectively. The reported MICs ranged from <0.001 to >64 mg/L. The huge variation in MIC is partly explained by the heterogeneity of the Trichophyton isolates, where some originated from routine specimens (wild types) whereas others came from non-responding patients with a known SQLE gene mutation. Another reason for the great variation in MIC is the use of different AFST methods where MIC values are not directly comparable. High MICs were reported particularly in isolates with SQLE gene mutation. The following SQLE alterations were reported: F397L, L393F, L393S, H440Y, F393I, F393

Background: Antifungal drug resistance in dermatophytes was first reported shortly after the turn of the millennium and has today been reported in Trichophyton and occasionally in Microsporum, but not in Epidermophyton species. Although drug resistance in dermatophytes is not routinely investigated, resistance in Trichophyton spp. is increasingly reported worldwide. The highest rates are observed in India (36% and 68% for terbinafine (MIC ≥4 mg/L) and fluconazole (MICs ≥16 mg/L), respectively), and apparently involve the spread of a unique clade related to the Trichophyton mentagrophytes/Trichophyton interdigitale complex. Objectives: The European Committee on Antimicrobial Susceptibility Testing Subcommittee on Antifungal Susceptibility Testing (EUCAST-AFST) has released a new method (E.Def 11.0) for antifungal susceptibility testing against microconidia-forming dermatophytes including tentative MIC ranges for quality control strains and tentative breakpoints against Trichophyton rubrum and T. interdigitale. Here, the details of the new procedure E.Def 11.0 are described. Sources: This technical note is based on the multicentre validation of the EUCAST dermatophyte antifungal susceptibility testing method, the mould testing method (E.Def 9.3.2) and the updated quality control tables for antifungal susceptibility testing document, v 5.0 (available on the EUCAST website). Contents: The method is based on the EUCAST microdilution method for moulds but significant differences include: (a) an altered test medium selective for dermatophytes; (b) an altered incubation time and temperature; and (c) a different end-point criterion (spectrophotometric determination) of fungal growth. It can easily be implemented in laboratories already performing EUCAST microdilution methods and has been validated for terbinafine, voriconazole, itraconazole and amorolfine against T. rubrum and T. interdigitale. Implications: This standardized procedure with automated end-point reading wil

Terbinafine is an antifungal agent used in the treatment of hair, nail, and skin dermatophyte infections. Skin side effects to terbinafine are not common. Lichenoid drug eruption is a medication-related adverse cutaneous event; the lesion morphology and pathology mimic lichen planus. A woman with onychomycosis developed a lichenoid drug eruption one week after starting terbinafine. The features of her dermatosis and the characteristics of two additional men who also experienced terbinafine-induced lichenoid drug eruption are discussed. They were receiving a daily terbinafine dosage of either 125mg or 250mg to treat onychomycosis or tinea cruris. The lichenoid drug eruption presented as diffuse or symmetric lesions within one to two weeks after starting terbinafine treatment. The extremities, chest, abdomen, and/or trunk were common sites. Less frequent locations were the lips, nails, palms, soles, and suprapubic region; lesions did not occur on the oral or genital mucosa. The eruption resolved after discontinuation of the medication (with or without treatment using topical corticosteroids, systemic corticosteroids, or both). In addition, more frequently occurring terbinafine-associated cutaneous adverse events (such as urticaria, erythematous eruptions, pruritus, acute generalized exanthematous pustulosis, subacute cutaneous lupus erythematosus, and papulosquamous conditions) are reviewed.

Introduction Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients' perception of skin disease. Methods A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome. Results Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days' wages of a labourer). Conclusion Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek a quick fixes' from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and pr

Introduction Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients' perception of skin disease. Methods A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome. Results Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days' wages of a labourer). Conclusion Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek a quick fixes' from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and pr

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Terbinafine is an antifungal agent used in the treatment of hair, nail, and skin dermatophyte infections. Skin side effects to terbinafine are not common. Lichenoid drug eruption is a medication-related adverse cutaneous event; the lesion morphology and pathology mimic lichen planus. A woman with onychomycosis developed a lichenoid drug eruption one week after starting terbinafine. The features of her dermatosis and the characteristics of two additional men who also experienced terbinafine-induced lichenoid drug eruption are discussed. They were receiving a daily terbinafine dosage of either 125mg or 250mg to treat onychomycosis or tinea cruris. The lichenoid drug eruption presented as diffuse or symmetric lesions within one to two weeks after starting terbinafine treatment. The extremities, chest, abdomen, and/or trunk were common sites. Less frequent locations were the lips, nails, palms, soles, and suprapubic region; lesions did not occur on the oral or genital mucosa. The eruption resolved after discontinuation of the medication (with or without treatment using topical corticosteroids, systemic corticosteroids, or both). In addition, more frequently occurring terbinafine-associated cutaneous adverse events (such as urticaria, erythematous eruptions, pruritus, acute generalized exanthematous pustulosis, subacute cutaneous lupus erythematosus, and papulosquamous conditions) are reviewed.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Onychomycosis is the fungal infection of the nails caused by dermatophytes or yeasts. Its importance lies in the associated problems such as pain, paraesthesia, difficulties in performing activities of daily living and damaging social interactions, so it is important to indicate adequate treatment. This article reviews the response to treatment with 2 oral antifungals (fluconazole and terbinafine). We here report a clinical case of an a male patient of a 24-year-old with 2 years history of a hypertrophic, dystrophic, yellowish and scaly lesion on the first left toe with prior treatment of fluconazole 300mg once a week for 1 year without having the expected response which goes to the El Chaupi Health Center where after diagnostic tests with Potassium Hydroxide and Mushroom Cultivation, The patient was treated with terbinafine 250 mg once a day for 4 months plus use of cyclopirox at 8%., La onicomicosis es la infección micótica de las uñas causada por dermatofitos o levaduras. Su importancia radica en los problemas asociados como dolor, parestesias, dificultades al realizar actividades de la vida diaria y perjudicar las inte-racciones sociales, por eso es importante indicar un adecuado tratamiento. En el presente artículo se revisa la respuesta al tratamiento con 2 anti fúngicos orales (fluconazol y terbinafina). Se presenta el caso clínico de un paciente de sexo masculino de 24 años que presenta una lesión hipertrófica, distrófica, amarillenta y descamativa en el primer dedo del pie izquierdo de 2 años de evolución con tratamiento previo de fluconazol 300mg una vez a la semana durante 1 año sin tener la respuesta esperada el cual acude al Centro de salud El Chaupi en donde después de exámenes diagnósticos con Hidróxido de Potasio y Cultivo de hongos se indica tratamiento con terbinafina 250 mg una vez al día por 4 meses más empleo de ciclopirox al 8%.

Background Photodynamic therapy (PDT) kills target microorganisms via reactive oxygen species (ROS) production. PDT seems to be a good alternative treatment option for onychomycosis. Objective To compare the efficacy of combined therapies based on oral terbinafine (TN) plus adjunctive PDT mediated by methylene blue (MB) (TN + MB/PDT) or methyl aminolevulinate (MAL) (TN + MAL/PDT) in the treatment of onychomycosis. Methods Twenty patients affected by severe dermatophyte onychomycosis in the nails of the big toe (>60% disease involvement of target nail) received oral TN for 12 weeks and concomitantly were randomly allocated to receive nine sessions, separated by 2‐week intervals, of urea (40%) plus a PDT protocol mediated by MB (TN + MB/PDT: group I) or mediated by MAL (TN + MAL/PDT: group II). Clinical and mycological efficacy was evaluated at 16‐, 40‐ and 52‐week follow‐up., Results Both protocols showed a significant decrease in Onychomycosis Severity Index (OSI) scores (P < .05), from 24.2 ± 4.6 to 0.7 ± 0.6 (group I)) and from 18.5 ± 10.1 to 2.1 ± 2.0 (group II). No side effects or complications were reported in any of the combinations used. Mycological cure rates were significantly higher during the last third of the evaluated period of time, reaching 100% and 90% in group I and group II, respectively, at the 52‐week follow‐up. In both modalities, complete cure was achieved in 70% of the patients at the 52‐week follow‐up. Conclusions TN + MB/PDT and TN + MAL/PDT show similar outcomes in the treatment of toenails with severe onychomycosis. PDT is an effective method to accelerate the TN‐mediated healing process.

Background: In this last decade, a huge increase in African anthropophilic strains causing tinea capitis has been observed in Europe. The Belgian National Reference Center for Mycosis (NRC) conducted a surveillance study on tinea capitis in 2018 to learn the profile of circulating dermatophytes. Methods: Belgian laboratories were invited to send all dermatophyte strains isolated from the scalp with epidemiological information. Strain identification was confirmed by ITS (Internal Transcribed Spacer) sequencing. Mutation in the squalene epoxidase (SQLE) gene was screened by PCR. Results: The main population affected by tinea capitis was children from 5–9 years. Males were more affected than females. The majority of the strains were collected in the Brussels area followed by the Liege area. Among known ethnic origins, African people were more affected by tinea capitis than European people. The major aetiological agent was Microsporum audouinii, followed by Trichophyton soudanense. One strain of Trichophyton mentagrophytes has been characterized to have a mutation on the squalene epoxidase gene and to be resistant to terbinafine. Conclusions: African anthropophilic dermatophytes are mainly responsible for tinea capitis in Belgium. People of African origin are most affected by tinea capitis. The monitoring of terbinafine resistance among dermatophytes seems necessary as we have demonstrated the emergence of resistance in T. mentagrophytes., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives: Lomentospora prolificans is an emerging cause of serious invasive fungal infections. Optimal treatment of these infections is unknown, although voriconazole-containing treatment regimens are considered the treatment of choice. The objective of this study was to evaluate the role of combination antifungal therapy for L. prolificans infections. Methods: We performed a retrospective review of medical records of patients with invasive L. prolificans infection diagnosed between 1 January 2008 and 9 September 2019 that were documented in the FungiScope® registry of rare invasive fungal infections. We compared clinical outcomes between antifungal treatment strategies. Results: Over the study period, 41 individuals with invasive L. prolificans infection from eight different countries were documented in the FungiScope® registry. Overall, 17/40 (43%) had treatment response/stable disease and 21/40 (53%) had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was associated with increased 28-day survival (15/24 survived versus 4/16 receiving monotherapy; p 0.027) and the combination voriconazole plus terbinafine trended to be associated with higher rates of treatment success (10/16, 63%, 95% CI 35%–85%) compared with other antifungal treatment regimens (7/24, 29%, 95% CI 13%–51%, p 0.053). In Kaplan–Meier survival analysis there was a higher survival probability in individuals receiving the voriconazole/terbinafine combination compared with other antifungal regimens (median survival 150 days versus 17 days). Conclusions: While overall mortality was high, combination antifungal treatment, and in particular combination therapy with voriconazole plus terbinafine may be associated with improved treatment outcomes compared with other antifungal regimens for the treatment of invasive L. prolificans infections.

Gastrointestinal (GI) pythiosis is a severe and often fatal disease in dogs that traditionally has been poorly responsive to medical treatment. Although aggressive surgical resection with wide margins is the most consistently effective treatment, lesion location and extent often preclude complete resection. Recently, it has been suggested that the addition of anti-inflammatory doses of corticosteroids may improve outcome in dogs with nonresectable GI pythiosis. This report describes 3 dogs with colonic pythiosis in which complete resolution of clinical signs, regression of colonic masses, and progressive decreases in serological titers were observed after treatment with itraconazole, terbinafine, and corticosteroids. This treatment protocol represents a promising treatment for dogs with GI pythiosis in which surgical intervention is not feasible.

Gastrointestinal (GI) pythiosis is a severe and often fatal disease in dogs that traditionally has been poorly responsive to medical treatment. Although aggressive surgical resection with wide margins is the most consistently effective treatment, lesion location and extent often preclude complete resection. Recently, it has been suggested that the addition of anti-inflammatory doses of corticosteroids may improve outcome in dogs with nonresectable GI pythiosis. This report describes 3 dogs with colonic pythiosis in which complete resolution of clinical signs, regression of colonic masses, and progressive decreases in serological titers were observed after treatment with itraconazole, terbinafine, and corticosteroids. This treatment protocol represents a promising treatment for dogs with GI pythiosis in which surgical intervention is not feasible.

Gastrointestinal (GI) pythiosis is a severe and often fatal disease in dogs that traditionally has been poorly responsive to medical treatment. Although aggressive surgical resection with wide margins is the most consistently effective treatment, lesion location and extent often preclude complete resection. Recently, it has been suggested that the addition of anti-inflammatory doses of corticosteroids may improve outcome in dogs with nonresectable GI pythiosis. This report describes 3 dogs with colonic pythiosis in which complete resolution of clinical signs, regression of colonic masses, and progressive decreases in serological titers were observed after treatment with itraconazole, terbinafine, and corticosteroids. This treatment protocol represents a promising treatment for dogs with GI pythiosis in which surgical intervention is not feasible.

Trichophyton rubrum and Trichophyton mentagrophytes spp. are two of the most frequently isolated dermatophytes causing dermatophytosis worldwide. Since the incidence of resistance to antifungal agents is increasing, antifungal susceptibility tests are needed to successfully treat dermatophytoses. Most of the methods currently available are complicated, time-consuming and lack of reference procedures. The aim of this work was to establish a simple protocol to test the susceptibility of dermatophytes isolated from clinical samples against five antifungal drugs using E-test and disk diffusion methods. We used the E-test on non-supplemented Mueller–Hinton agar plates to determine the minimum inhibitory concentrations (MICs) of fluconazole, itraconazole, voriconazole and amphotericin B, and disk diffusion method to determine the interpretive MIC of terbinafine. Fifty dermatophytes—10 T. rubrum and 40 T. mentagrophytes spp.—were assessed after only 96 h of colony growth. Terbinafine was the most active antifungal agent with an inhibition diameter greater than 70 mm (sensitivity > 20 mm), followed by voriconazole, itraconazole and amphotericin B with MICs ranging from 0.032 to 0.38 µg/mL, from 0.006 to 0.125 µg/mL and from 0.5 to 1.5 µg/mL, respectively. All isolates were resistant to fluconazole. Collectively, the less laborious E-test and disk diffusion method were shown to be suitable and reliable to determine antifungal sensitivity of dermatophytes. This simple standard protocol could be employed in the routine of clinical laboratories.

In recent years, cases involving terbinafine-resistant Trichophyton isolates have been reported increasingly, particularly in India. We present 14 cases of terbinafine treatment failure in Trichophyton-infected Danish patients due to acquired resistance. Patients infected with Trichophyton rubrum (n = 12) or Trichophyton interdigitale (n = 2) with elevated terbinafine MICs during 2013-2018 were included. Antifungal susceptibility testing (AFST) was performed following a modified EUCAST E.Def 9.3.1 method (5 days of incubation) with or without cycloheximide and chloramphenicol (CC) supplementation of the growth medium. The squalene epoxidase (SE) target gene was sequenced, and 3-dimensional enzyme homology modeling was performed. Most patients (12/14 (86%]) were male. The mean age was 53.5 years (range, 11 to 77 years). The mean duration of infections was 4.8 years at the time of resistance detection. Prior systemic terbinafine treatment was documented for all patients, and topical therapy for 62% (information was missing in one case). Overall, nine isolates (64%) displayed high terbinafine resistance (MICs, 4 to >8 mg/liter), while two (14%) displayed moderate (MICs, 1 to 2 mg/liter) and three (21%) displayed low (MICs, 0.125 to 0.25 mg/liter) terbinafine resistance compared with control isolates. MICs generated with or without CC supplementation were similar, but CC prevented contamination. Known and novel SE amino acid substitutions (F397L, L393F, L3935, F4155, H440Y F484Y, and I121M V237I) were detected in resistant but not control isolates. Three-dimensional homology modeling suggested a role of the novel I121M and V237I alterations. Terbinafine resistance has been detected in Denmark using a modified EUCAST method, which facilitated susceptibility testing of dermatophytes. Action is needed for this emerging public health problem.

Our in vitro studies showed that a combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including those with Cladophialophora carrionii , Cladophialophora arxii , Exophiala dermatitidis , Exophiala spinifera , Fonsecaea monophora , Fonsecaea nubica , Fonsecaea pedrosoi , and Phialophora verrucosa. This drug combination could provide an option for the treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora .

Exophiala is a genus of black fungi isolated worldwide from environmental and clinical specimens. Data on antifungal susceptibility of Exophiala isolates are limited and the methodology on susceptibility testing is not yet standardised. In this study, we investigated in vitro antifungal susceptibilities of environmental Exophiala isolates. A total of 87 Exophiala isolated from dishwashers or railway ties were included. A CLSI M38-A2 microdilution method with modifications was used to determine antifungal susceptibility for fluconazole, voriconazole, posaconazole, itraconazole, amphotericin B and terbinafine. Minimum inhibitory concentration (MIC) values were determined visually at 48 hours, 72 hours and 96 hours. MIC-0 endpoint (complete inhibition of growth) was used for amphotericin B and azoles, except fluconazole, for which MIC-2 endpoint (~50% inhibition compared to growth control) was used. Both MIC-0 and MIC-1 (~80% inhibition compared to growth control) results were analysed for terbinafine to enable comparison with previous studies. Fungal growth was sufficient for determination of MICs at 48 hours for all isolates except two Exophiala dermatitidis strains. At 72 hours, most active antifungal agents according to GM MIC were voriconazole and terbinafine, followed by posaconazole, itraconazole and amphotericin B in rank order of decreasing activity. While amphotericin B displayed adequate in vitro activity despite relatively high MICs, fluconazole showed no meaningful antifungal activity against Exophiala.

Key message: Terbinafine induced a significant increase of squalene production. Terbinafine increased the expression levels of squalene synthase. Cyclodextrins did not work as elicitors due to the gene expression levels obtained. Abstract: Plant sterols are essential components of membrane lipids, which contributing to their fluidity and permeability. Besides their cholesterol-lowering properties, they also have anti-inflammatory, antidiabetic and anticancer activities. Squalene, which is phytosterol precursor, is widely used in medicine, foods and cosmetics due to its anti-tumor, antioxidant and anti-aging activities. Nowadays, vegetable oils constitute the main sources of phytosterols and squalene, but their isolation and purification involve complex extraction protocols and high costs. In this work, Daucus carota cell cultures were used to evaluate the effect of cyclodextrins and terbinafine on the production and accumulation of squalene and phytosterols as well as the expression levels of squalene synthase and cycloartenol synthase genes. D. carota cell cultures were able to produce high levels of extracellular being phytosterols in the presence of cyclodextrins (12 mg/L), these compounds able to increase both the secretion and accumulation of phytosterols in the culture medium. Moreover, terbinafine induced a significant increase in intracellular squalene production, as seen after 168 h of treatment (497.0 ± 23.5 µg g dry weight−1) while its extracellular production only increased in the presence of cyclodextrins.The analysis of sqs and cas gene expression revealed that cyclodextrins did not induce genes encoding enzymes involved in the phytosterol biosynthetic pathway since the expression levels of sqs and cas genes in cyclodextrin-treated cells were lower than in control cells. The results, therefore, suggest that cyclodextrins were only able to release phytosterols from the cells to the extracellular medium, thus contributing to their acu

Exophiala is a genus of black fungi isolated worldwide from environmental and clinical specimens. Data on antifungal susceptibility of Exophiala isolates are limited and the methodology on susceptibility testing is not yet standardised. In this study, we investigated in vitro antifungal susceptibilities of environmental Exophiala isolates. A total of 87 Exophiala isolated from dishwashers or railway ties were included. A CLSI M38-A2 microdilution method with modifications was used to determine antifungal susceptibility for fluconazole, voriconazole, posaconazole, itraconazole, amphotericin B and terbinafine. Minimum inhibitory concentration (MIC) values were determined visually at 48 hours, 72 hours and 96 hours. MIC-0 endpoint (complete inhibition of growth) was used for amphotericin B and azoles, except fluconazole, for which MIC-2 endpoint (~50% inhibition compared to growth control) was used. Both MIC-0 and MIC-1 (~80% inhibition compared to growth control) results were analysed for terbinafine to enable comparison with previous studies. Fungal growth was sufficient for determination of MICs at 48 hours for all isolates except two Exophiala dermatitidis strains. At 72 hours, most active antifungal agents according to GM MIC were voriconazole and terbinafine, followed by posaconazole, itraconazole and amphotericin B in rank order of decreasing activity. While amphotericin B displayed adequate in vitro activity despite relatively high MICs, fluconazole showed no meaningful antifungal activity against Exophiala.

Our in vitro studies showed that a combination of amphotericin B and terbinafine had synergistic effects against the majority of melanized fungi associated with chromoblastomycosis (CBM) and similar infections, including those with Cladophialophora carrionii , Cladophialophora arxii , Exophiala dermatitidis , Exophiala spinifera , Fonsecaea monophora , Fonsecaea nubica , Fonsecaea pedrosoi , and Phialophora verrucosa. This drug combination could provide an option for the treatment of severe or unresponsive cases of CBM, particularly in cases due to species of Fonsecaea and Cladophialophora .

Dermatophytosis in children caused by Trichophyton rubrum is preferably treated with topical or systemic terbinafine. We report the first case of terbinafine resistance in a child with recurrent T. rubrum dermatophytosis and congenital ichthyosiform erythroderma.

White and opaque cells of Candida albicans have the same genome but differ in gene expression patterns, metabolic profiles, and host niche preferences. We tested whether these differences, which include the differential expression of drug transporters, resulted in different sensitivities to 27 antifungal agents. The analysis was performed in two different strain backgrounds; although there was strain-to-strain variation, only terbinafine hydrochloride and caspofungin showed consistent, 2-fold differences between white and opaque cells across both strains.

Introduction: Chromomycosis is a localized chronic mycosis of skin and subcutaneous tissue caused by pigmented fungi. It is most common in tropical regions. Lesion usually presented with trauma history, and characterized by nodular verrucous that grow slowly on the lower extremities. The disease is difficult to treat. Case Report: A 33-year-old male garderner came with the main complaint multiple bumps accompanied with itchy and pain sensation on left leg that has became wider since 15 years before. There was a history of a thorn trauma in his left lower extrimity and he used to contact with soil and plants. The patient was diagnosed as chromomycosis based on history, clinical features, and confirmed with potassium hydroxide 10% that showed muriform cell, and fungal culture revealed the species Fonsacaea pedrosoi. The patient has not improved significantly treated with ketoconazole 200 mg 2 times daily for 9 months. The treatment was replaced into itrakonazole 100 mg 2 x 2 tablets combined with terbinafine 250 mg 2 x 1 tablets for 7 months and it gave a good result. Discussion: Predisposing factors in this case were a history of thorn trauma and contact with soil and plants continously. The lesions improved after 7 months treated with itraconazole and terbinafine. Chromomycosis is very difficult to treat and until now the gold standard treatment is not available yet. Combination therapy, itraconazole and terbinafine, could be considered for the therapy of chromomycosis with good result. Combination therapy can be continued until 2-4 weeks after no palpable nodules anymore.

Introduction: Chromomycosis is a localized chronic mycosis of skin and subcutaneous tissue caused by pigmented fungi. It is most common in tropical regions. Lesion usually presented with trauma history, and characterized by nodular verrucous that grow slowly on the lower extremities. The disease is difficult to treat. Case Report: A 33-year-old male garderner came with the main complaint multiple bumps accompanied with itchy and pain sensation on left leg that has became wider since 15 years before. There was a history of a thorn trauma in his left lower extrimity and he used to contact with soil and plants. The patient was diagnosed as chromomycosis based on history, clinical features, and confirmed with potassium hydroxide 10% that showed muriform cell, and fungal culture revealed the species Fonsacaea pedrosoi. The patient has not improved significantly treated with ketoconazole 200 mg 2 times daily for 9 months. The treatment was replaced into itrakonazole 100 mg 2 x 2 tablets combined with terbinafine 250 mg 2 x 1 tablets for 7 months and it gave a good result. Discussion: Predisposing factors in this case were a history of thorn trauma and contact with soil and plants continously. The lesions improved after 7 months treated with itraconazole and terbinafine. Chromomycosis is very difficult to treat and until now the gold standard treatment is not available yet. Combination therapy, itraconazole and terbinafine, could be considered for the therapy of chromomycosis with good result. Combination therapy can be continued until 2-4 weeks after no palpable nodules anymore.

Solar urticaria is an uncommon condition characterized by erythema and whealing shortly after exposure to ultraviolet (UV) and/or visible light. We report a 25-year-old woman with an erythematous, edematous, pruritic reaction minutes after sun exposure while she was taking terbinafine for onychomycosis. Phototesting revealed a UVB-sensitive urticarial reaction, confirming the diagnosis of solar urticaria. This report describes the first patient with possible terbinafine-associated solar urticaria.

Solar urticaria is an uncommon condition characterized by erythema and whealing shortly after exposure to ultraviolet (UV) and/or visible light. We report a 25-year-old woman with an erythematous, edematous, pruritic reaction minutes after sun exposure while she was taking terbinafine for onychomycosis. Phototesting revealed a UVB-sensitive urticarial reaction, confirming the diagnosis of solar urticaria. This report describes the first patient with possible terbinafine-associated solar urticaria.

Chromomycosis is a chronic fungal skin infection. It manifests frequently by warty or vegetative lesions in exposed areas, most often secondary to trauma. The diagnosis, nevertheless, is confirmed by the presence of fungi in the mycological examination. In fact, the treatment remains a challenge given its recalcitrant nature.

Chromomycosis is a chronic fungal skin infection. It manifests frequently by warty or vegetative lesions in exposed areas, most often secondary to trauma. The diagnosis, nevertheless, is confirmed by the presence of fungi in the mycological examination. In fact, the treatment remains a challenge given its recalcitrant nature.

Onychomycosis was diagnosed in a two-year-old girl. The infection was caused by Trichophyton rubrum, which is the most frequent cause of toenail onychomycosis. The diagnosis was confirmed by polymerase chain reaction, microscopy and culture. She was treated with orally given terbinafine and topically given amorolfine with clinical improvement at the following control visit. Onychomycosis is rare in children, but the occurrence seems to be increasing. Medical treatment can be topical, systemic or a combination of these.

Onychomycosis was diagnosed in a two-year-old girl. The infection was caused by Trichophyton rubrum, which is the most frequent cause of toenail onychomycosis. The diagnosis was confirmed by polymerase chain reaction, microscopy and culture. She was treated with orally given terbinafine and topically given amorolfine with clinical improvement at the following control visit. Onychomycosis is rare in children, but the occurrence seems to be increasing. Medical treatment can be topical, systemic or a combination of these.