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Onychomycosis is a recalcitrant fungal nail infection. Topical antifungal agents may be preferred over systemic agents due to lack of systemic adverse effects.To investigate the efficacy and safety of topical terbinafine 10% solution (MOB-015) for the treatment of distal and lateral subungual onychomycosis.In a multicenter, double-blind, phase III, North American study, patients with mild to moderate distal and lateral subungual onychomycosis involving 20% to 60% of at least 1 great toenail were randomized to once daily application of MOB-015 or matching vehicle for 48 weeks. The primary efficacy variable was complete cure, while the secondary efficacy variables were mycological cure and treatment success. Safety evaluations were also performed.At week 52, the mycological cure (negative culture and potassium hydroxide microscopy) rate in the MOB-015 and vehicle groups was 69.9% and 27.7%, respectively (P .001), and complete cure (0% clinical disease involvement and mycological cure) was achieved in 4.5% and 0% of patients, respectively (P = .0195). At least 1 adverse event leading to discontinuation of treatment occurred in 2.8% of patients in the MOB-015 group and in 4.2% in the vehicle group.The follow-up period after end of treatment may not be sufficient to accurately reflect cure in distal and lateral subungual onychomycosis.MOB-015 is a treatment option for onychomycosis with an adverse event profile similar to vehicle.

Objective — to study the effectiveness of the method of treating onychomycosis using only local agents in patients suffering from psoriasis and having contraindications to the use of systemic antifungal agents. Materials and methods. The study involved 52 patients with psoriasis and lesions of the nail plates, aged 21 to 67 years. The duration of the disease was from 1 to 27 years.To verify the fungal infection of the nail plates, a microscopic examination of nail scales with 20 % KOH and molecular genetic studies using pan-fungal primers were carried out.Among 52 examined patients with psoriasis who had clinical signs of lesions of the nail plates, there were 37 people with mycotic infection lesions of the nail plates.Due to the somatic burden, the use of systemic antifungal agents was contraindicated. Treatment of onychomycosis in such patients was carried out using only local therapy and sanitary-hygienic measures. As a topical antifungal therapy, 1 % solution and 1 % cream of naftifine hydrochloride were prescribed in combination with drugs that improve the structure of the nail plates (Volvit, 5 mg once a day and Cytoflavin, 2 tablets 2 times a day for 1.5 months). Results and discussion. 1 month after the beginning of the use of the proposed method for the treatment of nail fungal infection in case of psoriasis of the scales of the nail plates, mycelium and fungal spores were absent in 6 (16.2 %) patients with distal lesions of the nail plates. After 4 months of treatment they were absent in 16 (43.4 %) patients with distal-lateral lesions of the nail plates, after 6 months — in 21 (56.7 %) patients, after 9 months — in 26 (70.2 %) patients. Conclusions. The proposed complex method is quite effective and of higher priority for the treatment of onychomycosis in patients with comorbid conditions that make it impossible to treat a fungal infection with systemic antimycotics.

Objectives: The objective of existent effort was topical proniosomal gel formulation and evaluation from the proniosomes of Ciclopirox to improve poor skin penetration and residence of the topical antifungal drugs. Methods: The co-acervation phase separation method was used to prepare proniosomes by using combination of different grades of non-ionic surfactant, cholestrol and lecithin. Characterized for pH, encapsulation efficiency, Particle size, in vitro drug permeation. Selected batches were converted into topical proniosomal gel and evaluated for ex vivo permeation. Then best fitted formulation batch C5CF8 were differentiate with marketed preparation for ex vivo drug release and anti-fungal activity. Results: Proniosomal gel pH be there 5.61± 0.25 to 7.31± 0.06 and encapsulation efficiency 82.40 to 92.20% and particle size 3.20 ± 0.15 to 6.45 ± 0.20. In vitro drug release is in between 37.65 to 57.04 %. Among the formulations CF1, CF2, CF3, CF4 and CF5 were developed into carbopol topical gel as C1CF2, C2CF32, C3CF5, C4CF6 and C5CF8 and evaluated for ex vivo drug permeation. Among these optimized formulation C5CF8 showed drug permeation 59.39 ± 0.10 % at 12 hr. with a flux value of 5.24μg/ cm2/hr., permeability coefficient of 0.262 cm2/hr. and higher correlation coefficient R2 0.9949 for zero order drug release and hence follows zero order release kinetics. The C5F8 showed prolonged drug release and zone of inhibition value higher for carbopol gel as compared to marketed preparation Conclusion: Developed carbopol topical gel had potential to act as controlled release drug carrier which prolonged the drug release for number of hours.

The topical antifungal efinaconazole was applied to 27 nails (17 patients), and the treatment effects were monitored over a stipulated period (after 3, 6, and 12 months). Fourteen nails were observed for 18 months. Effects of the treatment were determined on the basis of the improvement rate of the turbidity ratio compared with that before treatment. After 12 months, five nails were cured and marked improvement was noted, whereas moderate and marked improvements were noted in 11 and six nails, respectively. The cured patients exhibited a significantly better improvement rate at 6 months (68.8%) than the other groups. Only 10.6% improvement was observed at the same point in time for the mild improvement group. Thus, in cases where the improvement rate after 6 months of treatment was 10% or less, it was judged that oral treatment should be considered. Furthermore, of the nails monitored for 18 months, those that exhibited further growth in improvement rates at 12 months was 51.6%, suggesting that an improvement rate of 50% at 12 months after starting treatment could be used as an indicator to determine switching to oral treatment.

Background: Hyperkeratinization and changes in skin pH play very important role in pathogenesis of tinea infections resulting in treatment failure in multiple patients. The objective of the current consensus was to provide an experience-driven approach regarding the management of hyperkeratotic tinea infection with combination of topical antifungal and keratolytic agents. Materials and Methods: 9 experts in the field of dermatology participated in digital meeting to discuss the role of combination of topical antifungal and keratolytic agent based on prevalidated questionnaire consisting of 18 questions. Questions were graded on a scale of 1 to 10 (1 being not recommended and 10 being strongly recommended). Results: During the meeting panellists discussed regarding the pathophysiological aspects of hyperkeratotic tinea infection, impact of hyperkeratinization or scaling and changes in skin pH on management of patients with tinea infection, ideal topical antifungal and keratolytic agent and the rationale for combination, frequency, duration and method of application, initiation of therapy, safety of combination and precautions to be taken during treatment period. After the end of meeting total 18 recommendations were made based on a thorough discussion, available evidence and practical experience of the experts. Conclusion: This consensus will help in management of patients with hyperkeratotic tinea infection and will improve the treatment outcomes in these patients. Keywords: Hyperkeratotic tinea infections, Keratolytic, Combination, Luliconazole, Salicylic acid.

Introduction: Dermatophytosis is a superficial fungal infection of keratinized tissue. The infection is known as tinea. Various oral and topical antifungal agents used in clinicalpractice. Objective: Comparative study between oral terbinafine and griseofulvin in dermatophytosis infection in children between 5 to 15 years Methods: Patients of both gender and age between 5 to 15 years diagnosed as dermatophytic infection were enrolled for the study. Atotal of 100 patientswere divided into two groups. One group was treated with oral terbinafine and other withoral griseofulvin for 4 weeks. In addition a placebo cream/ lotion was applied locally. Limitation: Large studies are required for more confirmation. Conclusion: Oral terbinafine produced 88 percent cure while cure with griseofulvin was 72 percent .Clinical response to oral terbinafine was 16percentbetter.No significant adverse effects were noticed in either groups, except in some cases mild gastrointestinal disturbance. Keywords: Dermatophytosis, Terbinafine, Griseofulvin, Tinea, Fungicidal.

Highlights • Photorefractive keratectomy is a common refractive surgery which has excellent outcome in correcting refractive errors. • This procedure carries the risk of infectious keratitis due to removal of epithelial layer during the procedure. • Few cases has been reported with fungal keratitis following the procedure. • In the current case the culture was positive for bipolaris species and the patient showed excellent response to medical treatment. • Early diagnosis, appropriate laboratory testing, close observation and aggressive antifungal therapy can result in good outcomes., Introduction Fungal keratitis is an uncommon condition that can occur after ocular surgery or trauma to the eye. Some cases have been reported after corneal refractive surgery. Most cases of keratitis following refractive surgery are due to gram-positive bacteria. However, there are a few reports in the literature of fungal and protozoal infections. Case Presentation A 29-year-old healthy male developed fungal keratitis Five days following photorefractive keratectomy. Clinical findings and Investigations The patient was admitted to the hospital, corneal scraping was performed and sent for staining and routine cultures. A corneal swab was also performed and sent for polymerase chain reaction (PCR). On day 10 post-admission, the fungal culture was positive for Bipolaris. Intervention and Outcome Intensive topical antifungal drops were started initially then tapered when clinical improvement was evident. The patient had good final outcome with preservation of good vision and free of symptoms six months following the infection. Relevance and Impact Fungal keratitis following corneal refractive surgery is rare. However, it is an infection that can potentially lead to poor outcomes if appropriate management is delayed. Therefore, a high index of suspicion is required especially when multiple risk factors is present.

Immunosuppression after solid-organ transplantation can lead to opportunistic infections as cryptococcosis. A 69-year-old female, cadaveric renal-transplant recipient, manifested with ulcerative lesions on the 7th month of immunosuppression. Histological examination confirmed the diagnosis of cryptococcosis. Treatment with systemic and topical antifungal therapy for 7 months concluded in significant cutaneous improvement. This case presentation encourages high clinical suspicion of opportunistic pathogens such as Cryptococcus spp. and highlights the necessity of appropriate management.

Objectives: Microemulsions are fluid, isotropic, colloidal systems that have been widely studied as drug delivery systems. The percutaneous transport of active agents can be enhanced by their microemulsion formulation when compared to conventional formulations. The purpose of this study was to evaluate naftifine-loaded microemulsions with the objective of improving the skin permeation of the drug. Materials and Methods: Microemulsions comprising oleic acid (oil phase), Kolliphor EL or Kolliphor RH40 (surfactant), Transcutol (co-surfactant), and water were prepared and physicochemical characterization was performed. In vitro skin permeation of naftifine from microemulsions was investigated and compared with that of its conventional commercial formulation. Attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy was used to evaluate the interaction between the microemulsions and the stratum corneum lipids. Candida albicans American Type Culture Collection (ATCC) 10231 and Candida parapsilosis were used to evaluate the antifungal susceptibility of the naftifine-loaded microemulsions. Results: The microemulsion formulation containing Kolliphor RH40 as co-surfactant increased naftifine permeation through pig skin significantly when compared with the commercial topical formulation (p

In this study, voriconazole (VCZ) incorporated polyvinyl alcohol/sodium alginate electrospun nanofibers were produced and, then crosslinked with glutaraldehyde for topical antifungal treatment. The...

There is an increase in the incidence of onychomycosis, especially in at-risk populations. Onychomycosis is difficult to treat, as the efficacy of most antifungal agents is relatively low. Nondermatophyte molds (NDMs) and mixed infection (dermatophyte plus NDM) onychomycosis are contributing to growing antifungal resistance, as they are often underestimated and ignored due to incorrect diagnosis. There is a need for a paradigm shift in the management of onychomycosis to a patient-centered, holistic approach with an emphasis on laboratory diagnosis prior to initiating treatment, which enables the rational choice of the antifungal agent. Additionally, in the case of resistant infections, antifungal susceptibility testing is recommended. Strategies for effective management of onychomycosis include disinfection of fungal reservoirs in shoes and socks and prophylaxis posttreatment using topical antifungal agents. These measures may reduce the recurrence of onychomycosis and improve long-term clinical success.

A woman in her 20s presented to dermatology clinic with a four year history of a mildly itchy hypopigmented patch in her natal cleft, and similar itchy lesions that had gradually appeared on the back of both knees over the past six months (fig 1, fig 2). The lesions ranged from white to brown. Fig 1 Hypopigmented atrophic plaques in upper part of natal cleft Fig 2 Hypopigmented atrophic plaques in popliteal fossae Treatment with topical antifungal creams for suspected candidal intertrigo was unsuccessful. Cutaneous examination revealed multiple ill defined hypopigmented plaques in the upper part of the natal cleft and both popliteal fossae. On close inspection, the affected skin showed fine wrinkling and increased translucency (not clear in the figure) …

Chitosans represent a group of multifunctional drug excipients. Here, we aimed to estimate the impact of high-molecular weight chitosan on the physicochemical properties of clotrimazole&ndash, chitosan solid mixtures (CL&ndash, CH), prepared by grinding and kneading methods. We characterised these formulas by infrared spectroscopy, differential scanning calorimetry, and powder X-ray diffractometry, and performed in vitro clotrimazole dissolution tests. Additionally, we examined the antifungal activity of clotrimazole&ndash, chitosan mixtures against clinical Candida isolates under neutral and acid conditions. The synergistic effect of clotrimazole and chitosan S combinations was observed in tests carried out at pH 4 on Candida glabrata strains. The inhibition of C. glabrata growth reached at least 90%, regardless of the drug/excipient weight ratio, and even at half of the minimal inhibitory concentrations of clotrimazole. Our results demonstrate that clotrimazole and high-molecular weight chitosan could be an effective combination in a topical antifungal formulation, as chitosan acts synergistically with clotrimazole against non-albicans candida strains.

Onychomycosis (OM) is a chronic fungal infection of the nail caused by dermatophytes, yeasts, and nondermatophytes. Tioconazole is one of the topical antifungal belonging to imidazole derivatives. Tazarotene is a synthetic retinoid, with immunomodulating properties and anti-inflammatory activity. To evaluate the efficacy of tazarotene 0.1% gel alone in comparison with its combination with tioconazole nail paint in the treatment of onychomycosis. Forty patients presented with onychomycosis, subjected to a full history taking, clinical examination, and nail examination, which includes a clinical, dermoscopic, assessment of severity by using Onychomycosis Severity Index (OSI), KOH examination, and fungal culture. There was a statistically significant increase in the response of treatment in patients treated by a combination of tazarotene and tioconazole compared to tazarotene alone through (decrease in OSI, dermoscopic features, and mycological clearance). Tazarotene had antifungal activity specially against Aspergillus niger while its combination with tioconazole gave better results and can be used as an adjuvant to the standard systemic or topical antifungal treatment for OM.

Aspergillus niger is commonly associated with otomycosis. Currently, local guidelines lack appropriate guidance on the definitive treatment and management when the fungus is identified. The repeated use of antibiotics in children with refractory episodes of otitis externa is concerning and may contribute towards otomycosis. This case report highlights the importance of a well-collected pus swab from the ear and suggests a topical antifungal to use in paediatric patients with Aspergillus niger otomycosis.

The injudicious use of antifungals, indiscriminate use of corticosteroids for instant relief, persistence of predisposing factors like sweat retention and uncontrolled diabetes, and emerging resistance to antifungals across the globe have rendered the management of an erstwhile simple infection, the superficial cutaneous mycoses highly complicated and tricky. Ciclopirox is an old yet efficacious, versatile, and safe topical antifungal of the hydroxypyridone family. Despite its numerous beneficial properties over the majority of other topical antifungals, it remains underutilized.

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Congenital candidiasis infection often presents as a skin rash with variable involvement of nails and mucous membranes. Isolated nail involvement is rare, may present late, and can often be managed with topical antifungal medication. We report a case of congenital candidiasis limited to the fingernails that resolved completely within 3 months with topical treatment.

Immobilization of antifungal drugs into various nano- and submicron carriers is a perspective way to overcome such limitations associated with their application as high toxicity and unfavorable physicochemical properties. The current study introduces a novel formulation for the poor soluble antimicotic drug. Griseofulvin, which is based on mesoporous calcium carbonate particles offering enhanced loading capacity and bioavailability. Proposed particulate system provides delivery and accumulation into the skin that reveals promising outlook for topical antifungal treatment providing targeted delivery to the lesion area of skin.

Topical antifungal treatments for onychomycosis are applied to clean, unpolished nails for 48 weeks or longer. Patients often wish to mask their infection with nail polish yet there is no evidence to suggest antifungal efficacy in the presence of nail polish.To determine if tavaborole retains the ability to penetrate the nail plate and inhibit fungal growth in the presence of nail polish.Tavaborole was applied to human fingernails painted with 2 or 4 coats of nail polish, and unpainted nails in an ex vivo model. Nails were mounted on TurChubTavaborole exhibited antifungal activity in all experimental groups. The zones of inhibition of T. rubrum for all experimental groups (2 or 4 coats of polish, unpolished) were greater than infected controls (polished and unpolished), p

Various treatment methods other than oral and topical antifungal medications have been employed to treat onychomycosis. Treatment methods include mechanical removal of the affected part of the nail plate by using a toenail cutter or grinder and chemical removal by using occlusive dressing therapy with salicylic acid plaster or urea cream. In recent years, laser therapies have received attention as modalities for treatment of onychomycosis. Favorable outcomes in patients with onychomycosis have been reported in Japan from treatment combining carbon dioxide laser and topical antifungal drug, treatment with photodynamic therapy, and treatment with Nd:YAG laser. However, irradiation conditions, number of irradiation sessions, and efficacy evaluation methods vary among institutions and studies; thus, there is no established evidence to support these outcomes. In addition, a study reported that a combination of Nd:YAG laser and external antifungal drugs was more effective than each of the treatments alone. Future studies are required to provide clinical evidence on the effectiveness of laser therapies, on the enhancement of effect from the combination of laser and external antifungal drugs, and on the possibility of shortening treatment duration using laser therapies in the management of patients with onychomycosis.

Dermatophytes are amongst the most common causative agents of fungal infections worldwide and widespread in the developing countries. Various studies have found the significantly rising trend of this infection in India especially in last 4-5 years. The growing epidemic of recurrent/chronic dermatophytosis has led to the need for newer antifungal agents and/or preparations. Furthermore, resistance to commonly used topical and oral antifungals has increased alarmingly. Significantly increasing resistance has led to state of anxiety in physicians and significant distress to the patients socially, emotionally, and financially. Newer formulations or newer derivatives of existing drug classes and few newer drug classes are being developed to tackle this menace. Other forms of local therapies including lasers and photodynamic therapy are still in developmental phase and still need to be optimized in terms of dosing schedule, frequency of use and duration of therapy. Moreover, cost of these therapies remained most important obstacle in developing countries like India. We are hereby reviewing the newer formulations of topical therapies and drugs/interventions in experimental phase.

A 50-year-old man presented to the dermatology department with a 1-year history of itchy axillary and groin lesions. He had been treated with a topical antifungal preparation (cyclopyroxolamin), without improvement, by his family physician, who had suspected fungal intertrigo. On physical

A woman in her 40s presented to the emergency department with a 3 day history of fever (~39°C), bilateral swelling of the ankle joints, and multiple severely painful skin nodules on her shins (fig 1). She had applied a topical steroid to the leg lesions but this had not helped. Fig 1 Multiple severely painful skin nodules on the shins For the previous five years she had recurrent oral ulcerations (more than four episodes per year) and several instances of vulval ulceration. During this time, she had tried stress relief for the oral ulcers and topical antifungal, antiviral, and steroid ointments three times a day for two weeks for the vulval lesions. However, response to these treatments was poor and the ulcerations still occurred intermittently. On examination, the erythematous shin nodules measured 1-2 cm in diameter and were firm and severely …

The purpose of present work was to formulate Fluconazole loaded microsponge-based topical delivery system for modified release. Microsponges with varied drug–polymer ratios were prepared by emulsion solvent diffusion technique using Ethyl cellulose as release retard material. Prepared microsponges were studied for particle size and physical characterization. Scanning electron microscopy (SEM) images showed the microsponges porous and spherical in shape. The microsponges were then incorporated in carbopol gel and evaluated for pH, viscosity, spreadability, drug content, in-vitro release. The In vitro drug release showed that microsponges with 1:1.5 drug–polymer ratios (F3) were more efficient to give sustained release of 74.2% at the end of 8 hr. All the microsponge gel formulations (i.e.F1- F10) showed better results like pH between 6.5-7.0, viscosity between 25,030-47,390 cps, spreadability 2-4 cm/s and drug content of 76.20±0.02% to 96.41±0.01%. Hence, the fabricated microsponge based formulation of Fluconazole would be anticipation and promising substitute to conventional therapy of skin infections.

Superficial fungal infections occur in approximately 20% of the population. Dermatophyte infections are mainly caused by organisms from the Trichophyton, Epidermophyton, and Microsporum genera, and should not be confused with infections caused by Candida sp. since management may differ. The diagnosis of cutaneous dermatophyte infections are confirmed with potassium hydroxide (KOH) preparations as clinical diagnosis is not always accurate, and may result in inappropriate treatment. Most dermatophyte infections are successfully managed with topical antifungal preparations; however, systemic therapy provides an increased cure rate and reduces re-occurrence. This review focuses on the most common dermatophyte infections seen by South African health-care providers and briefly describes the available treatment options, which may differ from agents used elsewhere in the world.Keywords: Tinea pedis, Tinea corporis, Tinea capitis, Tinea crusis, Tinea unguium, pharmacotherapy

The role of topical antifungal agents in the long-term management of toenail onychomycosis is not well established. The current study evaluated durability of clinical benefit of tavaborole topical solution, 5%, for the treatment of toenail onychomycosis.We conducted a pooled analysis of 8-week, post-study follow-up (PSFU) data from two phase 3, randomized controlled trials in a subset of patients who experienced complete or almost clear nail (CN) at the end of treatment (week 52); 48 weeks of treatment with once-daily tavaborole compared with placebo in adults with distal subungual onychomycosis was evaluated at week 60. Complete cure (completely CN plus negative mycology) of the target great toenail and treatment success (10% nail involvement plus negative mycology) were evaluated at week 52 versus week 60.Of the 62 patients who completed the PSFU, complete cure was higher in the tavaborole-treated group versus the vehicle control group (28.6% vs. 7.7%). Additionally, treatment success was 53.1% for the tavaborole group versus 23.1% in the vehicle group. Small sample size entering the PSFU limited robust statistical analysis.Tavaborole topical solution, 5%, appears to provide durable clinical benefit, making it an attractive long-term treatment option for dermatophyte-associated onychomycosis of the toenail.

Background: Although systemic and topical antifungal agents are widely used to treat onychomycosis, oral medications can cause adverse effects and the efficacy of topical agents is not satisfying. Currently, laser treatment has been studied for its efficacy in the treatment of onychomycosis. Our study was aimed to evaluate the efficacy of fractional carbon dioxide (CO2) laser treatment combined with terbinafine cream for 6 months in the treatment of onychomycosis and to analyze the influencing factors. Methods: A total of 30 participants (124 nails) with clinical and mycological diagnosis of onychomycosis received fractional CO2 laser treatment at 2-week interval combined with terbinafine cream once daily for 6 months. The clinical efficacy rate (CER) was assessed from the percentage of fully normal-appearing nails or nails with ≤5% abnormal appearance, and the mycological clearance rate (MCR) was assessed from the percentage of nails with negative fungal microscopy. Results: The CER was evaluated...

Dermatophytes are fungi that commonly cause superficial skin infections. While these rashes are typically benign and easily treated with topical antifungal medications, extensive presentations can indicate a more serious underlying immunodeficiency. We report on a teenage girl whose extensive rash led to a diagnosis of human immunodeficiency infection.

Onychomycosis is an important medical disorder affecting both health and quality of life of patients. This study was done to compare the efficacy of CO2 laser in combination with topical tioconazole versus CO2 laser only versus topical tioconazole alone in onychomycosis. A total of 120 patients with onychomycosis were randomly assigned to three groups. Group A patients were treated with fractional CO2 laser followed by topical tioconazole 28% for five sessions with 3 weeks interval. Group B patients were treated with only fractional CO2 laser for five sessions with 3 weeks interval. Group C patients were treated with only topical tioconazole 28% for 16 weeks. The clinical effect, KOH examination, and culture for the affected nails in the three groups were analyzed. One month after the last session, regarding clinical response, 55% showed complete clinical improvement in Group A versus 30% in Group B versus 25% in Group C with a significant difference in between. There was a significant difference between the three studied groups as regard KOH test and culture after treatment. Fractional CO2 laser combined with topical antifungal is a safe and effective treatment for onychomycosis.