RESUMO
ABSTRACT: Multiple pathophysiologic and biomolecular processes lead to bullae, including disruption of adhesion molecules, accumulation of cell injury, and traumatic injury. Blistering disorders of the foot can cause symptoms such as pruritus, pain, and drainage and significantly impact quality of life. Microbiologic and histopathologic examination of tissue specimens should be considered for concerns regarding atypical etiology.This retrospective case series describes patients seen in a community hospital outpatient wound center in southeastern Wisconsin between January 2021 and June 2023 for atypical blistering disorders of the foot. The cases herein describe the history, clinical presentation, and treatment of three atypical blistering disorders of the foot. An 86-year-old man presented complaining of intensely pruritic blistering lesions to both feet. Histopathologic findings indicated eosinophilic infiltrate, and the patient was treated for an eosinophilic drug reaction. A 65-year-old man presented complaining of multiple painful blisters to the plantar aspect of both feet. Histopathologic examination of unroofed blister indicated bullous tinea. Finally, a 44-year-old man with long-standing type 1 diabetes presented complaining of a several-week history of a single blister to his anterior right foot of unknown etiology. The patient was diagnosed with bullosis diabeticorum.Blistering disorders of the foot are diagnostic challenges; diagnostic clarity is assisted by thorough history, clinical presentation, treatment response, microbial analysis, and histopathologic findings.
Assuntos
Vesícula , Humanos , Masculino , Idoso de 80 Anos ou mais , Idoso , Vesícula/diagnóstico , Vesícula/etiologia , Adulto , Estudos Retrospectivos , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Dermatoses do Pé/patologiaRESUMO
BACKGROUND: Dermatophytoma, also described as a longitudinal streak/spike, is a form of onychomycosis that presents as yellow/white streaks or patches in the subungual space, with dense fungal masses encased in biofilm. This scoping review of the literature was conducted to address a general lack of information about the epidemiology, pathophysiology, and treatment of dermatophytomas in onychomycosis. METHODS: A search was performed in the PubMed and Embase databases for the terms "longitudinal spike" or "dermatophytoma." Outcomes of interest were definition, prevalence, methods used for diagnosis, treatments, and treatment efficacy. Inclusion and exclusion of search results required agreement between two independent reviewers. RESULTS: Of a total of 51 records, 37 were included. Two reports provided the first unique definitions/clinical features of dermatophytomas. Overall, many descriptions were found, but one conclusive definition was lacking. Prevalence data were limited and inconsistent. The most frequently mentioned diagnostic techniques were clinical assessment, potassium hydroxide/microscopy, and fungal culture/mycology. Oral terbinafine and topical efinaconazole 10% were the most frequently mentioned treatments, followed by topical luliconazole 5% and other oral treatments (itraconazole, fluconazole, fosravuconazole). In studies with five or more patients without nail excision, cure rates were highest with efinaconazole 10%, which ranged from 41% to 100% depending on the clinical and/or mycologic assessment evaluated. Other drugs with greater than or equal to 50% cure rates were topical luliconazole 5% (50%), oral fosravuconazole (57%), and oral terbinafine (67%). In studies that combined oral terbinafine treatment with nail excision using surgical or chemical (40% urea) methods, cure rates ranged from 50% to 100%. CONCLUSIONS: There is little published information regarding dermatophytomas in onychomycosis. More clinical research and physician education are needed. Although dermatophytomas have historically been considered difficult to treat, the efficacy data gathered in this scoping review have demonstrated that newer topical treatments are effective, as are oral antifungals in combination with chemical or surgical methods.
Assuntos
Antifúngicos , Onicomicose , Humanos , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Onicomicose/terapia , Onicomicose/tratamento farmacológico , Antifúngicos/uso terapêutico , Prevalência , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Tinha/diagnóstico , Tinha/terapia , Tinha/epidemiologia , Tinha/tratamento farmacológico , Feminino , MasculinoRESUMO
Onychomycosis is a fungal infection of the nail, and the most common nail infection worldwide, causing discoloration and thickening of the nail plate. It is predominantly caused by dermatophytes. Clinical presentation is polymorphous. Diagnosis must be confirmed by mycological examination before initiating any therapy. Management is an ongoing challenge, often requiring several months' treatment, with a high risk of recurrence. Treatment must be adapted to clinical presentation and severity and to the patient's history and wishes. Debridement of all infected keratin is the first step, reducing fungal load. Systemic treatments are more effective than topical treatments, and combining the two increases the cure rate. Terbinafine is the drug of choice for dermatophyte onychomycosis, due to low drug interaction and good cost-effectiveness. Itraconazole and fluconazole are broad-spectrum antifungals that are effective against dermatophytes, yeasts, and some non-dermatophytic molds. Recurrence rates for onychomycosis are high. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurence.
Assuntos
Antifúngicos , Onicomicose , Onicomicose/terapia , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Humanos , Antifúngicos/uso terapêutico , Desbridamento , Dermatoses do Pé/terapia , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Terbinafina/uso terapêutico , Naftalenos/uso terapêutico , Administração TópicaRESUMO
AbstractBACKGROUND:Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects.OBJECTIVES:To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones.METHODS:Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment.RESULTS:McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure.CONCLUSIONS:The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatoses do Pé/terapia , Dermatoses da Mão/terapia , Lasers de Gás/uso terapêutico , Onicomicose/terapia , Fotoquimioterapia/métodos , Terapia Combinada/métodos , Satisfação do Paciente , Reprodutibilidade dos Testes , Resultado do TratamentoRESUMO
Este trabalho caracterizou-se por um estudo de caso, no qual pudemos verificar a aplicabilidade do vaso extraordinário Chong Mai no tratamento da onicomicose no hálux. Embora as alterações ungueais não caracterizassem a queixa principal da paciente fomos motivados pela oportunidade de testar esta aplicabilidade. O tratamento acupuntural foi realizado por um período de quatro meses no qual foi possível verificar uma significativa melhora, não só dos sintomas que caracterizavam sua queixa principal, mas acima de tudo da aparência da unha do hálux.(AU)
This study was characterized by a case study in which we could verify the applicability of the extraordinary vessel Chong Mai in the treatment of onychomycosis of the hallux. White nail changes do not charaterize the main complaint of the patient were motivated by the opportunity to test this applicability. Acupunctural treatment was carried out for a period of four months in which we observed significant improvement, not only of the symptoms that was charaterized as their main complaint, but above all the appearance of the nail of the hallux.(AU)
Assuntos
Humanos , Feminino , Adulto , Terapia por Acupuntura , Dermatoses do Pé/terapia , Onicomicose/terapia , Pontos de Acupuntura , HalluxRESUMO
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Dermatologia/estatística & dados numéricos , Dermatoses do Pé/epidemiologia , Dermatoses da Mão/epidemiologia , Onicomicose/epidemiologia , Onicomicose/terapia , Brasil/epidemiologia , Comorbidade , Exercício Físico/fisiologia , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/terapia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/terapia , Onicomicose/diagnóstico , Prevalência , Fatores de RiscoAssuntos
Humanos , Feminino , Pessoa de Meia-Idade , Dermatoses do Pé/terapia , Terapia a Laser , Onicomicose/terapia , TrichophytonRESUMO
A tungíase é uma infestação zooantropofílica causada pela Tunga penetrans. É endêmica na América Latina e no Caribe. Ocorre, principalmente, em comunidades carentes e sem saneamento básico e em indivíduos que visitam áreas contaminadas. O local mais comum de penetração do ectoparasita é a região periungueal dos pés. Os autores mostram a ocorrência de uma forma disseminada num habitante da zona rural.
Tungiasis is a zoophilic and anthropophilic infestation caused by Tunga penetrans. It is endemic in Latin America and in the Caribbean. It occurs mainly in impoverished communities that have no access to basic sanitation and in individuals that visit contaminated areas. The most common penetration site of this ectoparasite is the periungueal region of the feet. The authors present its disseminated form occurring in a patient inhabiting a rural area.
Assuntos
Adulto , Humanos , Masculino , Dermatoses do Pé/diagnóstico , Tungíase/diagnóstico , Dermatoses do Pé/terapia , Tungíase/terapiaRESUMO
A infecçäo dos pés é um dos principais e mais comuns problemas da diabetes mellitus. Cerca de 25 por cento dos pacientes sofrem deste mal durante a vida. Esta crônica e comprometedora complicaçäo da diabetes mellitus causa considerável sofrimento, mudanças no estilo e qualidade de vida do paciente, impedimento de suas funçöes normais, morbidade e, finalmente, em alguns casos, amputaçäo. Medidas terapêuticas correntes, juntamente com o manuseio adequado de todos os fatores de risco fisiopatológicos e complicaçöes, auxiliaräo a reduzir a taxa de incidência de infecçäo do pé diabético, assim como os custos de tratamento, hospitalizaçäo e amputaçäo, além de diminuir o sofrimento do paciente e produzir a melhoria de suas condiçöes gerais
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Humanos , Diabetes Mellitus/complicações , Diabetes Mellitus/fisiopatologia , Dermatoses do Pé/etiologia , Úlcera Cutânea/etiologia , Amputação Traumática , Artrite Gotosa/diagnóstico , Diagnóstico Diferencial , Dermatoses do Pé/microbiologia , Dermatoses do Pé/prevenção & controle , Dermatoses do Pé/terapia , Artropatias/diagnóstico , Fatores de Risco , Manifestações CutâneasRESUMO
Age-associated nail changes and disorders are common in elderly patients. Characteristic changes in color, contour, growth, surface, thickness, and histology occur in the nail unit as persons become older. Several onychodystrophies are frequently observed in these elderly patients: brittle nails, those induced by faulty biomechanics and trauma, infections, onychauxis, onychoclavus, onychogryphosis, onychophosis, splinter hemorrhages and subungual hematomas, and subungual exostosis. Awareness of the signs and symptoms of the aging nail will enable better assessment and management of the onychologic concerns of this group of older patients.