Frequency of onychomycoses in chronic renal failure patients undergoing hemodialysis in Porto Alegre, Brazil.

Onychomycosis is one of the most frequent infections affecting the fingernails or the toenails and it is caused mainly by dermatophytes. The aim of the study was to assess the frequency of onychomycoses in hemodialysis patients and to relate sex, age, duration of hemodialysis and causes of renal failure to the development of nail disorders. The study included 100 patients with chronic renal failure undergoing hemodialysis. The patients underwent detailed clinical examination of the toenails and those with any kind of clinical finding had nail scraping for mycological testing. In the study population, the frequency of onychomycosis was 39%. The most commonly isolated fungi were dermatophytes (69.23%), Candida spp. (15.38%) and nondermatophyte molds (15.38%). T. interdigitale was the most prevalent fungus followed by Candida ssp. and T. rubrum. The risk of onychomycosis increases by 1.9% for each additional year in age and diabetic patients are 88% more likely to develop onychomycosis than nondiabetic ones. The duration of hemodialysis treatment and sex were not associated with the development of onychomycosis. In conclusion, in hemodialysis patients, the frequency of onychomycosis was higher in those at advanced age and with diabetes.

Antifungal susceptibility of dermatophytes isolated from patients with chronic renal failure.

BACKGROUND: The prevalence of dermatophytosis in the general population is high, particularly in patients with chronic renal failure. Treatment requires the use of topical and/or systemic antifungal drugs. The efficacy of antifungal agents for the treatment of dermatophytosis has yet to be evaluated. Studies evaluating the in vitro activity of antifungal agents are rare, particularly in filamentous fungi. OBJECTIVE: To evaluate the susceptibility profile of different species of dermatophytes isolated from patients with chronic renal failure to nine antifungal drugs available on the market for the treatment of dermatophytosis. METHODS: Twenty-six isolates of dermatophytes obtained from patients with chronic renal failure were analyzed with respect to their susceptibility to nine antifungal agents (ketoconazole, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, miconazole, piroctone olamine, terbinafine and tioconazole), using the broth microdilution method proposed by the Clinical and Laboratory Standards Institute (CLSI) and adapted for dermatophytes. RESULTS: Of the antifungal agents tested, the best results in terms of sensitivity were found with terbinafine and tioconazole, while the antifungal activity of fluconazole was found to be weak, particularly against strains of M. gypseum. Ciclopirox olamine, although less effective than terbinafine, also yielded satisfactory results. CONCLUSIONS: In general, the sensitivity profile of the antifungal agents tested in this study was similar to results obtained in previous studies, confirming the need to determine which species is causing the dermatophytosis given that antifungal susceptibility varies from one species to another. Furthermore, the present findings show the importance of conducting in vitro sensitivity tests, since the sensitivity profile may differ among isolates of the same species.

Perfil de suscetibilidade a antifúngicos de dermatófitos isolados de pacientes com insuficiência renal crônica / Antifungal susceptibility of dermatophytes isolated from patients with chronic renal failure

FUNDAMENTOS: As dermatofitoses apresentam alta prevalência na população em geral e, principalmente, em pacientes com insuficiência renal crônica, necessitando tratamento com antifúngicos tópicos e/ou sistêmicos, cuja eficácia precisa ser avaliada. Estudos in vitro para avaliar a ação de antifúngicos são raros, especialmente, em fungos filamentosos. OBJETIVO: Avaliar o perfil de suscetibilidade de diferentes espécies de dermatófitos, isolados de pacientes com insuficiência renal crônica, em relação a nove antifúngicos disponíveis comercialmente para o tratamento de dermatofitoses. MÉTODO: Analisaram-se 26 isolados de dermatófitos de pacientes com insuficiência renal crônica em relação a nove antifúngicos (cetoconazol, ciclopirox olamina, fluconazol, griseofulvina, itraconazol, miconazol, piroctona olamina, terbinafina e tioconazol) pelo método de microdiluição em caldo proposto pelo Clinical and Laboratory Standards Institute (CLSI), com modificações para dermatófitos. RESULTADOS: Entre os antifúngicos testados, a terbinafina e o tioconazol obtiveram os melhores resultados de sensibilidade e o fluconazol apresentou baixa atividade, especialmente para as amostras da espécie M. gypseum. O ciclopirox olamina, apesar de menos eficaz que a terbinafina, também mostrou resultados satisfatórios. CONCLUSÕES: De modo geral, o perfil de sensibilidade dos antimicóticos testados seguiu o padrão de resultados mostrados por estudos anteriores, ratificando a necessidade de conhecimento da espécie causadora de dermatofitose, devido à variação do perfil de suscetibilidade entre as espécies. Além disso, nossos resultados demonstram a importância da realização de ensaios de sensibilidade in vitro, pois alguns isolados da mesma espécie apresentaram diferente perfil de sensibilidade.

BACKGROUND: The prevalence of dermatophytosis in the general population is high, particularly in patients with chronic renal failure. Treatment requires the use of topical and/or systemic antifungal drugs. The efficacy of antifungal agents for the treatment of dermatophytosis has yet to be evaluated. Studies evaluating the in vitro activity of antifungal agents are rare, particularly in filamentous fungi. OBJECTIVE: To evaluate the susceptibility profile of different species of dermatophytes isolated from patients with chronic renal failure to nine antifungal drugs available on the market for the treatment of dermatophytosis. METHODS: Twenty-six isolates of dermatophytes obtained from patients with chronic renal failure were analyzed with respect to their susceptibility to nine antifungal agents (ketoconazole, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, miconazole, piroctone olamine, terbinafine and tioconazole), using the broth microdilution method proposed by the Clinical and Laboratory Standards Institute (CLSI) and adapted for dermatophytes. RESULTS: Of the antifungal agents tested, the best results in terms of sensitivity were found with terbinafine and tioconazole, while the antifungal activity of fluconazole was found to be weak, particularly against strains of M. gypseum. Ciclopirox olamine, although less effective than terbinafine, also yielded satisfactory results. CONCLUSIONS: In general, the sensitivity profile of the antifungal agents tested in this study was similar to results obtained in previous studies, confirming the need to determine which species is causing the dermatophytosis given that antifungal susceptibility varies from one species to another. Furthermore, the present findings show the importance of conducting in vitro sensitivity tests, since the sensitivity profile may differ among isolates of the same species.

Use of oral isotretinoin in photoaging therapy.

BACKGROUND: Many drugs are being used for prevention and treatment of photoaging, especially topical retinoids. The use of systemic retinoids, more specifically, isotretinoin, for this purpose has not been properly addressed to date. Our study was designed to assess the systemic use of isotretinoin used alone for the therapy of cutaneous photoaging. OBJECTIVE: To demonstrate that isotretinoin is converted into retinoid and improves the appearance of the photoaged skin. METHODS: Fifty women aged 40 to 60 years, phototype I, II, or III according Fitzpatrick, were selected to receive 20 mg of isotretinoin orally 3 times a week for a 3-month period. Patients underwent clinical and laboratory evaluation. Two biopsies and photographic control were performed. Patients were requested to use only topical photoprotecting agents during the treatment. Improvement in photoaging clinical parameters were evaluated through pictures taken and also through an evaluation form. Anatomopathologic parameters were obtained by comparing collagen degeneration and skin trophism. Results. Thirty patients fully complied with study requirements and were adequately analyzed. From the anatomopathologic data, an improvement of photoaging in 20 patients was observed. CONCLUSIONS: Isotretinoin improves photoaging with few adverse events because of the low dose used and to the short treatment duration.

Doença de Cowden ou Síndrome dos Hamartomas Múltiplos / Cowden's Disease or Multiple Hamartoma Syndrome

Os autores descrevem um caso de doença de Cowden ou síndrome dos hamartomas múltiplos. Doença de transmissão autossômica dominante cuja tríade dermatológica clássica compõe-se de tricolemomas faciais múltiplos (hamartomas do infundíbulo folicular), fibromas orais e queratoses acrais benignas. Afeta múltiplos órgãos e é associada a várias neoplasias, tais como de mamas, tireóide, cólon e outras. Os autores apresentam um caso de paciente do sexo feminino em cujo exame físico notaram-se pápulas cor da pele na face, lesões papulosas na cavidade oral, mucosa jugal, língua plicata e hiperceratose palmoplantar puntata bilateral. História patológica pregressa de tireoidectomia subtotal por adenoma folicular