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1.
Lakartidningen ; 1162019 11 19.
Artigo em Sueco | MEDLINE | ID: mdl-31742652

RESUMO

During February and March 2019, an accumulation of clinically similar erythematous plantar nodules was observed at the University Children's Hospital and several primary care facilities in Uppsala, Sweden. At least 20 children sought medical advice, and all cases presented with a recurrent plantar hidradenitis after within a day after visiting Uppsala's largest waterpark and arena for swimming. The presented symptoms were identical with a condition called pseudomonas hot-foot syndrome described in the literature. An investigation led by the local public health authorities revealed heavy growth of Pseudomonas aeruginosa in water-filled toys in a children's play area and in samples taken from the floor of a pool where the surface was partly damaged. After closing the affected part of the pool and removal of the contaminated toys, no more people sought medical advice. Pseudomonas hot-foot syndrome is believed to be more frequent than diagnosed today, and increased awareness is essential to avoid unwarranted diagnostic tests and treatments, and to identify and eradicate the source of infection.


Assuntos
Dermatoses do Pé/microbiologia , Hidradenite/microbiologia , Infecções por Pseudomonas/diagnóstico , Piscinas , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/patologia , Hidradenite/diagnóstico , Hidradenite/epidemiologia , Hidradenite/patologia , Humanos , Masculino , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/isolamento & purificação , Suécia/epidemiologia
3.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(8): 666-672, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185505

RESUMO

Introducción: La dermatitis de pies es un motivo frecuente de consulta en las Unidades de Alergia Cutánea. Objetivos: Conocer las características demográficas, el diagnóstico y los alérgenos más frecuentemente implicados en los pacientes a los que se les han practicado pruebas epicutáneas. Material y métodos: Estudio observacional transversal en un Servicio de Dermatología con todos los pacientes estudiados con la batería estándar española durante 13 años (2004-2016). Comparamos los resultados de las pruebas epicutáneas y los diagnósticos finales entre los distintos subgrupos de pacientes con eczema de pies. Resultados: Estudiamos un total de 3.265 pacientes; 308 (9,4%) presentaban eczema en los pies, 176 (57,9%) tenían afectación solo en los pies y 132 (42,1%) afectación concomitante en manos y pies. En el subgrupo con afectación exclusiva en los pies se observó un mayor porcentaje de pacientes con pruebas epicutáneas positivas (61,5% solo pies, 53,4% manos y pies). En el subgrupo de afectación concomitante de manos y pies se observó un menor porcentaje de pruebas epicutáneas positivas entre los menores de 18 años (51,3% en menores y 64,4% en mayores). El alérgeno con relevancia presente más frecuente en todos los subgrupos fue el dicromato potásico. La dermatitis de contacto alérgica (49,1%) fue el diagnóstico más frecuente en los pacientes con afectación exclusiva de los pies, mientras que en los pacientes con eczema en manos y pies fue la psoriasis (33,6%) en los adultos y la dermatitis atópica en los menores de 18 años (60,0%). Conclusión: La realización de pruebas epicutáneas es de gran utilidad tanto en los pacientes con eczema de afectación exclusiva de los pies como en aquellos con afectación concomitante de manos y pies


Introduction: Foot eczema is a common complaint encountered by skin allergists. Objective: To study a series of patients with foot eczema who underwent patch testing and describe their demographic profile, diagnoses, and the main allergens involved. Material and methods: Cross-sectional observational study of all patients tested with the standard Spanish patch test series at a dermatology department over a period of 13 years (2004-2016). We studied patch test results and definitive diagnoses by comparing different subgroups of patients with foot eczema. Results: Of the 3,265 patients included in the study, 308 (9.4%) had foot eczema, 176 (57.9%) had foot eczema only and 132 (42.1%) had concomitant foot and hand eczema. Positive patch test results were more common in patients with foot eczema only (positivity rate of 61.5% vs. 53.4% for foot and hand eczema). In the subgroup of patients with concomitant foot and hand involvement, patients aged under 18 years had a lower rate of positive results (51.3% vs. 64.6% for patients >18 years). Potassium dichromate was the most common allergen with current relevance in all subgroups. The main diagnosis in patients with foot involvement only was allergic contact dermatitis (49.1%). In the subgroup of patients with concomitant hand and foot eczema, the main diagnoses were psoriasis in adults (33.6%) and atopic dermatitis in patients aged under 18 years (60.0%). Conclusion: Patch tests are a very useful diagnostic tool for patients with foot eczema with or without concomitant hand involvement


Assuntos
Humanos , Masculino , Feminino , Dermatopatias Eczematosas/diagnóstico , Testes do Emplastro/métodos , Alérgenos , Dermatoses do Pé/diagnóstico , Eczema/diagnóstico , Dermatoses do Pé/etiologia , Dermatoses do Pé/fisiopatologia , Estudos Transversais , Distribuição por Sexo , Distribuição por Idade , Dermatoses da Mão/diagnóstico
5.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413063

RESUMO

This case report presents a patient who, while undergoing oral isotretinoin therapy for acne vulgaris, developed onychocryptosis and asymptomatic external urethritis. These uncommon adverse events are not well-documented in medical literature. While his urethritis spontaneously resolved, his onychocryptosis symptoms necessitated surgical intervention. This report illustrates both cosmetic and functional adverse effects of isotretinoin and provides insight into the progression of these reactions over time.


Assuntos
Fármacos Dermatológicos/efeitos adversos , Dermatoses do Pé/diagnóstico , Isotretinoína/efeitos adversos , Onicomicose/diagnóstico , Uretrite/diagnóstico , Acne Vulgar/tratamento farmacológico , Administração Oral , Adolescente , Diagnóstico Diferencial , Dermatoses do Pé/induzido quimicamente , Dermatoses do Pé/complicações , Humanos , Masculino , Onicomicose/induzido quimicamente , Onicomicose/complicações , Uretrite/induzido quimicamente , Uretrite/complicações
6.
Clin Podiatr Med Surg ; 36(4): 685-694, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31466575

RESUMO

The lower extremity presents several challenges from a dermatologic standpoint: there are different anatomic areas that not only vary from a stratum corneum thickness and histologic standpoint but are also subject to trauma that is unique (shoe gear, gait cycle). Attention to appropriate diagnosis and management is always warranted but should be especially vigilant to those treating issues of the lower extremity. This article reviews diagnosis and treatment of the most common skin and nail conditions of the foot and ankle.


Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Doenças da Unha/diagnóstico , Doenças da Unha/terapia , Feminino , Dermatoses do Pé/etiologia , Humanos , Masculino , Doenças da Unha/etiologia , Adulto Jovem
8.
Acta Dermatovenerol Croat ; 27(2): 129-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31351511

RESUMO

Dear Editor, We report a case of a patient admitted to our Department presenting a typical digital myxoid cyst. A 54-year-old man was referred by his general practitioner to the Department of Dermatology at our hospital due to the presence of an asymptomatic lesion on the third right toe. Physical examination revealed a rounded, red-bluish lesion in the eponychium less than 0.5 cm in diameter with a cystic appearance that secondarily caused a longitudinal depression in the nail plate (Figure 1). Dermoscopy showed arboriform telangiectasias over white, bluish, and reddish-orange diffuse areas (Figure 2, a). Direct needle puncture with a 25-gauge needle and drainage was performed showing a clear gelatinous material (Figure 2, b), confirming the diagnosis of digital myxoid cyst. No recurrence was seen during the 9-month follow-up period. A digital myxoid (or mucous) cyst is a benign recurrent cystic lesion of less than 1 cm in diameter and rounded or oval morphology typically located at the distal interphalangeal joint (DIJ) or eponychium in the digits. Digital myxoid cysts have a higher incidence in adult women and are more likely to be found on the fingers than on the toes, especially on the index finger of the dominant hand. Typically, digital myxoid cysts are recognized as unique asymptomatic lesions and do not require treatment, although there can be multiple lesions in case of osteoarthritis (1,2). Its etiology and pathogenesis remains unclear, although some theories indicate that myxoid cysts could appear as a result of a mucoid degeneration of the connective tissue, the exit of synovial fluid from the DIJ capsule, repetitive trauma, the herniation of tendon sheaths or synovial linings associated with degenerative joint diseases and osteophytes in the elderly, or due to an overproduction of mucin by fibroblasts (1,3,4). Furthermore, there is no treatment consensus nor a treatment algorithm for its management, although surgical excision has shown high cure rates. Dermoscopy is a non-invasive imaging technique that allows accurate diagnosis of the digital myxoid cyst. As reported in this case, dermoscopy examination facilitates identification of telangiectasias following different vascular patterns (arboriform, polymorphic, punctate, or linear vessels), reddish-violet lagoons, ulceration, and a bright-whitish reticulum that could be related to an increase in collagen (5,6). Differential diagnosis mainly includes ganglion, Heberden's nodes associated with osteoarthritis, glomus tumors, and dermatofibromas (5). Treatment options range from observation (when there is no symptomatology), puncture and drainage of the cyst and corticosteroid injections to surgical intervention with reported healing rates of 95%. Sclerotherapy, cryotherapy, CO2 laser vaporization, infrared coagulation, caustic elimination, and manual compression of the cyst can also be used. Within non-surgical measures sclerotherapy has reported a 77% healing rate, followed by cryotherapy (72%), corticosteroid injections (61%), and manual compression (39%) (1,7). In summary, we reported a case of a digital myxoid cyst in an adult patient presenting with its main characteristics and typical location. This cystic lesion must be considered in the differential diagnosis with other benign tumors. Dermatoscopy should be an essential diagnostic tool and must be taken into account in cases of doubtful diagnosis. Its value in the evaluation of tumor processes is already well-known but it cannot be ignored when assessing other skin lesions or cutaneous infections.


Assuntos
Cistos/diagnóstico , Dermatoses do Pé/diagnóstico , Dedos do Pé , Dermoscopia , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Dermatol ; 46(8): 641-651, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31206779

RESUMO

We evaluated the efficacy of efinaconazole 10% topical solution in long-term use, for up to 72 weeks, for onychomycosis, including severe cases. Among 605 participants, 219 patients diagnosed as having onychomycosis were evaluated for the efficacy of efinaconazole. The treatment success rate (<10% clinical involvement of the target toenail) at the final assessment time point was 56.6%, the complete cure rate was 31.1% and the mycological cure rate was 61.6%, all of which increased over time, demonstrating that continuous application contributed to the improvement of cure rate. Even in severe cases, reduction of the affected nail area was observed, showing the potential efficacy of the treatment. Responses to a quality of life questionnaire among patients with onychomycosis, OnyCOE-t, suggested that efinaconazole treatment improved the patients' quality of life. The incidence of adverse drug reaction in the patients eligible for the assessment was 6.3%, and this developed only in the administration site in all cases. No systemic adverse event was observed. In addition, no increase in the incidence of adverse drug reaction due to long-term use was found. Efinaconazole therapy was proved to exhibit excellent balance between efficacy and safety, and thus may serve as a useful treatment option for onychomycosis.


Assuntos
Antifúngicos/administração & dosagem , Dermatoses do Pé/tratamento farmacológico , Onicomicose/tratamento farmacológico , Triazóis/administração & dosagem , Administração Tópica , Idoso , Antifúngicos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Incidência , Assistência de Longa Duração/métodos , Masculino , Pessoa de Meia-Idade , Onicomicose/diagnóstico , Qualidade de Vida , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Triazóis/efeitos adversos
11.
Mycoses ; 62(8): 659-664, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062415

RESUMO

Because of their similar clinical presentation, discrimination between nail psoriasis and onychomycosis often is difficult. We aim to investigate the actual frequency of onychomycosis in psoriatic patients and to compare it between psoriatic and non-psoriatic patients. This retrospective study included a total of 9281 patients, referring to our Mycology Laboratory from September 2003 to May 2018. The patients are divided into two groups: PsoGroup (patients with psoriasis) and non-PsoGroup (non-psoriatic patient). Direct microscopic examination with 20% KOH and culture was carried out in both groups. In PsoGroup (711 patients, 59.50% female, 40.50% male, median age of 52.22 ± 15.01), the prevalence of onychomycosis was 49.08%. On the other hand, in non-PsoGroup (8570 patients (71.65% female, 28.35% male, median age of 48.51 ± 19.31 years), the prevalence of onychomycosis was 51.30%. There was no statistically significant difference between the prevalence of onychomycosis in PsoGroup 49.08% (349/711) compared to 51.30% (4397/8570) of non-PsoGroup (P = 0.2578). However, yeasts were significantly more prevalent in non-psoriatic than in psoriatic patients (P = 0.0144.). In our Mycological Laboratory, we observed a similar prevalence of onychomycosis in psoriatic patients and non-psoriatic patients. However, the spectrum of fungal species isolated was different from each other, with a higher prevalence of yeasts in non-PsoGroup that reflect a recent oriental trends.


Assuntos
Dermatoses da Mão/epidemiologia , Unhas/microbiologia , Onicomicose/diagnóstico , Onicomicose/epidemiologia , Psoríase/epidemiologia , Adulto , Idoso , Arthrodermataceae/isolamento & purificação , Aspergillus/isolamento & purificação , Candida/isolamento & purificação , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Unhas/patologia , Onicomicose/microbiologia , Prevalência , Psoríase/microbiologia , Estudos Retrospectivos
13.
J Drugs Dermatol ; 18(2): 190-195, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811142

RESUMO

Background: This study was designed to evaluate the safety, tolerability, pharmacokinetics (PK), and efficacy of tavaborole in pediatric patients. Study Design: In this open-label, single-arm study, pediatric patients (aged 6 to <17 years) with distal subungual onychomycosis affecting ≥20% of the target great toenail applied tavaborole once daily to all affected toenails (2 drops/great toenail, 1 drop/other toenail) for 48 weeks. In addition, a maximal-use subgroup (aged 12 to <17 years) applied tavaborole to all 10 toenails and ≤2 mm of surrounding skin for the first 28 days. Results: Treatment-emergent adverse events (TEAEs) were reported by 55.6% of patients; the most frequently reported (≥5% of patients) were nasopharyngitis, contusion, sinusitis, and vomiting. Most TEAEs and local treatment reactions (LTRs) were mild or moderate and considered unrelated to treatment. There was 1 serious AE (severe appendicitis, considered unrelated to treatment) and there were no deaths, discontinuations because of AEs, or dose adjustments because of AEs. The most frequently reported LTRs were erythema and scaling. The incidence of LTRs diminished over time. Tavaborole was absorbed systemically, and plasma concentrations were measurable. The PK parameters determined in this study under maximal-use conditions indicate that steady state was achieved within the study period. For efficacy, 8.5% of patients achieved complete cure (clear nail and negative mycology [negative fungal culture and negative potassium hydroxide wet mount]) at week 52, and 14.9% achieved complete/almost complete cure at week 52 (clear or almost clear nail [≤5% dystrophic or discolored distal toenail plate] and negative mycology). Conclusion: Tavaborole was well tolerated in this pediatric population, and safety, PK, and efficacy profiles were comparable with those in adults. Trial registration: ClinicalTrials.gov identifier: NCT03405818 J Drugs Dermatol. 2019;18(2):190-195.


Assuntos
Antifúngicos/administração & dosagem , Compostos de Boro/administração & dosagem , Compostos Bicíclicos Heterocíclicos com Pontes/administração & dosagem , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Administração Tópica , Adolescente , Antifúngicos/química , Compostos de Boro/química , Compostos Bicíclicos Heterocíclicos com Pontes/química , Criança , Composição de Medicamentos , Feminino , Humanos , Masculino , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/química , Resultado do Tratamento
14.
An Bras Dermatol ; 94(1): 86-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726470

RESUMO

We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Dermatoses do Pé/patologia , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Verrugas/patologia , Adulto , Biópsia , Diagnóstico Tardio , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Metástase Linfática , Melanoma Amelanótico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Verrugas/diagnóstico
15.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710900

RESUMO

Bullous lupus erythematosus is a rare clinical form of lupus. The diagnosis is challenging and involves the exclusion of other subepidermal bullous dermatoses. We present a 21-year-old woman with erythematosus, polycyclic plaques with vesiculobullae along the periphery, creating an erythema gyratum repens-like pattern on acral regions. The cutaneous biopsy, analytical, and autoimmune studies support the diagnosis of systemic lupus erythematosus. Dapsone and glucocorticosteroids were given with prompt resolution of the lesions within two weeks. To our knowledge this is the first case of bullous lupus erythematosus with this atypical acral presentation.


Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Dermatoses da Perna/diagnóstico , Lúpus Eritematoso Sistêmico/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Anti-Infecciosos/uso terapêutico , Dapsona/uso terapêutico , Eritema , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/etiologia , Dermatoses do Pé/patologia , Glucocorticoides/uso terapêutico , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/etiologia , Dermatoses da Mão/patologia , Humanos , Dermatoses da Perna/tratamento farmacológico , Dermatoses da Perna/etiologia , Dermatoses da Perna/patologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/imunologia , Lúpus Eritematoso Sistêmico/patologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/patologia , Adulto Jovem
16.
An. bras. dermatol ; 94(1): 86-88, Jan.-Feb. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-983745

RESUMO

Abstract: We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Humanos , Feminino , Adulto , Neoplasias Cutâneas/patologia , Verrugas/patologia , Melanoma Amelanótico/patologia , Dermatoses do Pé/patologia , Neoplasias Cutâneas/diagnóstico , Biópsia , Verrugas/diagnóstico , Melanoma Amelanótico/diagnóstico , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Diagnóstico Tardio , Dermatoses do Pé/diagnóstico , Metástase Linfática
17.
J Eur Acad Dermatol Venereol ; 33(2): 281-287, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30005134

RESUMO

Due to the high relapse rates and the rise of predisposing factors, the need for curing onychomycosis is paramount. To effectively address onychomycosis, the definition of cure used in a clinical setting should be agreed upon and applied homogeneously across therapies (e.g. oral, topical and laser treatments). In order to determine what is or what should be used to define cure in a clinical setting, a literature search was conducted to identify methods used to evaluate treatment success. The limitations, strengths, prevalence and utility of each outcome measure were investigated. Seven ways to measure treatment success were identified; mycological cure, patient/investigator assessments, complete cure, quality of life instruments, severity indexes, clinical cure and temporary clearance. Despite its shortcomings, mycological cure is the most objective and consistent outcome measure used across onychomycosis studies. It is suggested that diagnostic goals of onychomycosis should be used to define cure in a clinical setting. Modifications to outcome measures such as incorporating molecular-based techniques could be a future avenue to explore.


Assuntos
Antifúngicos/administração & dosagem , Terapia a Laser/métodos , Onicomicose/diagnóstico , Onicomicose/tratamento farmacológico , Qualidade de Vida , Administração Oral , Administração Tópica , Atitude do Pessoal de Saúde , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Humanos , Masculino , Onicomicose/cirurgia , Relações Médico-Paciente , Prognóstico , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Am Acad Dermatol ; 80(4): 835-851, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29959961

RESUMO

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily life, and impair social interactions. In this continuing medical education series we review the epidemiology, risk factors, and clinical presentation of onychomycosis and demonstrate current and emerging diagnostic strategies.


Assuntos
Onicomicose/diagnóstico , Biofilmes , Dermoscopia , Diagnóstico Diferencial , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Humanos , Microscopia Confocal , Técnicas de Tipagem Micológica , Onicomicose/epidemiologia , Onicomicose/microbiologia , Onicomicose/patologia , Exame Físico , Reação em Cadeia da Polimerase , Prevalência , Fatores de Risco , Tomografia de Coerência Óptica
20.
Br J Dermatol ; 180(3): 637-646, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30216405

RESUMO

BACKGROUND: The determination of causative organisms of onychomycosis is still not optimal. There remains a need for a cheap, fast and easy-to-perform diagnostic tool with a high capacity to distinguish between organisms. OBJECTIVES: To determine whether attenuated total-reflectance Fourier transform infrared (ATR-FTIR) spectroscopy can detect and differentiate causative agents in culture-based, ex vivo nail and in vivo nail models. METHODS: A methodological study was conducted. Both the ex vivo nail model and in vivo pilot study were carried out in an academic university hospital. RESULTS: Analysis of cultured fungi revealed spectral differences for dermatophytes (1692-1606 and 1044-1004 cm-1 ) and nondermatophytes and yeasts (973-937 cm-1 ), confirmed by dendrograms showing an excellent separation between samples from different genera or species. Exploration of dermatophytes, nondermatophytes and yeasts growing on ex vivo nails exposed prominent differences from 1200 to 900 cm-1 . Prediction models resulted in a 96·9% accurate classification of uninfected nails and nails infected with dermatophytes, nondermatophytes and yeasts. Overall correct classification rates of 91·0%, 97·7% and 98·6% were obtained for discrimination between dermatophyte, nondermatophyte and yeast genera or species, respectively. Spectra of in vivo infected and uninfected nails also revealed distinct spectral differences (3000-2811 cm-1 , 1043-950 cm-1 and 1676-1553 cm-1 ), illustrated by two main clusters (uninfected vs. infected) on a dendrogram. CONCLUSIONS: Our data suggest that ATR-FTIR spectroscopy may be a promising, fast and accurate method to determine onychomycosis, including identification of the causative organism, bypassing the need for lengthy fungal cultures.


Assuntos
Arthrodermataceae/isolamento & purificação , Dermatoses do Pé/diagnóstico , Dermatoses da Mão/diagnóstico , Onicomicose/diagnóstico , Trichophyton/isolamento & purificação , Adulto , Idoso , Feminino , Dermatoses do Pé/microbiologia , Dermatoses do Pé/patologia , Dermatoses da Mão/microbiologia , Dermatoses da Mão/patologia , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/microbiologia , Onicomicose/patologia , Projetos Piloto , Estudo de Prova de Conceito , Espectroscopia de Infravermelho com Transformada de Fourier
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