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1.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(8): 673-680, oct. 2019. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-185506

RESUMO

La dermatosis ampollar IgA lineal es una enfermedad vesicoampollar subepidérmica, adquirida, mediada por inmunoglobulinas. Presentamos nuestra serie con el objetivo de describir las características clínicas, evolución y tratamientos instaurados. Se realizó un estudio descriptivo, observacional retrospectivo. Se incluyeron 17 pacientes. Como antecedentes 2 niños recibieron vacunas 2 semanas antes del inicio de los síntomas; en 2 casos la enfermedad estuvo precedida por cuadros respiratorios broncoobstructivos. Un paciente recibió antibioticoterapia endovenosa antes del inicio del cuadro. Hallamos asociación con hepatitis autoinmune en un caso y con alopecia areata en otro. Un niño padecía asociación VACTERL. El diagnóstico se confirmó con histopatología e inmunofluorescencia directa. Como tratamiento 16 pacientes recibieron dapsona, 8 de ellos asociaron corticoides orales y 2 esteroides tópicos. Destacamos la presencia de rebrotes con compromiso perioral ante cuadros infecciosos e inmunizaciones, la asociación con síndrome de VACTERL y con hepatitis autoinmune


Linear IgA bullous dermatosis is an acquired subepidermal immunoglobulin-mediated vesiculobullous disease. In this retrospective, observational, descriptive study, we describe the clinical characteristics, treatments, and outcomes of 17 patients with linear IgA bullous dermatosis. Two children had been vaccinated 2 weeks before the onset of symptoms, 2 had had bronco-obstructive respiratory symptoms, and 1 had received intravenous antibiotic therapy. We also observed an association with autoimmune hepatitis in one patient and alopecia areata in another. One boy had VACTERL association. Diagnosis was confirmed by histopathology and direct immunofluorescence. Sixteen patients were treated with dapsone, which was combined with oral corticosteroids in 8 cases and topical corticosteroids in two. Of note in this series was the occurrence of relapses in the perioral area coinciding with infections and vaccination, and the association between linear IgA bullous dermatosis and autoimmune hepatitis and VACTERL association


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Dermatose Linear Bolhosa por IgA/diagnóstico , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Dermatoses Faciais/tratamento farmacológico , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Perna/tratamento farmacológico , Epidemiologia Descritiva , Estudos Retrospectivos , Dermatose Linear Bolhosa por IgA/patologia , Dapsona/uso terapêutico , Corticosteroides/uso terapêutico , Esteroides/uso terapêutico , Administração Tópica , Técnica Indireta de Fluorescência para Anticorpo/métodos , Diagnóstico Diferencial
3.
J Drugs Dermatol ; 18(7): 663-665, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334626

RESUMO

Recalcitrant plantar warts pose a therapeutic challenge. Cidofovir is a viral DNA polymerase inhibitor that has been used in treatment of verrucae with greater success than traditional treatments in some cases. Laser-assisted drug delivery enhances drug penetration beyond the epidermis and is particularly well-suited, though under-utilized, to target palmoplantar verrucae. We report the use of an erbium:yttrium-aluminum-garnet (Er:YAG) ablative fractional laser (AFL) followed by topical cidofovir in treating recalcitrant plantar warts. Two patients were treated with a 2940-nm Er:YAG laser at depths of 1.2-1.5 mm followed by topical application of cidofovir 75 mg/mL. Both patients exhibited a significant reduction in lesion size and improvement in symptoms. AFL-assisted delivery of topical cidofovir represents a promising therapeutic option for recalcitrant plantar warts. J Drugs Dermatol. 2019;18(7):663-665.


Assuntos
Cidofovir/administração & dosagem , Sistemas de Liberação de Medicamentos/instrumentação , Dermatoses do Pé/tratamento farmacológico , Verrugas/tratamento farmacológico , Administração Cutânea , Adulto , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Absorção Cutânea/efeitos da radiação , Soluções , Resultado do Tratamento
4.
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
5.
J Dtsch Dermatol Ges ; 17(5): 503-516, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30994260

RESUMO

BACKGROUND: Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disease-related to psoriasis. Its treatment is challenging, and little is known about the sustainability of different medications. The aim of this study was to analyze drug survival rates and drug discontinuation in the treatment of PPP under real-world conditions. PATIENTS AND METHODS: Patients with PPP treated in the dermatology departments of five German university medical centers between 01/2005 and 08/2017 were included in our retrospective study. Drug survival of systemic therapies was assessed with Kaplan-Meier analysis and multivariate regression. RESULTS: Overall, 347 patients with 935 treatment courses were identified. Within the group of non-biologic systemic agents, apremilast showed the highest median drug survival (15 months), followed by cyclosporine (12 months), the combination of acitretin and topical PUVA (9 months), MTX (8 months), acitretin monotherapy (6 months), alitretinoin (5 months), and fumaric acid esters (3 months). Among biologicals, the highest maintenance rate was detected for certolizumab pegol (restricted mean: 47.4 months), followed by infliximab (median: 26 months), golimumab (22 months), ustekinumab (21 months), adalimumab (18 months), secukinumab (9 months), and etanercept (8 months). CONCLUSIONS: Biologicals and apremilast may serve as second-line options for treatment of PPP and should be further evaluated.


Assuntos
Fármacos Dermatológicos/uso terapêutico , Substituição de Medicamentos , Psoríase/tratamento farmacológico , Adulto , Produtos Biológicos/uso terapêutico , Feminino , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia PUVA/métodos , Terapia PUVA/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
Pediatr Dermatol ; 36(3): 406-407, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30859616

RESUMO

Herpetic whitlow of the toe is a common infection in an uncommon location, leading it to be frequently misdiagnosed; however, as the virus responds well to conservative management or antivirals alone, proper identification is necessary to prevent unnecessary interventions. We present a case of herpetic whitlow of the toe with an unusually ominous appearance in a previously healthy and otherwise well-appearing child. This case illustrates the spectrum of herpetic whitlow's clinical presentations and enourages consideration of the disease even for atypical location and severity.


Assuntos
Celulite (Flegmão)/virologia , Dermatoses do Pé/virologia , Herpes Simples/diagnóstico , Herpesvirus Humano 1 , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/patologia , Pré-Escolar , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/patologia , Herpes Simples/tratamento farmacológico , Humanos , Masculino , Dedos do Pé
7.
Dermatol Ther ; 32(3): e12883, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30920153

RESUMO

Gram-negative bacterial toe web infection (GNBTWI) caused by Pseudomonas Aeruginosa combined with fungal infection has variety of treatments. However, these treatments have been poorly described in the literature. Our retrospective study describes patients that had been treated in our medical center with acetic acid combined with local antifungal treatment, to evaluate evidences for the appropriateness of this treatment. Ten patients with evidence of GNBTWI caused by Pseudomonas Aeruginosa combined with local fungal infection which have been treated with acetic acid in Emek Medical Center were identified. Eight patients (80%) had a complete response while two patients (20%) showed only a partial response. Side effects were minimal and included temporary stinging sensation. Acetic acid is a relatively cheap ingredient with minimal side effect profile and highly effective outcomes as a treatment for GNBTWI caused by Pseudomonas Aeruginosa and should be considered as an adjuvant treatment.


Assuntos
Ácido Acético/uso terapêutico , Dermatoses do Pé/tratamento farmacológico , Micoses/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Adulto , Idoso , Antifúngicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dedos do Pé
8.
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
9.
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
11.
Dermatol Ther ; 32(2): e12816, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30623542

RESUMO

Cigarette smoking may decrease serum levels of vitamin D and reduce its efficacy. We aimed to evaluate the safety and efficacy of intralesional vitamin D in the treatment of warts and to investigate the effect of smoking on its efficacy in these cases. The study included 20 patients with verruca vulgaris and deep palmoplantar warts. The wart to be injected was cleaned by alcohol and then injected with 0.1 mL of prilocaine (20 mg/mL). 0.2 mL of vitamin D3 (7.5 mg/mL) solution was slowly injected into the base of each wart. The maximum total amount of vitamin D3 injected into a patient in one session was 7.5 mg. The injection was done at 4 weeks interval until clearance or for a maximum of two sessions. Clinical and dermoscopic follow-up of the treated and distant warts was carried out. Forty percent of the treated lesions showed complete clearance and the rate of distant wart response was 17.65%. Among different demographic and clinical variables in the studied patients, smoking and older age seemed to decrease the therapeutic response Intralesional vitamin D is effective in the treatment of warts, however, smoking and aging may reduce its efficacy.


Assuntos
Fumar Cigarros/epidemiologia , Vitamina D/administração & dosagem , Verrugas/tratamento farmacológico , Adulto , Fatores Etários , Feminino , Seguimentos , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Humanos , Injeções Intralesionais , Masculino , Resultado do Tratamento
12.
Nat Rev Rheumatol ; 15(2): 113-122, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30610219

RESUMO

Dactylitis is diffuse swelling of the digits that is usually related to an underlying inflammatory or infiltrative disorder. Psoriatic arthritis (PsA) is the most common severe disease thought to cause dactylitis. Our understanding of the pathogenesis of PsA-related dactylitis comes from experimental animal models of PsA-like disease, as well as advances in imaging and other clinical studies. Clinical trials in PsA have increasingly included dactylitis as an important secondary outcome measure. These studies indicate that cytokines drive multi-locus microanatomical pan-digital pathology. Given the importance of pro-inflammatory cytokines, the pathogenesis of dactylitis is best understood as an initial aberrant innate immune response to biomechanical stress or injury, with subsequent adaptive immune mechanisms amplifying the dactylitis inflammatory response. Regarding the treatment of dactylitis, no studies have been conducted using dactylitis as the primary outcome measure, and the current knowledge comes from analysis of dactylitis as a secondary outcome measure.


Assuntos
Artrite Psoriásica/complicações , Dermatoses do Pé/etiologia , Dermatoses da Mão/etiologia , Animais , Artrite Psoriásica/diagnóstico por imagem , Artrite Psoriásica/tratamento farmacológico , Modelos Animais de Doenças , Dermatoses do Pé/diagnóstico por imagem , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/diagnóstico por imagem , Dermatoses da Mão/tratamento farmacológico , Humanos , Fenômenos Imunogenéticos , Índice de Gravidade de Doença
13.
J Cosmet Dermatol ; 18(1): 124-128, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29687566

RESUMO

BACKGROUND: Warts, or verrucae, are benign epithelial profilerations of skin and mucosa caused by infection with HPV and poses a challenge to treat. OBJECTIVE: To compare between single and microneedling-assisted multipuncture techniques of intralesional application in treatment of plantar warts. METHODS: The study included 60 Patients who were divided into two groups (A&B). Each group consisted of (30) patients. Group (A) subjects received intralesional bleomycin with a single injection using syringe needle. For Group (B) subjects, we combined microneedling with topical spraying of bleomycin (MN + Bleo) and followed by occlusion for 2 hours. RESULTS: The results revealed complete clearance of warts in 21 patients in group (A) (70%) whom were treated by intralesional (IL) bleomycin vs 25 patients (83.3%) in group (B) whom were treated by spraying of bleomycin following microneedling. Side effects other than pain, erythema, and transient induration were relatively infrequent, and no nail changes or Raynaud's phenomenon was observed in both groups. CONCLUSION: We established a good safety and efficacy profile for bleomycin in plantar wart treatment and we demonstrated that microneedling followed by bleomycin spraying had a higher clearance and proved less painful as opposed to bleomycin injection.


Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Bleomicina/administração & dosagem , Dermatoses do Pé/tratamento farmacológico , Verrugas/tratamento farmacológico , Administração Cutânea , Adolescente , Adulto , Antibióticos Antineoplásicos/efeitos adversos , Bleomicina/efeitos adversos , Feminino , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Agulhas/efeitos adversos , Adulto Jovem
14.
J Cosmet Laser Ther ; 21(3): 179-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30052090

RESUMO

BACKGROUND: Onychomycosis is a common but difficult to treat nail disorder. Treatment strategies thus far have included oral and topical antifungals, surgical treatment and recently lasers have emerged as a therapeutic modality. OBJECTIVE: The objective of this study was to assess whether efinaconazole together with laser would result in greater clinical and mycologic cure and lower rate of relapse compared to efinaconazole alone. METHODS: Thirty subjects were randomized to either self-apply efinaconazole 10% once daily for 48 weeks, or follow the same treatment plan but also receive six treatments with a 1064 nm Nd: YAG laser every 4 weeks. The primary endpoint was to assess the proportion of subjects who achieved complete cure at week 52. RESULTS: The combination therapy group showed significantly quicker mycological cure at the 48- and 52-week follow-up. CONCLUSION: Both efinaconazole and combination with laser were efficacious treatment, but the combination therapy leads to quicker resolution with fewer rate of relapse.


Assuntos
Antifúngicos/uso terapêutico , Dermatoses do Pé/terapia , Terapia a Laser/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Onicomicose/terapia , Triazóis/uso terapêutico , Administração Tópica , Adulto , Idoso , Antifúngicos/administração & dosagem , Terapia Combinada , Feminino , Seguimentos , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Onicomicose/tratamento farmacológico , Onicomicose/cirurgia , Satisfação do Paciente , Fotografação , Estatísticas não Paramétricas , Resultado do Tratamento , Triazóis/administração & dosagem
15.
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.
Am J Clin Dermatol ; 20(1): 123-133, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30456537

RESUMO

Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophyte molds, and yeasts. Treatment of this infection can be difficult, with relapse likely to occur within 2.5 years of cure. The objective of this article is to review factors that can impact cure and to suggest practical techniques that physicians can use to maximize cure rates. Co-morbidities, as well as disease severity and duration, are among the many patient factors that could influence the efficacy of antifungal therapies. Furthermore, organism, treatment, and environmental factors that may hinder cure include point mutations, biofilms, affinity for non-target enzymes, and exposure to fungal reservoirs. To address patient-related factors, physicians are encouraged to conduct confirmatory testing and treat co-morbidities such as tinea pedis early and completely. To combat organism-focused factors, it is recommended that disruption of biofilms is considered, and drugs with multiple routes of delivery and unique mechanisms of action are prescribed when traditional agents are not effective. Extending follow-up periods, using combination treatments, and considering pulse regimens may also be of benefit. Through these practical techniques, physicians can maximize cure and limit the risk of relapse and re-infection.


Assuntos
Antifúngicos/uso terapêutico , Dermatologia/normas , Dermatoses do Pé/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Onicomicose/tratamento farmacológico , Administração Oral , Administração Tópica , Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Dermatologia/métodos , Exposição Ambiental/efeitos adversos , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/prevenção & controle , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Fungos/fisiologia , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Dermatoses da Mão/prevenção & controle , Humanos , Onicomicose/diagnóstico , Onicomicose/microbiologia , Onicomicose/prevenção & controle , Guias de Prática Clínica como Assunto , Recidiva , Piscinas , Resultado do Tratamento , Microbiologia da Água
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