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1.
J Dermatol ; 51(9): 1172-1179, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39115330

RESUMO

Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%-10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real-world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well-established oral medication, experienced a substantial decrease in prescription volume. The sex- and age-adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019-2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first-line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost-effective treatment strategies. This study provides valuable insights into the real-world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.


Assuntos
Antifúngicos , Bases de Dados Factuais , Onicomicose , Onicomicose/tratamento farmacológico , Onicomicose/economia , Humanos , Japão , Antifúngicos/economia , Antifúngicos/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Adulto , Administração Tópica , Administração Oral , Prescrições de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/economia , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/economia , Adulto Jovem , Adolescente , Revisão da Utilização de Seguros , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Medicamentos , Terbinafina/uso terapêutico , Terbinafina/economia , Terbinafina/administração & dosagem
2.
Medicine (Baltimore) ; 103(34): e39355, 2024 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-39183436

RESUMO

RATIONALE: Plantar warts, caused by human papillomavirus (HPV) infection, are a common skin condition on the plantar surface. Despite the availability of various treatments, achieving satisfactory outcomes remains elusive. This study explores a novel therapeutic approach combining traditional Chinese medicine (TCM) soaking therapy with cryotherapy to address this challenge. PATIENTS CONCERNS: This study focuses on 3 patients who presented with multiple and giant plantar warts, each with a disease duration exceeding 2 years. These patients had undergone numerous unsuccessful cryotherapy treatments, leaving them with persistent and troublesome warts. DIAGNOSES: All 3 patients were diagnosed with multiple and giant plantar warts caused by HPV infection. INTERVENTIONS: Following unsuccessful cryotherapies, the patients were administered TCM soaking therapy as an adjunct treatment. OUTCOMES: Remarkably, all 3 patients achieved complete remission of their plantar warts within 2 to 4 months after combining cryotherapy with TCM soaking therapy. LESSONS: Our findings suggest that relying solely on cryotherapy is insufficient for effectively treating plantar warts. The key to successful treatment lies in inhibiting wart proliferation and continuously thinning them, which can be achieved through soaking in TCM. This study demonstrates the potential of combining cryotherapy with TCM soaking as a novel and effective therapeutic approach for treating multiple and giant plantar warts.


Assuntos
Crioterapia , Medicina Tradicional Chinesa , Verrugas , Humanos , Verrugas/terapia , Crioterapia/métodos , Medicina Tradicional Chinesa/métodos , Masculino , Adulto , Feminino , Terapia Combinada , Infecções por Papillomavirus/terapia , Infecções por Papillomavirus/complicações , Resultado do Tratamento , Dermatoses do Pé/terapia , Adulto Jovem
3.
Dermatol Online J ; 30(2)2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38959933

RESUMO

Drug-induced pseudoporphyria is commonly linked to nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, oxaprozin, ketoprofen, and ibuprofen. The NSAID meloxicam is not a commonly reported inciting agent. We report a case of meloxicam-induced pseudoporphyria in a 55-year-old woman with a past medical history of hypertension, hyperlipidemia, gastroesophageal reflux disease, and osteoarthritis. She presented to the clinic with tense and denuded bullae on her dorsal feet, which was diagnosed as pseudoporphyria after further workup. Upon evaluating the patient's medication history, meloxicam was identified as the most likely inciting agent. The patient's condition resolved with the discontinuation of this medication. Our findings can help dermatologists effectively diagnose and treat meloxicam-induced pseudoporphyria in patients with similar cases.


Assuntos
Anti-Inflamatórios não Esteroides , Meloxicam , Humanos , Meloxicam/efeitos adversos , Feminino , Pessoa de Meia-Idade , Anti-Inflamatórios não Esteroides/efeitos adversos , Tiazóis/efeitos adversos , Porfirias/induzido quimicamente , Dermatoses do Pé/induzido quimicamente , Dermatoses do Pé/patologia , Tiazinas/efeitos adversos
5.
J Coll Physicians Surg Pak ; 34(7): 757-760, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38978235

RESUMO

OBJECTIVE: To assess the effectiveness of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 1064 nm in the management of onychomycosis. STUDY DESIGN: Descriptive observational study. Place and Duration of the Study: Department of Dermatology, PNS Shifa Hospital, Karachi, Pakistan, from December 2022 to May 2023. METHODOLOGY: Thirty patients, of either gender, aged between 20 and 60 years, with a clinical diagnosis and a positive KOH test for onychomycosis. Long-pulsed 1064-nm Nd:YAG laser therapy was administered to patients. On the basis of nail plate thickness, laser therapy was given once a week for a month at a speed of 25 mm/sec and a spot diameter of 4 mm, with fluencies ranging from 40 - 60 J/cm2. Before and six months' post-treatment, the patients' photos were taken and were evaluated based on dermoscopic results and clinical improvement. RESULTS: The patients' average age was 40.20 ± 15.85 years, and their average duration of disease was 3.0 ± 1.41 years. Six (20%) were males and 24 (80%) cases were females. The most prevalent clinical type was distolateral subungual onychomycosis 22 (73%). Fourteen (46.6%) cases showed excellent improvement, 6 (20%) cases showed good improvement, and 10 (33.3%) cases showed mild improvement. CONCLUSION: Long-pulsed Nd:YAG laser is a safe and efficient option for onychomycosis because of its high clinical cure rates, lack of side effects, and clinical therapeutic efficacy. KEY WORDS: Onychomycosis, Nd:YAG laser 1064-nm, Dermatology, Nail, Lasers in dermatology.


Assuntos
Lasers de Estado Sólido , Onicomicose , Humanos , Onicomicose/terapia , Feminino , Masculino , Adulto , Lasers de Estado Sólido/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem , Paquistão , Dermatoses do Pé , Terapia com Luz de Baixa Intensidade/métodos
8.
West Afr J Med ; 41(4): 363-371, 2024 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-39002161

RESUMO

INTRODUCTION: Onychomycosis is a fungal infection of the nail unit and one of the common nail diseases that occurs commonly in diabetic patients. It poses a threat of diabetic foot complications to diabetics and negatively affects the quality of life of the patients. OBJECTIVES: The overall aim of the study was to determine the prevalence and clinical features of onychomycosis in diabetics, as well as the spectrum of causative fungi in Nigeria as compared with age and sex-matched controls. METHODOLOGY: This was a hospital-based, comparative cross-sectional study. One hundred and fifty consecutive adult diabetics and 150 healthy controls (accompanied persons and staff) matched for age and sex were recruited from the Diabetic Clinics and the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. The participants were interviewed using a pre-tested structured questionnaire, nail scrapings were collected for fungal studies, and clippings for nail histopathology using Periodic Acid Schiff. RESULTS: The prevalence of onychomycosis among DM subjects was 45.3% vs. 35.3% in controls, which was not statistically significant (P value 0.078). Distal-lateral subungual onychomycosis was the most common clinical type in both study groups and presented mainly with nail discolouration, onycholysis, and subungual hyperkeratosis. The most common fungi isolated were dermatophytes (Trichophyton soudanense), non-dermatophytes (Aspergillus spp.), and Candida species (Candida albicans). CONCLUSION: Onychomycosis in diabetics is a very common nail disorder in the South-Eastern part of Nigeria with a high prevalence. The presence of foot ulcers was associated with onychomycosis in diabetics, and they were more likely to have non-dermatophytic onychomycosis.


INTRODUCTION: L'onychomycose est une infection fongique de l'unité de l'ongle et l'une des maladies des ongles les plus courantes chez les patients diabétiques. Elle pose une menace de complications du pied diabétique et affecte négativement la qualité de vie des patients. OBJECTIFS: L'objectif général de l'étude était de déterminer la prévalence et les caractéristiques cliniques de l'onychomycose chez les diabétiques, ainsi que le spectre des champignons causaux au Nigeria par rapport à un groupe témoin apparié selon l'âge et le sexe. MÉTHODOLOGIE: Il s'agissait d'une étude transversale comparative réalisée en milieu hospitalier. Cent cinquante diabétiques adultes consécutifs et 150 témoins sains (personnes accompagnatrices et personnel) appariés selon l'âge et le sexe ont été recrutés dans les cliniques de diabète et la clinique de dermatologie de l'Hôpital Universitaire du Nigeria à Ituku-Ozalla. Les participants ont été interrogés à l'aide d'un questionnaire structuré pré-testé, des échantillons de grattage d'ongles ont été prélevés pour des études fongiques, et des échantillons pour l'histopathologie des ongles utilisant l'acide périodique de Schiff. RÉSULTATS: La prévalence de l'onychomycose chez les sujets atteints de diabète était de 45,3 % contre 35,3 % chez les témoins, ce qui n'était pas statistiquement significatif (valeur de p 0,078). L'onychomycose sousunguéale distale-latérale était le type clinique le plus courant dans les deux groupes d'étude et se manifestait principalement par une décoloration des ongles, une onycholyse et une hyperkératose sousunguéale. Les champignons les plus couramment isolés étaient les dermatophytes (Trichophyton soudanense), les non-dermatophytes (Aspergillus spp.) et les espèces de Candida (Candida albicans). CONCLUSION: L'onychomycose chez les diabétiques est un trouble des ongles très courant dans le sud-est du Nigeria avec une prévalence élevée. La présence d'ulcères du pied était associée à l'onychomycose chez les diabétiques, et ils étaient plus susceptibles de présenter une onychomycose non-dermatophytique. MOTS - CLÉS: Onychomycose, Diabète sucré, Prévalence, Champignons, Nigeria.


Assuntos
Onicomicose , Humanos , Onicomicose/epidemiologia , Onicomicose/microbiologia , Nigéria/epidemiologia , Masculino , Feminino , Estudos Transversais , Prevalência , Pessoa de Meia-Idade , Adulto , Estudos de Casos e Controles , Idoso , Pé Diabético/epidemiologia , Pé Diabético/microbiologia , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia
9.
Eur J Dermatol ; 34(3): 260-266, 2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-39015959

RESUMO

Onychomycosis, a fungal nail infection, is primarily caused by dermatophytes, yeasts, and non-dermatophyte moulds (NDMs). The incidence of this disease and the predominance of specific pathogens vary across different regions and evolve. This study aimed to elucidate the epidemiology of onychomycosis and the pattern of causative pathogens in Beijing, and to ascertain the in vitro antifungal susceptibility profiles of Trichophyton rubrum against itraconazole (ITR), terbinafine (TER), and fluconazole (FLU). Involving 245 patients of onychomycosis with positive fungal culture results, the study implemented internal transcribed spacer (ITS) sequencing of ribosomal DNA (rDNA) on all collected samples. The mean age of the participants was 37.93 ± 13.73 years, with a male-to-female ratio of 1.53:1. The prevalence of toenail infections was significantly higher than that of fingernails. Distal and lateral subungual onychomycosis (DLSO) were the most frequent clinical classifications. PCR results indicated that dermatophytes were the most prevalent pathogens, followed by yeasts and NDMs, among which T. rubrum was the most dominant dermatophyte. TER demonstrated high sensitivity to T. rubrum. However, in clinical settings, some patients with onychomycosis exhibit a poor response to TER treatment. The relationship between in vitro antifungal sensitivity and clinical effectiveness is complex, and understanding the link between in vitro MIC values and clinical efficacy requires further investigation.


Assuntos
Antifúngicos , Fluconazol , Dermatoses do Pé , Itraconazol , Testes de Sensibilidade Microbiana , Onicomicose , Terbinafina , Humanos , Onicomicose/microbiologia , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Masculino , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Feminino , Adulto , Pessoa de Meia-Idade , Terbinafina/farmacologia , Terbinafina/uso terapêutico , Dermatoses do Pé/microbiologia , Dermatoses do Pé/tratamento farmacológico , Itraconazol/farmacologia , Itraconazol/uso terapêutico , Fluconazol/farmacologia , Arthrodermataceae/efeitos dos fármacos , Adulto Jovem , Dermatoses da Mão/microbiologia , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/epidemiologia , China/epidemiologia , Prevalência , Trichophyton/efeitos dos fármacos , Idoso , Adolescente
11.
Adv Skin Wound Care ; 37(8): 429-433, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39037097

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/patologia
12.
Contact Dermatitis ; 91(2): 112-118, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38840483

RESUMO

BACKGROUND: Mainly women work as foot care specialists (FCS). They are at risk to develop occupational dermatitis (OD). OBJECTIVES: The objective of this study is to describe the contact sensitisation pattern of female FCS with OD. METHODS: In a retrospective study, patch test and clinical data collected by the Network of Departments of Dermatology (IVDK) from 2008 to 2022 were analysed. Data of 116 female FCS with OD were compared with data of 13 930 female patients with OD working in other professions and 78 612 female patients without OD. RESULTS: Hand dermatitis (93.1%) was significantly more common and face dermatitis (0.9%) significantly less common in female FCS with OD compared to other female patients with or without OD. Frequent suspected allergen sources were disinfectants, gloves, leave-on and nail cosmetics. Occlusion and wetness were important co-factors. The most common diagnoses were irritant contact dermatitis (26.7%) and allergic contact dermatitis (21.6%). No sensitisation to any of the baseline series allergens was significantly more frequent in female FCS with OD than in the two control groups. However, sensitisations to allergens which FCS are abundantly exposed to, including fragrances, preservatives, rubber ingredients and disinfectants, were most common. CONCLUSIONS: FCS should be aware of the OD risk and prevention should be promoted.


Assuntos
Dermatite Alérgica de Contato , Dermatite Irritante , Dermatite Ocupacional , Dermatoses da Mão , Testes do Emplastro , Humanos , Feminino , Dermatite Ocupacional/epidemiologia , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/diagnóstico , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/epidemiologia , Dermatite Alérgica de Contato/diagnóstico , Estudos Retrospectivos , Adulto , Pessoa de Meia-Idade , Estudos de Casos e Controles , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/etiologia , Dermatite Irritante/epidemiologia , Dermatite Irritante/etiologia , Alérgenos/efeitos adversos , Dermatoses Faciais/epidemiologia , Dermatoses Faciais/etiologia , Cosméticos/efeitos adversos , Desinfetantes/efeitos adversos , Luvas Protetoras/efeitos adversos , Dermatoses do Pé/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-38753536

RESUMO

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 , Masculino
14.
J Dermatol ; 51(8): 1098-1103, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38711284

RESUMO

The clinical characteristics and pathogenesis of acral melanoma of the foot (AMF) have not been sufficiently elucidated. Clinical or subclinical persistent inflammation of the feet is caused by dermatophytosis of the feet (DPF). Persistent inflammation is potentially associated with oncogenesis. Moreover, diabetes has been reported to be associated with the development of dermatophytosis and cancer. The present study aimed to elucidate the clinical association between DPF and AMF, with consideration of diabetes. The medical records of 114 Japanese patients were retrospectively examined and divided into an AMF group (n = 30) and a control group consisting of patients with foot diseases other than melanoma (n = 84). Microscopic DPF screening was performed on all patients who reported symptoms in the foot, with or without AMF. Patients underwent a microscopic test to detect the presence of dermatophytes, and the diagnosis of DPF was made based on a positive result. In the AMF group, 18 (60.0%) and eight (26.7%) patients had DPF and diabetes, respectively. Four patients (13.3%) had both DPF and diabetes. In the control group, 25 (29.8%) and 11 (13.1%) patients had DPF and diabetes, respectively. Five patients (6.0%) had both DPF and diabetes. Univariate analyses showed a significantly higher prevalence of DPF in the AMF group than in the control group (odds ratio, 3.540; p = 0.003, Pearson χ2 test). Furthermore, multivariate analyses of sex, body mass index, DPF, and diabetes revealed DPF as a significant factor associated with AMF (odds ratio, 4.285; p = 0.002, logistic regression analysis). The hyperkeratotic type of DPF was more frequently observed in patients with AMF than in control patients (odds ratio, 11.083; p < 0.001, Pearson χ2 test). In conclusion, the present study found a significantly higher prevalence of DPF, especially its hyperkeratotic type, in patients with AMF. DPF may be associated with AMF pathogenesis.


Assuntos
Melanoma , Neoplasias Cutâneas , Tinha , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prevalência , Idoso , Melanoma/epidemiologia , Melanoma/diagnóstico , Melanoma/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/diagnóstico , Tinha/epidemiologia , Tinha/diagnóstico , Tinha/microbiologia , Japão/epidemiologia , Adulto , Idoso de 80 Anos ou mais , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses do Pé/diagnóstico
15.
J Dermatol ; 51(8): 1091-1097, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38700273

RESUMO

Onychomycosis is a chronic and intractable disease whose prevalence increases during aging. In elderly patients, if onychomycosis is left untreated and progresses to a severe stage it may cause functional decline of the lower limbs due to foot pain. This could lead to a decline in activities of daily living and secondary impairment such as cognitive decline. Thus, the treatment of onychomycosis in elderly patients is important. We have previously shown that fosravuconazole is relatively safe and effective for onychomycosis in elderly patients. In the present study, we continued the follow-up study and investigated the efficacy of re-administration of fosravuconazole in patients with recurrent onychomycosis. One hundred and twenty-five patients aged ≥65 years who had been initially diagnosed with onychomycosis at our hospital's dermatology department, and who had responded well to fosravuconazole at 48 weeks after the initial treatment, were followed up until 144 weeks after the start of the initial treatment. Patients who experienced a recurrence within 24 weeks after the start of the follow-up were assigned to the short-term recurrence group, and those who experienced a recurrence after 24 weeks were assigned to the long-term recurrence group. All patients in both groups were re-treated with fosravuconazole to evaluate its efficacy. The short-term and long-term recurrence groups consisted of 17 (14.3%) and 10 (8.4%) patients, respectively. There were no significant differences in mean age and sex ratio between the two groups. There were no serious adverse effects in either group, and the toenail opacity ratio was significantly reduced after 12 weeks of re-treatment in both groups. The short-term and long-term recurrence groups were significantly more likely to have wedge-shaped onychomycosis and total dystrophic onychomycosis, respectively. The results suggest that re-administration of fosravuconazole is safe and as effective as the first administration for elderly patients with recurrent onychomycosis. This study was registered at UMIN-CTR (UMIN000053516).


Assuntos
Antifúngicos , Onicomicose , Recidiva , Triazóis , Humanos , Onicomicose/tratamento farmacológico , Idoso , Feminino , Masculino , Seguimentos , Antifúngicos/administração & dosagem , Antifúngicos/efeitos adversos , Antifúngicos/uso terapêutico , Triazóis/administração & dosagem , Triazóis/uso terapêutico , Triazóis/efeitos adversos , Resultado do Tratamento , Idoso de 80 Anos ou mais , Dermatoses do Pé/tratamento farmacológico , Retratamento , Tiazóis
18.
Photodiagnosis Photodyn Ther ; 46: 104087, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38614271

RESUMO

Plantar wart is one of the most recalcitrant types of cutaneous warts with a high recurrence rate. Recalcitrant plantar warts are resistant to traditional treatments such as cryotherapy. Photodynamic therapy (PDT) is a modern, non-invasive method utilized to treat benign and malignant skin disorders. Several previous studies have reported the effective application of PDT treatment for plantar warts. We reported three cases of recalcitrant plantar warts successfully treated with PDT.


Assuntos
Ácido Aminolevulínico , Fotoquimioterapia , Fármacos Fotossensibilizantes , Verrugas , Humanos , Verrugas/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Masculino , Feminino , Ácido Aminolevulínico/uso terapêutico , Adulto , Resultado do Tratamento , Adulto Jovem , Dermatoses do Pé/tratamento farmacológico
19.
J Dermatol ; 51(8): 1079-1082, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38558466

RESUMO

We conducted a cross-sectional study on the clinical and mycological features of onychomycosis in patients in the dermatology ward of Iwate Medical University Hospital, an acute care hospital. Of the 226 hospitalized patients, 73 (32.3%) had onychomycosis and 61 (26.9%) were diagnosed after admission. The toenail was the most common site of onychomycosis (94.5%), while toenail plus fingernail and fingernail only sites were 4.1% and 1.4%, respectively. The most common clinical form of onychomycosis was distal and lateral subungual onychomycosis (79%) with Trichophyton rubrum (66.7%) and T. interdigitale (27.8%) as the main causative species. Patients who were older, or had neurological diseases, or needed stretcher transfer had onychomycosis significantly more frequently than those who were obese, had diabetes, cancer, needed an escort for moving, or could move independently. Our study suggests that there is likely to be a significant number of untreated and undiagnosed patients with onychomycosis in acute care hospitals. Therefore, it is necessary to increase awareness of onychomycosis in hospitals.


Assuntos
Onicomicose , Humanos , Onicomicose/epidemiologia , Onicomicose/diagnóstico , Onicomicose/microbiologia , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Prevalência , Idoso , Fatores de Risco , Adulto , Idoso de 80 Anos ou mais , Dermatoses do Pé/epidemiologia , Dermatoses do Pé/microbiologia , Dermatoses do Pé/diagnóstico , Adulto Jovem , Japão/epidemiologia , Adolescente , Trichophyton/isolamento & purificação , Unhas/microbiologia , Unhas/patologia , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/microbiologia , Dermatoses da Mão/diagnóstico , Arthrodermataceae
20.
JAMA Dermatol ; 160(6): 691, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38598197
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