Cosmetological competence of nail patches in combating onychomycosis-An approach to improve the quality of life

Onychomycosis (Tinea unguium) is said to be the most common cosmetological nail fungal infection. Dermatophyte is a type of fungus that causes this condition. Discoloration and thickening of the nail are found to be the common symptoms of all nail diseases. In this scenario, Onychomycosis is considered as one of the cosmetic problems that leads to cellulitis in adults and diabetic patients. Anatomical structure of the nail and disease manifestations made nail disorders as a difficult endeavor. Onychomycosis is chronic and difficult to eradicate. Many oral antifungal agents are available for the treatment of nail infections. The oral and parenteral administration of antifungal agents can elevate the serum hepatic enzyme levels and causes typical hepatocellular injury within a few weeks of therapy. The goal of this review is to study the role of transungal delivery systems (nail patches) as a promising tool for onychomycosis to encounter the clinical conditions of the patient. Longer therapies and technical treatment methods may frustrate the patients. This novel antifungal therapy helps to avoid the surgical removal of nail for onychomycosis patients. Eradication of issues with Onychomycosis can be achieved by an excellent delivery system with deeper drug release and drug retention in the nail cuticle. Patients who are suffered from onychomycosis are facing embarrassment and disfigurement in the society. So, this newer treatment solution can improve the quality of life of patients.1-3

Standardization of resazurin use in susceptibility testing of natural products against yeasts in planktonic cells and in biofilms formation

Natural products, such as the ethanolic propolis extract (PE), have been shown to be a safe and effective therapeutic alternative for the treatment of fungal skin and nail diseases. However, the presence of the resin and the physicochemical characteristics of the extract sometimes difficult the reading and determination of breakpoints of the in vitro tests, evidencing the need for alternatives that facilitate the reading. The present study aimed to standardize the use of resazurin in tests of susceptibility of PE with planktonic yeast cells and biofilm forms. The antifungal activity of PE was determined by minimum inhibitory concentration (MIC) and we observed that, for all Candida spp. tested, the most reproducible MIC results were obtained when resazurin was placed after 24 hours of incubation and remained more 24 hours with yeasts plus PE. For encapsulated yeasts, there was no dye reduction and color transition. Resazurin was also used for the evaluation of minimal biofilm inhibitory concentration and minimal biofilm eradication concentration and it was metabolized and reproduced the action of PE on Candida biofilms. In addition, microdilution checkerboard plates were made with the dye, which assisted reading the result of the interaction between PE and nystatin. We observed that the resin, the color and the turbidity of the PE slightly changed the color of the resazurin in high concentrations of the extract and did not impair the reading. Therefore, the resazurin standardization tests were proven to be efficient and grounds that it should be used as an auxiliary methodology for reading and interpretation of the susceptibility tests for non-encapsulated yeasts with natural products, which form turbidity or precipitation, such as propolis.

Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

Background: Onychomycosis accounts for 30% of all superficial mycoses and 50% of all nail diseases. One of the most studied predisposing factors is diabetes mellitus, with a frequency of onychomycosis of 31.5% in these patients. Many show resistance to standard therapeutics and have “polypharmacy”, which represents a risk for pharmacological interactions. Objective: The objective was to assess the clinical response to therapy, evaluate with histopathology, direct examination with KOH and white-calcofluor, and culture the most frequent etiologic agents associated with the development of onychomycosis in patients with diabetes mellitus. Materials and Methods: A non-randomized, uncontrolled, open-ended, prospective cohort study was conducted on 46 patients with onychomycosis and diabetes mellitus. Treatment was assigned according to clinical findings and specific indications for treatment. Results: From the samples taken for direct examination with KOH and calcofluor-white, culture, and histopathological study, positive results were: 39 (84.1%) patients to the direct examination, 32 (69.6%) to the culture, 27 (65.2%) with a positive histopathological study, and 17 (54.86%) to the calcofluor-white. On clinical evaluation, we found no treatment response in 8 patients (20%), a partial response in 14 patients (25%), and a complete response in 18 patients (45%). Out of the 46 patients evaluated initially, 25 persisted with onychomycosis after six months of follow-up. Conclusion: The prevalence of onychomycosis is increasing and requires correct diagnosis since there are other non-fungal diseases of the nails that resemble onychomycosis. Presumably, the immunosuppression of diabetes, its systemic affection, and the foot abnormalities of a diabetic patient cause more nail dystrophy, an increased fungal load, and treatment resistance.

NAIL VARIATIONS IN PAPULO-SQUAMOUS DISORDERS: A CLINICAL INVESTIGATION

Background: Nail diseases account for about 10% of all dermatological conditions. Any abnormality that affects any part of the nail unit is classified as a nail condition. The plate, matrix, bed, proximal and lateral folds, hyponychium, and underlying distal phalanx are all part of the nail unit. Heredity, skin problems, infections, systemic disease, and the ageing process, as well as internal and external drugs, physical and environmental agents, trauma, and benign and malignant tumours, can all affect these tissues. Papulo-squamous disorder is one of the main causes. Nail changes in Papulo-squamous disease have received insufficient attention, with only a few research available. Aims & Objectives: This study attempts to shed some information on the frequency and patterns of nail involvement in Papulo-squamous illnesses. Methodology: This is a descriptive research project. Over the course of two years, it was conducted at the dermatology department of a tertiary healthcare centre in central India. Examinations of the general, systemic, and dermatological systems were performed. The nails were meticulously examined. In pertinent cases, special examinations such as skin biopsy and potassium hydroxide (KOH) mount were performed. Results: Papulo-squamous disorder affected 100 people. Psoriasis was the most frequent Papulo-squamous condition, followed by lichen-planus and PRP. Pitting was the most prevalent nail alteration (81%) while dorsal pterygium was the least common. Conclusion: The nail is an important appendage that affects a variety of dermatoses and serves as a diagnostic window. Knowing the normal and abnormal variations, as well as their relationship to various Papulo-squamous illnesses, aids not only in diagnosis but also in treatment. Key words: Papulo-squamous disorder, nail changes, psoriasis, lichen-planus.

Prevalence and etiology of onychomycosis in patients with psoriasis: a single-center study

BACKGROUND: Changes in nails with psoriasis are observed in 8090% of patients. Pathological processes in the nail apparatus in patients with psoriasis are associated with both the underlying disease and the infectious nature. AIMS: To evaluate the clinical features of the affected nail plates in patients with psoriasis, the prevalence and etiology of onychomycosis in patients with psoriasis with altered nail plates. MATERIALS AND METHODS: 102 patients with psoriasis vulgaris, mild and moderate, stationary stage with altered nail plates were examined. A clinical and laboratory (microscopic and cultural) study of the affected nail plates was carried out. RESULTS: After mycological studies and physical examination of the affected nails of 102 patients, the following groups of nail diseases in patients with psoriasis were identified: psoriatic onychodystrophy (76; 74.5%) patients, onychomycosis (30; 29.4%) patients, traumatic onycholysis (4; 3,9%) patient, onychocryptosis (3; 2.9%) patients. 11 (14.5%) patients with psoriatic onychodystrophy had a complication in the form of a fungal infection. Distal-lateral subungual form of onychomycosis was detected in 17 patients (56.7%), total dystrophic form ― in 10 patients (33.3%), white superficial form ― in 2 patients (6.6%), proximal subungual form ― in 1 patient (3.3%). CONCLUSIONS: According to the results of clinical and mycological examination of the affected nails of patients with psoriasis, it was revealed that 74.5% of patients have manifestations of psoriatic onychodystrophy, 29.4% ― onychomycosis. Among patients with psoriatic onychodystrophy, 14.5% had a complication in the form of a secondary fungal infection. The main causative agents of onychomycosis are Candida spp. (63.3%). The incidence of dermatophytes (Trichophyton spp.) Was 36.7% of the total number of cases. The main clinical forms of onychomycosis in patients with psoriasis are distal-lateral (56.6%), total dystrophic (33.3%).

Nail Peeling with Glycolic Acid 50%: A Prospective Study of 20 Cases

<b><i>Background:</i></b> Surface abnormalities of the nail may be due to nail diseases or chemical abuse. So, every nail plate change does not require medical treatment. The aim of our study was to support the benefit of glycolic acid (GA) in both pathological conditions and dry, discolored nails due to cosmetics. <b><i>Methods:</i></b> A prospective single open label uncontrolled study is conducted in our department from January until April 2017. We divided our cases into 2 groups: G1 (consequences of cosmetics) and G2 (pathological conditions). In G1, we used 1–2 coat of GA 50% in 1–2 sitting at weekly intervals, but we needed multiple sittings (6–12 weeks) in G2 with 2–4 coats. <b><i>Results:</i></b> We have collected 20 cases: 12 in G1 and 8 in G2. In G1, 8 patients had good response. In G2, 6 had good response. Adverse effects were tolerable. <b><i>Conclusion:</i></b> Good response in G1 was also noted in the Indian report. The improvement in the chemotherapy side effect led us to widen the sample in order to have more credible results. GA 50% peels can offer aesthetically better looking nails. However, larger studies with a longer follow-up are required to validate the results.

Clinical, dermoscopic, and histopathological evaluations of patients with nail disorders

Objective: This study aimed to assess the possible role of dermoscopy in the diagnosis of different nail disorders compared with the clinical and histopathological diagnosis. Methods: This study included 104 patients with any nail disorders of both sex and any age. All the patients were subjected to a detailed medical history taken, clinical general examination, clinical and dermoscopic examinations of 20 nails. Potassium hydroxide examination was used to examine all patients with suspicious of onychomycosis. Histopathological evaluation was used to examine of clinically ambiguous nail disorders. Results: The most common nail diseases were onychomycosis (54.81%) followed by nail psoriasis (19.2%), and nail lichen planus (3.8%). Conclusion: Clinical evaluation was an important in diagnosis of different nail diseases. Nail dermoscopy could confirm clinical diagnosis and help in getting an accurate diagnosis of nail diseases and guide in the management of nail diseases by permitting better visualization of nail structure and pathology. Histopathological examination provided the most definitive method in reaching an accurate diagnosis due to it could provide etiologic, diagnostic, and prognostic information. There was good agreement between clinical, dermoscopic, and histopathological examinations for accurate diagnosis of different nail diseases.