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Biomedical subjects

Aditya K Gupta

Publications and source records attributed to Aditya K Gupta.

At least 37 records · Page 2Linked to original sources
PubMed2004

A review of the use of infliximab to manage cutaneous dermatoses.

BACKGROUND: Infliximab is a chimeric monoclonal antibody that binds specifically to human tumor necrosis factor-alpha (TNF-alpha), decreasing the effect of the cytokine in inflammatory diseases. OBJECTIVE: The aim of this study was to review the efficacy and safety of infliximab in the treatment of dermatological diseases. METHODS: A MEDLINE search (1966-January 2003), using the keyword "infliximab" was performed to find relevant articles pertaining to the use of infliximab in dermatology. RESULTS: Infliximab has been used in the following dermatological diseases: psoriasis, Behcet's disease, graft versus host disease, hidradenitis suppurativa, panniculitis, pyoderma gangrenosum, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, sarcoidosis, subcorneal pustular dermatosis, Sweet's syndrome, toxic epidermal necrolysis, and Wegener's granulomatosis. There is a generally good safety profile for infliximab, which is similar to that when it is used to treat Crohn's disease and rheumatoid arthritis. CONCLUSION: Although not approved for use in dermatological diseases, there have been numerous reports of the efficacy of infliximab in cutaneous inflammatory diseases. The most promise lies in those diseases that have increased amounts of TNF-alpha in the cutaneous lesions, such as psoriasis.

Antibodies, Monoclonal↗
PubMed2004

Treatment of onychomycosis: pros and cons of antifungal agents.

BACKGROUND: Antifungal agents are beneficial in the treatment of onychomycosis in the general population, as well as in children, the elderly, and immunocompromised individuals. Special patient populations can be more difficult to treat due to such factors as drug interactions with concomitant medications, adverse events, and poor compliance. In addition, there is limited information about the use of antifungal agents in special populations, e.g., children. OBJECTIVE: The pros and cons of oral and topical antifungal agents are discussed, with focus on special patient populations. METHODS: We searched MedLine (1966 to April 2003) for clinical studies evaluating the efficacy of oral and topical antifungal agents to treat onychomycosis. The key words used in conjunction with "onychomycosis" include: "terbinafine," "itraconazole," "fluconazole," "amorolfine nail lacquer," "ciclopirox nail lacquer," "HIV," "transplant patients," "diabetes," "children," and "elderly." Studies were excluded if published in a language other than English. RESULTS: Studies have shown that antifungal agents can be of benefit in treating the elderly, children, and immunocompromised individuals (e.g., transplant patients, Down's patients, HIV patients, and diabetics) with onychomycosis. CONCLUSION: The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.

Administration, Oral↗
PubMed2004

Skin diseases associated with Malassezia species.

The yeasts of the genus Malassezia have been associated with a number of diseases affecting the human skin, such as pityriasis versicolor, Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and--less commonly--with other dermatologic disorders such as confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection. The study of the clinical role of Malassezia species has been surrounded by controversy because of their fastidious nature in vitro, and relative difficulty in isolation, cultivation, and identification. Many studies have been published in the past few years after the taxonomic revision carried out in 1996 in which 7 species were recognized. Two new species have been recently described, one of which has been isolated from patients with atopic dermatitis. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. It also highlights the importance of individual Malassezia species in the different dermatologic disorders related to these yeasts.

Dermatitis, Atopic↗
PubMed2004

Prevalence of Malassezia species on various body sites in clinically healthy subjects representing different age groups.

To investigate the distribution of Malassezia species on four body sites (scalp, forehead, chest and back), we employed contact plates filled with Leeming-Notman agar to sample 245 clinically healthy subjects, representing six age groups (AG) (AG I, 0-3 years; AG II, 4 14 years; AG III, 15-25 years; AG IV, 26-40 years; AG V, 41-60 years; AG VI, over 60 years). The number of colony forming units was recorded for every plate positive for Malassezia species, and the species were identified. Younger individuals (< 14 years) yielded a culture positive for Malassezia significantly less frequently than did older individuals (> or = 15 years). M. globosa was cultured at significantly elevated frequency on younger subjects. M. sympodialis was present at low frequency on younger subjects, but was found in higher amounts on the skin of adolescents and adults. The amount and kind of Malassezia species that can be recovered from human skin varies with age and body site.

Adolescent↗
PubMed2004

Identification and typing of Malassezia species by amplified fragment length polymorphism and sequence analyses of the internal transcribed spacer and large-subunit regions of ribosomal DNA.

Malassezia yeasts are associated with several dermatological disorders. The conventional identification of Malassezia species by phenotypic methods is complicated and time-consuming, and the results based on culture methods are difficult to interpret. A comparative molecular approach based on the use of three molecular techniques, namely, amplified fragment length polymorphism (AFLP) analysis, sequencing of the internal transcribed spacer, and sequencing of the D1 and D2 domains of the large-subunit ribosomal DNA region, was applied for the identification of Malassezia species. All species could be correctly identified by means of these methods. The results of AFLP analysis and sequencing were in complete agreement with each other. However, some discrepancies were noted when the molecular methods were compared with the phenotypic method of identification. Specific genotypes were distinguished within a collection of Malassezia furfur isolates from Canadian sources. AFLP analysis revealed significant geographical differences between the North American and European M. furfur strains.

Animals↗
PubMed2004

Etiology and management of Seborrheic dermatitis.

Seborrheic dermatitis (SD) is a common dermatological disorder that varies greatly in severity between individuals and with time. The etiology of this disease is poorly understood. Early investigators focused on the role of Malassezia (previously Pityrosporum) yeasts in the development of SD. Some researchers have hypothesized that there is an immunological component to SD and that this disease is caused by an altered immune response to Malassezia yeasts. However, other researchers view this condition as the result of hyperproliferation. Both antifungal and anti-inflammatory preparations have been used to treat SD effectively and safely. The wide range of antifungal formulations available (creams, shampoos, oral drugs) provides safe, effective and flexible treatment options for SD.

Adolescent↗
PubMed2004

Seborrhoeic dermatitis: current treatment practices.

Seborrhoeic dermatitis (SD) is a recurrent, chronic inflammation of the skin that occurs on sebum rich areas such as the face, scalp and chest, characterised by red scaly lesions. The are many studies indicating that Malassezia yeasts play an important role in the aetiology of this condition, most of the evidence for which comes from demonstrated responsiveness to treatment with antifungal agents. Its aetiology, however, is far from being resolved. Some believe that it is the immune response of the skin to the Malassezia that is the cause of the disease. Traditional treatments of SD have been the use of keratolytic agents or corticosteroids. Since the discovery of ketoconazole, a considerable amount of research has been focused on determining the efficacy of various antifungal agents. This article reviews clinical trial data on treatment options available for SD.

Administration, Cutaneous↗
PubMed2004

Optimal management of fungal infections of the skin, hair, and nails.

Superficial fungal infections are chronic and recurring conditions. Tinea capitis is a scalp infection, primarily affecting prepubescent children. Ringworm infections, such as tinea corporis and tinea cruris, involve the glabrous skin. Tinea nigra is a rare mycotic infection that may be related to travel abroad. Piedra, black or white, is limited to the hair shaft without involvement of the adjacent skin. Pityriasis (tinea) versicolor and seborrheic dermatitis are dermatoses associated with yeasts of the genus Malassezia that affect the lipid-rich areas of the body. The taxonomy of the Malassezia yeasts has been revised to include nine species, eight of which have been recovered from humans. Tinea pedis, an infection of the feet and toes, is one of the most common forms of dermatophytosis. Onychomycosis is a fungal infection affecting the nail bed and nail plate; it may be chronic and can be difficult to treat. In instances where the superficial fungal infection is severe or chronic, an oral antifungal agent should be considered. Terbinafine, itraconazole, and fluconazole are oral antifungals that are effective in the treatment of superficial mycoses.

Administration, Oral↗
PubMed2004

Role of antifungal agents in the treatment of seborrheic dermatitis.

Seborrheic dermatitis is a superficial fungal disease of the skin, occurring in areas rich in sebaceous glands. It is thought that an association exists between Malassezia yeasts and seborrheic dermatitis. This may, in part, be due to an abnormal or inflammatory immune response to these yeasts. The azoles represent the largest class of antifungals used in the treatment of this disease to date. In addition to their antifungal properties, some azoles, including bifonazole, itraconazole, and ketoconazole, have demonstrated anti-inflammatory activity, which may be beneficial in alleviating symptoms. Other topical antifungal agents, such as the allylamines (terbinafine), benzylamines (butenafine), hydroxypyridones (ciclopirox), and immunomodulators (pimecrolimus and tacrolimus), have also been effective. In addition, recent studies have revealed that tea tree oil (Melaleuca oil), honey, and cinnamic acid have antifungal activity against Malassezia species, which may be of benefit in the treatment of seborrheic dermatitis. In cases where seborrheic dermatitis is widespread, the use of an oral therapy, such as ketoconazole, itraconazole, and terbinafine, may be preferred. Essentially, antifungal therapy reduces the number of yeasts on the skin, leading to an improvement in seborrheic dermatitis. With a wide availability of preparations, including creams, shampoos, and oral formulations, antifungal agents are safe and effective in the treatment of seborrheic dermatitis.

Administration, Cutaneous↗
PubMed2004

Management of onychomycosis: examining the role of monotherapy and dual, triple, or quadruple therapies.

The high prevalence of onychomycosis warrants effective lasting treatment. Currently available monotherapeutic options in the United States include surgical or chemical nail avulsion/debridement, a topical antifungal nail lacquer, and systemic antifungal agents. Failure to respond to therapy and relapse rates of approximately 25% to 50% both point to the need for a shift in the approach to treating this chronic disease. In vitro data indicate synergistic and additive effects when combining certain antifungal agents, eg, ciclopirox and terbinafine. Clinical reports suggest that combining topical and oral antifungal agents (eg, ciclopirox nail lacquer and oral terbinafine), administered for a shortened duration compared with the standard regimen, may yield cure rates as good as, if not better than, the indicated oral monotherapy regimen. Drug penetration to different parts of the nail unit and complimentary modes of action may contribute to the success of combination therapy.

Administration, Oral↗
PubMed2004

Onychomycosis: review of recurrence rates, poor prognostic factors, and strategies to prevent disease recurrence.

Treatment of onychomycosis is associated with substantial disease reappearance rates. Identification of factors associated with therapeutic failure may help develop strategies to prevent recurrence of onychomycosis. Aspects of a patient's health and lifestyle, local factors involving the nail, therapeutic options, and environmental conditions are associated with poor therapeutic response. Strategies to reduce recurrence of disease involve the reduction of both relapse (delayed failure) and reinfection. The topical antifungal agent ciclopirox nail lacquer, may be a consideration for prophylaxis of this chronic disease.

Antifungal Agents↗