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Biomedical subjects

B E Elewski

Publications and source records attributed to B E Elewski.

At least 55 records · Page 3Linked to original sources
PubMed1996

Diagnostic techniques for confirming onychomycosis.

Other nail diseases may mimic a fungal infection. Therefore the diagnosis of onychomycosis requires an assessment of both clinical and laboratory features. Onychomycosis is comprised of four distinct types, each of which requires a different technique to obtain a nail specimen. A potassium hydroxide (KOH) preparation may be used to confirm the presence of fungi. However, a fungal culture is required to identify the specific genus and species of the pathogen. It may be necessary to perform histopathologic analysis of the nail unit in cases in which the clinical appearance suggests the presence of a fungal nail infection, but the KOH preparation and culture are negative.

Diagnosis, Differential↗
PubMed1996

Intermittent fluconazole dosing in patients with onychomycosis: results of a pilot study.

BACKGROUND: Therapeutic limitations of griseofulvin in treating onychomycosis have led to a search for alternative antimycotic agents. An optimal dosing regimen for fluconazole has yet to be defined. OBJECTIVE: Our purpose was to evaluate the intermittent use of fluconazole (either once-weekly or alternate-day dosing) without concurrent nail avulsion in patients with moderate to severe onychomycosis. METHODS: Eleven patients with mycologically confirmed onychomycosis of the toenails or fingernails (43 infected nails) were treated with intermittent fluconazole until clinical cure was obtained. Eight patients received fluconazole 300 mg once weekly, one patient received 200 mg once weekly, and two patients received 100 or 200 mg of fluconazole every other day. Eight patients also used an adjunctive topical antimycotic preparation. RESULTS: All six patients with toenails involved (32 infected nails) were clinically cured after a mean treatment duration of 6 months, and all five patients with fingernails involved (11 infected nails) were cured after 3.7 months. There were no significant clinical or laboratory adverse events. CONCLUSION: Intermittent fluconazole, taken once weekly or on alternate days, is a well-tolerated and efficacious method to treat onychomycosis.

Administration, Cutaneous↗
PubMed1996

Onychomycosis caused by Scytalidium dimidiatum.

We report a case of onychomycosis caused by Scytalidium dimidiatum (syn., Hendersonula toruloidea) in a patient who did not live in an endemic area. This nondermatophyte mold may produce disease indistinguishable from dermatophyte fungi, but it does not respond to current systemic antimycotic therapy. Distal subungual onychomycosis, lateral onycholysis followed by lateral nail plate invasion, and chronic paronychia are common nail presentations.

Aged↗
PubMed1996

A U.S. epidemiologic survey of superficial fungal diseases.

BACKGROUND: Large-scale studies performed outside the United States have demonstrated that most cases of onychomycosis and tinea pedis are caused by dermatophytes, primarily Trichophyton rubrum. However, other studies have suggested that yeasts and nondermatophytic molds may play a role, particularly in onychomycosis. OBJECTIVE: This study was undertaken to determine the epidemiology of superficial fungal infections in a U.S. population. METHODS: Fungal cultures were performed on patients with clinically suspected tinea cruris, tinea corporis, tinea capitis, tinea pedis, and onychomycosis. RESULTS: Dermatophytes were the most commonly isolated fungi in each type of superficial fungal disease studied. T. rubrum was the most commonly isolated dermatophyte species, although Trichophyton tonsurans was more common in tinea capitis and equally common in tinea corporis/tinea cruris. In tinea pedis and onychomycosis, dermatophytes appeared in approximately 95% and 82% of isolates, respectively. Candida albicans and nondermatophyte molds played only a minor role in onychomycosis; C. albicans was isolated in 7% of nail cultures and nondermatophytic molds were isolated in 11%. CONCLUSION: These results are in general agreement with other major epidemiologic studies performed outside the United States. Dermatophyte fungi cause most superficial fungal infections.

Arthrodermataceae↗
PubMed1996

Update on the management of onychomycosis: highlights of the Third Annual International Summit on Cutaneous Antifungal Therapy.

Onychomycosis is an increasingly common fungal infection of the nail, which has traditionally been difficult to diagnose and treat and has physical and psychological consequences for the patient. Onychomycosis can be caused by dermatophytes, nondermatophytic filamentous fungi, and yeasts. The relative percentages of cases due to these etiologic agents vary with geographic location; however, in the United States, dermatophytes are the most common pathogens. Toenails are affected four times as often as fingernails. Microscopy and culture are the diagnostic "gold standards" for onychomycosis, although biopsy of the nail may be required to obtain a definitive diagnosis when conditions that mimic onychomycosis, such as psoriasis, are suspected. The treatment of onychomycosis includes a combination of topical therapy, surgical or chemical nail avulsion, and systemic therapy. The new generation of systemic agents (itraconazole, fluconazole, and terbinafine) is associated with a higher cure rate and shorter courses of treatment than are the older systemic antifungal drugs (i.e., griseofulvin and ketoconazole); these characteristics have sparked new interest in onychomycosis. Of these newer antifungals, itraconazole and terbinafine are the only agents currently approved by the U.S. Food and Drug Administration for the treatment of onychomycosis.

Administration, Oral↗
PubMed1996

Cutaneous mycoses in children.

This article describes common cutaneous mycoses in children: mucocutaneous candidiasis, pityriasis versicolor, tinea corporis, tinea pedis, onychomycosis and tinea capitis. Topical therapy is effective in tinea corporis and pedis, pityriasis versicolor and cutaneous candidiasis. It is ineffective in tinea capitis, in immunocompromised children and onychomycosis. Griseofulvin has been the main treatment until now in children, but it is only fungistatic, may cause interactions and has to be given for long periods. Ketoconazole has not been widely accepted for use in children because of hepatotoxicity and it is not an effective as griseofulvin. There are few data on paediatric use of fluconazole, although it is available in liquid form, has an excellent safety profile and may become important for treating paediatric mycoses. Similarly, there are only limited data on itraconazole in this area, with most experience in tinea capitis. There is only a 100-mg capsule available, which is not easy to administer in paediatric dosages. All azoles have the potential for drug interaction. Most experience in the treatment of children with the allylamine, terbinafine, has been in tinea capitis. A treatment time of 4 weeks with terbinafine and 8 weeks with griseofulvin has produced similar results at 12 weeks. There are also limited data on the use of terbinafine in paediatric onychomycosis. Terbinafine has the best safety profile, least risk of drug interactions and may be the most suitable alternative to griseofulvin in children. The lack of a liquid formulation may preclude its use. Itraconazole and fluconazole are also potential replacement drugs for griseofulvin.

Administration, Cutaneous↗
PubMed1996

Restructuring dermatology education at Cleveland medical centers affiliated with Case Western Reserve University.

We describe our response to the changing needs for dermatologic education and training at Cleveland medical centers affiliated with Case Western Reserve University School of Medicine (CWRU) located in Cleveland, Ohio. Our departmental plan for change is a multifaceted approach that alters the number of dermatology residents we train and also the way we interact with and educate our generalist colleagues. Like many other dermatologists, we have both idealistic and practical reasons for increasing our involvement in interdisciplinary education. One of our primary objectives is maximizing quality of care for dermatologic patients in our community. Traditionally, the majority of skin care in the United States has been provided by nondermatologists, and with the growth of managed care, this proportion is increasing. This has motivated us to increase our medical student teaching activities and to support the American Academy of Dermatology in its current efforts to develop a dermatology core curriculum for students. We should also be involved in the education of generalist physicians, since prior studies have suggested that their knowledge of dermatology needs improvement. Our goals should be both to improve the direct patient care skills of primary care physicians and to teach clinically appropriate referral thresholds. The American Academy of Dermatology has recently issued guidelines for the referral of dermatology patients in managed care settings to help ensure that our specialty has input into this process. In addition, teaching gatekeeper physicians to use appropriate referral criteria is important to many dermatologists in capitated managed care systems who often prefer limited as opposed to unrestricted access to their services.

Curriculum↗
PubMed1996

Comparison of an antifungal agent used alone with an antifungal used with a topical steroid in inflammatory tinea pedis.

The efficacy and safety of monotherapy with oxiconazole nitrate cream, 1 percent, a topical broadspectrum antifungal agent, were compared with those of combination therapy with oxiconazole nitrate cream, 1 percent, and fluticasone propionate cream, 0.05 percent, in a multicenter, randomized, double-blind, vehicle-controlled, parallel-group study of patients with inflammatory tinea pedis. Both combination therapy and monotherapy were associated with significantly greater proportions of mycologic and clinical cure, and a better global response than vehicle. An unexpected finding in this study was that more than 70 percent of patients with interdigital tinea pedis also had plantar or plantar plus vesiculobullous infection.

Administration, Topical↗
PubMed1996

Nondermatophyte causes of onychomycosis and superficial mycoses.

Compared to dermatophytes, nondermatophytes that may cause distal and lateral subungual onychomycoses are Aspergillus species, Acremonium species, Fusarium oxysporum and Scopulariopsis brevicaulis. White superficial onychomycosis may be caused by nondermatophyte species, for example, Acremonium species, Aspergillus terreus, other Aspergillus species and Fusarium oxysporum. Nondermatophyte molds such as Scopulariopsis brevicaulis may uncommonly result in cutaneous infections. Scytalidium dimidiatum (Scytalidium anamorph of Hendersonula toruloidea) and Scytalidium hyalinum may cause interdigital tinea pedis, and less frequently "moccasin foot" or plantar tinea pedis. Nondermatophytes have generally responded poorly to griseofulvin and ketoconazole. There have been reports of some nondermatophyte fungi responding to itraconazole and terbinafine.

Aspergillosis↗
PubMed1995

Zosteriform zygomycosis.

We describe a patient with zygomycosis that resembled herpes zoster infection. The diagnosis was readily made with a potassium hydroxide preparation that revealed sparsely to non-septate hyphae. The patient responded to combination antifungal therapy with amphotericin B and fluconazole. The clinical response correlated with antifungal susceptibility test results.

Adult↗
PubMed1995

Antifungal agents.

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Antifungal Agents↗