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At least 19 recordsLinked to original sources
PubMed2000

Prevalence and risk factors of tinea unguium and tinea pedis in the general population in Spain.

This study prospectively evaluated the prevalence and risk factors of tinea unguium and tinea pedis in the general adult population in Madrid, Spain. One thousand subjects were clinically examined, and samples of nails and scales from the interdigital spaces of the feet were taken from those patients presenting with signs or symptoms of onychomycosis and/or tinea pedis, respectively. In addition, a sample from the fourth interdigital space of both feet was collected from all individuals with a piece of sterilized wool carpet. Tinea unguium was defined as a positive direct examination with potassium hydroxide and culture of the etiological agent from subjects with clinically abnormal nails. Patients with positive dermatophyte cultures of foot specimens were considered to have tinea pedis. The prevalence of tinea unguium was 2.8% (4.0% for men and 1.7% for women), and the prevalence of tinea pedis was 2.9% (4.2% for men and 1.7% for women). The etiological agents of tinea unguium were identified as Trichopyton rubrum (82.1%), followed by Trichopyton mentagrophytes var. interdigitale (14.3%) and Trichopyton tonsurans (3.5%). Trichophyton rubrum (44.8%) and Trichophyton mentagrophytes (44.8%), followed by Epidermophyton floccosum (7%) and T. tonsurans (3.4%), were the organisms isolated from patients with tinea pedis. The percentage of subjects who suffered simultaneously from both diseases was 1.1% (1.7% for men and 0.6% for women). In a multivariate logistic regression analysis, age (relative risk [RR], 1.03) and gender (RR, 2.50) were independent risk factors for tinea unguium, while only gender (RR, 2.65) was predictive for the occurrence of tinea pedis. In both analyses, the presence of one of the two conditions was associated with a higher risk for the appearance of the other disease (RR, >25).

Adult↗
PubMed1993

KONCPA: a new method for diagnosing tinea unguium.

Tinea unguium (TU) is very common in tropical and subtropical regions. An inexpensive, quick and sensitive test is essential for screening the nail specimens. We investigated if a test using potassium hydroxide (KOH)-treated nail clippings, which were then crushed and stained with periodic acid-Schiff (PAS), could be useful for diagnosing TU. The new method (abbreviated as KONCPA) was proved to be more fruitful to identify fungal hyphae in comparison with conventional KOH nail scraping preparation, histopathologic examination and fungal culture. The positive rates of each method were 77, 44, 60 and 16%, respectively. All 10 KONCPA-negative nails failed to show fungus by the other three methods. The KONCPA slides can be permanently stored as records. In addition, we also found that treatment of nail specimens in 20% KOH at 56 degrees C for 10 min prior to histopathologic processing is a simple method to soften the nail plate.

Humans↗
PubMed1999

A review of the epidemiology of tinea unguium in the community.

Tinea unguium is a common, chronic fungal infection of the nails. Many epidemiological studies have looked at the frequency with which this condition is seen in hospital outpatients clinics or mycological laboratories along with other dermatomycoses. Only recently have studies begun to emerge looking at the prevalence of this condition in populations. Hospital and mycological laboratory-based studies give valuable information about tinea unguium prevalence in a particular clinic, but cannot be compared with other studies due to confounding factors inherent in the different people attending individual clinics. From population-based studies the prevalence of tinea unguium lies between 2 and 8%. Tinea unguium increases steadily with age. It is infrequent but definitely found in children. With the increasing life expectancy in the Western world the prevalence of tinea unguium is likely to increase further without adequate prevention and treatment.

Adolescent↗
PubMed2001

[Observation of tinea unguium by neutral red staining].

To evaluate the viability of dermatophytes in tinea unguium, we applied neutral red staining (NRS) for nail powder obtained from direct microscopic examination (DME) of positive tinea unguium patients. The nail powder from tinea unguium patients by grinder was applied following three sets of examinations, NRS, DME, and culture on Mycosel medium. The positive rates of nail powder obtained from 50 tinea unguium patients were 35 (70%), 37 (74%) and 2 (4%), respectively. Correlation of three sets of examinations were as follows: twenty-five patients were NRS positive, DME positive and culture negative, 10 patients were NRS negative, DME positive and culture negative, and 8 patients were NRS positive, DME negative and culture negative. These findings suggest that application of NRS for nail powder from tinea unguium patients is a practical method for evaluation of the viability of fungal elements.

Adult↗
PubMed2002

[Diversified treatments of Tinea unguium].

Antifungal agents and therapeutic approaches for tinea unguium have been increasing in number. Itraconazole, terbinafine and fluconazole were developed in the 1990s, and many useful methods with them for tinea unguium have been reported, including pulse therapy and short duration therapy. There have been many reports of not only oral treatments but also contrived topical treatments, in most of which improvement rates were high. However, each treatment has had some drawbacks and did not seem to gain the complete compliance of patients. Many patients dropped out, still having affected nails. It seems important to us to understand thoroughly the merits and demerits of each diversified treatment for tinea unguium and to provide the preferential treatment for each patient.

Administration, Oral↗
PubMed2002

Therapeutic efficacy of topically applied KP-103 against experimental tinea unguium in guinea pigs in comparison with amorolfine and terbinafine.

The therapeutic efficacy of KP-103, a novel topical triazole, in a guinea pig tinea unguium model was investigated. Experimental tinea unguium and tinea pedis were produced by inoculation of Trichophyton mentagrophytes SM-110 between the toes of the hind paw of guinea pigs. One percent solution (0.1 ml) of KP-103, amorolfine, or terbinafine was topically applied to the nails and whole sole of an infected foot once daily for 30 consecutive days, and terbinafine was also orally administered at a daily dose of 40 mg/kg of body weight for 30 consecutive days, starting on day 60 postinfection. The fungal burdens of nails and plantar skin were assessed using a new method, which makes it possible to recover infecting fungi by removing a carryover of the drug remaining in the treated tissues into the culture medium. Topically applied KP-103 inhibited the development of nail collapse, significantly reduced the fungal burden of the nails, and sterilized the infected plantar skin. On the other hand, topical amorolfine and topical or oral terbinafine were ineffective for tinea unguium, although these drugs eradicated or reduced the fungal burden of plantar skin. The in vitro activities of amorolfine and terbinafine against T. mentagrophytes SM-110 were 8- and 32-fold, respectively, decreased by the addition of 5% keratin to Sabouraud dextrose broth medium. In contrast, the activity of KP-103 was not affected by keratin because its keratin affinity is lower than those of the reference drugs, suggesting that KP-103 largely exists in the nails as an active form that was not bound to keratin and diffuses in the nail without being trapped by keratin. The effectiveness of KP-103 against tinea unguium is probably due to its favorable pharmacokinetic properties in the nails together with its potent antifungal activity.

Administration, Oral↗
PubMed2001

Interferon-gamma production in peripheral lymphocytes of patients with tinea pedis: comparison of patients with and without tinea unguium.

The precise mechanism of the host defense that protects the nail from dermatophyte invasion is not known. Recent immunological findings in dermatophytosis suggest the hypothesis that the T helper 1 (Th1) response may play a role in protecting the nail from dermatophyte invasion. Our present study focused on interferon-gamma (IFN-gamma) release in patients with tinea pedis with or without tinea unguium, and pathogenesis of tinea unguium is discussed in relation to the association with a possible deficiency of Th1 response in the host defense mechanism. The production of IFN-gamma by peripheral blood mononuclear cells from the patients with tinea unguium in response to stimulation with trichophytin was not impaired in contrast to that from the patients without tinea unguium. Comparable lymphocyte proliferation to trichophytin was observed in both groups. Normal healthy persons with no clinical evidence of tinea could be divided into two groups based on lymphocyte proliferation and IFN-gamma production in response to trichophytin: high responder and low responder, with high responders being correlated with a clinical history of previous tinea pedis. In this study, a lack of a Th1 response to dermatophyte antigen was not shown in patients with tinea unguium by measuring the release of IFN-gamma, which plays a role in the effector phase of the delayed-type hypersensitivity reaction. A deficiency in the Th1 response to dermatophyte antigen, therefore, does not appear to play an important role in the establishment of tinea unguium.

Female↗
PubMed1999

Current topics in diagnosis and treatment of tinea unguium in Japan.

The number of patients with tinea unguium accounts for 0.5% to 2% of the total number of outpatients in Japan. The diagnosis of tinea unguium can be relatively easily made on the basis of clinical symptoms and direct microscopic findings. However onychomycosis due to fungi other than dermatophytes should always be suspected if no dermatophytes are cultured despite positive findings in direct microscopy. In such cases, it is necessary to repeat cultures and conduct histopathological evaluation using PAS-staining technique or enzyme antibody technique. At present, oral administration of griseofulvin and terbinafine are the treatments covered by health insurance in Japan. In the future, however, other orally active antifungal drugs such as itraconazole and fluconazole will become available for use by in-patients who do not respond to griseofulvin. It is essential to patiently continue treatment even if oral therapy is impossible, because other therapies such as ODT therapy using topical antifugal agents and urea ointment or abrading affected nails as much as possible with a file or dental drill may be effective without oral therapy.

Administration, Oral↗
PubMed2003

Clinical and mycological study of occult tinea pedis and tinea unguium in dermatological patients from Tokyo.

An epidemiological investigation was conducted to determine the prevalence and circumstances of untreated, unsuspected tinea pedis and tinea unguium, morbid conditions that could be termed occult athlete's foot, in patients visiting a dermatology clinic in Tokyo, Japan, for the first time, for other complaints. All subjects completed a questionnaire covering comprehensive anamnestic details, and were examined for disposition of toes, presence of signs suggestive of tinea pedis, other diseases of the foot, score of clinical signs and symptoms, potassium hydroxide (KOH) test, severity score, and mycological culture. The results showed that the prevalence of occult athlete's foot was 25%, and that 59% of those cases were complicated by tinea unguium. The characteristics of patients with occult athlete's foot included a higher proportion of men and a tendency toward a low clinical score together with a high severity score. In the patient background, a strong correlation was observed between a positive KOH test result and characteristics such as age, disposition of toes, and predisposing disease.

Adolescent↗
PubMed1987

A modified method for rapid mycological diagnosis of Tinea unguium in Taiwan, Republic of China.

This is a study to modify and simplify the classical laboratory procedures of mycological diagnosis of Tinea unguium. By means of a tube KOH digestion technique for microscopic examination of nail clippings and a paper disc transfer technique using a more uniform wool-fiber-yeast extract culture fluid as inoculum for all tests necessary for fungal identification, dermatophytes can be identified to a species level. To authenticate the advantage of the etiologic diagnosis of Tinea unguium by mycological studies, the promising result of our previous clinical therapeutic trial with Griseofulvin was presented.

Adolescent↗
PubMedDate not supplied

Clinical and pharmacokinetic investigations of oral terbinafine in patients with tinea unguium.

A clinical trial of once-daily administration of a 125-mg tablet of terbinafine, an oral antimycotic agent, was performed on patients with tinea unguium to evaluate its efficacy, safety, possible side-effects and its incorporation into nails and hair. Thirty-four patients were recruited into the study. For the statistical analysis, one of these patients was used only for the safety rating. Accordingly, 33 patients were used for the efficacy rating, and all 34 patients were employed for the safety rating. The efficacy rating in the overall efficacy evaluation was 90.9% (30/33). No adverse effects, including abnormal changes in laboratory test values, were observed. A pharmacokinetic study revealed that terbinafine was detected in the nail tissue at and after week 2. It reached 0.78 ng mg-1 at the end of week 12 and remained at almost the same level thereafter. Terbinafine was also detected in hair at and after week 23. The average value was 3.14 ng mg-1. The plasma concentration of the drug reached a steady state (280.3 ng ml-1) at approximately week 10, and no tendency to further accumulation was noted. These results confirm the favourable incorporation of terbinafine into nail and hair. On the basis of these results, it was concluded that the drug demonstrates excellent efficacy and satisfactory safety in patients with tinea unguium. The pharmacokinetic investigation also demonstrated its excellent treatment efficacy.

Administration, Oral↗
PubMed2001

[Treatment of tinea unguium with terbinafine: an open study comparing twelve weeks and twenty-four weeks of continuous terbinafine therapy, and determination of terbinafine level in the target nails].

The study protocol was approved by the Ethical Committee of Sakai Municipal Hospital. A total of 40 outpatients with tinea unguium of the toenails, fingernails or both took part after giving voluntary written informed consent. Inclusion criteria were suggestive clinical appearance, a positive KOH preparation and an opaqueness of more than 50% of the nail length. The patients received 125 mg terbinafine once a day. The medication was taken after the evening meal and treatment was continued for 12 weeks. Medication stopped in twenty patients who responded well and a follow-up study was continued for 64 weeks. In the other 20 patients, medication was continued for 24 weeks and the follow-up study continued for 64 weeks. At 4-week intervals, the patients were evaluated for their clinical and mycological statuses and adverse reactions. Clipping of distal nail samples, including any attached subungual tissue, was done using nail clippers at 4-week intervals after cessation of therapy and the level of terbinafine was measured in the laboratory. No adverse reactions were detected. Tinea unguium of fingernails (1) and the third toes (2) were cured easily in the short term in the 12 week therapy group. One case in the 24 week therapy group was excluded because systemic steroid therapy was started for bullous pemphigoid at 32 weeks. The results of treatment of big toe onychomycosis were compared between the 12 week (17) and the 24 week (19). In the former group, 9 (52.9%) showed complete cure and 8 (47.1%) showed relapse or worse after cessation of therapy was. In 24 week therapy group, complete cure was achieved in 14 (73.7%) and relapse or worse in 5 (26.3%). The cure rate between the 2 groups was statistically not significant. Terbinafine was detected in the target nails up to 24 weeks after cessation of medication in both groups. Onychomycosis or tinea pedis reappeared in a few cases 12 to 16 weeks after medication ceased in the 12 week group. Topical antimycological therapy is necessary after cessation of oral terbinafine.

Administration, Oral↗
PubMedDate not supplied

The proteolytic activity of strains of T. mentagrophytes and T. rubrum isolated from tinea pedis and tinea unguium infections.

To understand the significance of proteolytic enzymes in the pathogenesis of dermatophyte infections, we have studied the expression of proteolytic activity in vitro. Cultures were extracted after 1, 2, 3, 4 and 5 weeks of growth and the proteolytic activity measured by a peptide release assay using human stratum corneum as a substrate. Maximum activity was noted at 3 weeks which corresponded to the dissolution of the stratum corneum particles. Isolates of Trichophyton mentagrophytes and Trichophyton rubrum from 42 patients with tinea pedis or tinea unguium were established on 2% glucose peptone plates. Using the peptide release assay it was found that after 3 weeks culture, T. mentagrophytes showed higher activity that T. rubrum in tinea pedis (2044 +/- 1067 micrograms protein released h-1 mg-1, n = 13 compared to 828 +/- 614 micrograms protein released h-1 mg-1, n = 13). In tinea unguium, the values at 3 weeks were generally lower. Trichophyton mentagrophytes activity was 837 +/- 121 micrograms protein released h-1 mg-1 (n = 3) compared to 470 +/- 271 micrograms protein released h-1 mg-1 (n = 13) for T. rubrum. Thus, as well as a variation in activity between the two species, there appears to be a variation in site in terms of expression of activity.

Female↗
PubMed1992

Is tinea unguium still widely incurable? A review three decades after the introduction of griseofulvin.

BACKGROUND: Tinea unguium, especially of the feet, for ages has been looked on as an incurable disease. Today, therapeutic outcome is still controversial. To evaluate the present state of antifungal therapy of dermatophytoses of the nails, a survey of the pertinent literature has been performed. OBSERVATIONS: The introduction of griseofulvin three decades ago was first considered a major breakthrough. Today, however, conventional griseofulvin treatment regimens must be called disappointing in terms of clinical and microbiological cure to be achieved. Cure rates of 40% to 100% have been reported for fingernail infections, but only 3% to 38% for toenail tinea. Microbiological cure rates look only slightly better. Limited experience suggests that additional measures such as surgical nail avulsion or topical antifungal treatment might improve therapeutic outcome. Toenail avulsion increases cure rates to 47% to 82%. The lack of an adequate follow up, however, makes all statements questionable. CONCLUSIONS: Results are only limited with respect to newly developed oral antifungal agents. Whereas ketoconazole treatment had to be omitted due to its hepatotoxic effect, its congener, intraconazole, is under investigation. High cure rates have been obtained in a preliminary study with oral terbinafine, 0.25 g/d, for 12 months, which have cleared toenail tinea in 15 of 17 patients. The value of topical treatment alone has not yet been definitely established. The application of a topical azole (bifonazole) in combination with chemical nail avulsion, using urea paste under occlusion, has resulted in negative cultures in 62% of the patients 3 months after the end of treatment.

Administration, Oral↗
PubMed2001

Tinea unguium in Lahore, Pakistan.

During a period of 1 year, out of 202 clinically suspected cases of tinea unguium, 53 (26%) were confirmed by mycological cultures for dermatophytes. Trichophyton rubrum was the most common fungus isolated in 46 (87%) patients, followed by T. violaceum in four (7%), T. interdigitale in two (4%) and Epidermophyton floccosum in one (2%). The disease was more common in adult males and fingernails were found to be affected more often than toenails. The distal and lateral variety was seen in 41 (77%) patients, total secondary dystrophic type in 11 (21%) and proximal subungual type in one (2%). Clinical diagnosis alone is not reliable and mycological confirmation is mandatory for this potentially curable disease.

Adult↗
PubMed1995

Results of German multicenter study of antimicrobial susceptibilities of Trichophyton rubrum and Trichophyton mentagrophytes strains causing tinea unguium. German Collaborative Dermatophyte Drug Susceptibility Study Group.

Thirty-two strains of Trichophyton rubrum and 16 strains of Trichophyton mentagrophytes isolated from patients with tinea unguium in various parts of Germany were subjected to a microdilution test with six systemic or topical antimycotic agents. Apart from griseofulvin, there were no species-specific differences between the two species. Terbinafine was the most active antimycotic agent, with a MIC not exceeding 0.05 micrograms/ml.

Antifungal Agents↗