Meta-analysis of the antifungal activities of three essential oils as alternative therapies in dermatophytosis infections

Use of a 3D Model with Reconstructed Human Epidermis Infected with Fungi and Covered with a Bovine Nail to Simulate Onychomycosis and to Evaluate the Effects of Antifungal Agents

An in vitro 3D model using fungus colonized Reconstructed Human Epidermis (RHE) represents an effective preclinical model to simulate the pathological conditions of onychomycosis. We evaluated the suitability of this 3D onychomycosis model and use it to assess the effects of topical products on fungus growth and nail structure. Five sets of differentiated RHE were colonized with Trichophyton rubrum and covered with bovine nails. Colonized RHE with no product application (CNA) served as the control. Four different products classified as medical devices were applied once daily on the nails: Urgo Damaged Nails (UDN), Excilor (EXlor), Poderm Purifying (PDermP), Poderm Booster (PDermB). After 5 days, T. rubrum presence was visualized by the Grott Methenamine Silver staining method and quantified as the sum signal intensity of processed acquisitions. Fungal hyphae and the nail structure were analyzed by SEM. A semi-quantitative evaluation of fungal presence showed a reduction after UDN (-34%, p < 0.001) and EXlor (-28%, p < 0.020) applications compared to CNA. No significant difference was observed after PDermP applications (-2%). The nail structure appeared preserved after UDN applications and severely damaged after EXlor and PDermP applications. These findings demonstrate significant effects of different products on fungal growth and nail structure, suggesting that this 3D model might be a valuable tool for predicting the effects of antimycotic treatment in humans.

Synergistic potential of essential oil combinations against Microsporum, Trichophyton, and Epidermophyton

Dermatophyte infections globally account for 20 to 25% of fungal infections. Dermatophytes have begun exhibiting antifungal drug resistance, making it challenging to treat this particular infection. Essential oils could be used as alternative solutions as they have been used for a long period to treat different infections. The research has demonstrated the antifungal efficacy of cinnamon, clove, lemongrass, tea tree, thyme, and garlic essential oils, and the impact of their combinations was assayed against Microsporum canis, Trichophyton tonsurans, T. violaceum, T. verrucosum, and Epidermophyton floccosum. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was used to identify the most prevalent M. canis. The accession number of M. canis was obtained as ON007275. All tested essential oils exhibited antidermatophytic action except garlic. A synergistic effect was attained by cinnamon + clove, cinnamon + lemongrass, clove + lemongrass, clove + tea tree, and thyme + tea tree combinations. Concerning antifungal activity, M. canis was the most susceptible dermatophytic species, except in the case of thyme T. violaceum, which was the most susceptible dermatophytic species. The maximum inhibition was recorded in the cases of cinnamon and cinnamon + lemongrass combination against M. canis. The least minimum inhibitory concentrations were attained by cinnamon and clove against M. canis, cinnamon + clove against M. canis and T. violaceum, and cinnamon + lemongrass against M. canis, T. violaceum, T. verrucosum, and E. floccosum. The least minimum fungicidal concentration showed by cinnamon against M. canis, cinnamon + clove against M. canis and T. violaceum, cinnamon + lemongrass against M. canis, T. violaceum, T. verrucosum, and E. floccosum, and clove + lemongrass against M. canis.

PGPR and nutrient consortia promoted cotton growth, antioxidant enzymes, and mineral uptake by suppressing sooty mold in arid climate

Introduction

Cotton (Gossypium hirsutum L.) plays a vital role in Pakistan's economy, providing significant employment opportunities and supporting the country's textile industry. However, cotton productivity is severely impacted by pests and diseases, such as black spots caused by sooty mold, posing critical challenges to sustainable agriculture. This study investigates a novel integration of plant growth-promoting rhizobacteria (PGPR) with recommended NPK fertilizers and micronutrients to enhance cotton growth, yield, disease resistance, and post-harvest soil properties.

Methodology

A consortium of Bacillus megaterium (ZR19), Paenibacillus polymyxa (IA7), and Bacillus sp. (IA16) were evaluated under six treatments: control (T1), PGPR (T2), recommended NPK (T3), recommended NPK + PGPR (T4), recommended NPK + micronutrients (T5), and recommended NPK + micronutrients + PGPR (T6).

Results

The results depicted a significant increase in antioxidant activities of 19% in superoxide dismutase (SOD), 29% peroxidase (POX), 28% peroxidase dismutase (POD), and 14% catalase (CAT) activity under T6 as compared to control. Similarly, growth parameters substantially improved root length (39%), shoot length (19%), and root and shoot biomass by up to 31 and 20%, respectively, under T6. Moreover, the yield attributes like single boll weight and lint percentage were also enhanced by 32 and 13%, respectively, under the integration. In contrast, the PGPR consortium demonstrated considerable biocontrol potential against sooty mold, as disease incidence was reduced by 68% in cotton, the disease index was 75%, and control efficacy reached 75%. The PGPR consortium also substantially improved post-harvest soil biological and chemical properties, including bacterial populations, microbial biomass nitrogen, organic matter, and essential nutrient availability.

Discussion

So, these findings witnessed the dual behavior of the Bacillus and Paenibacillus strains with balanced nutrition and can lead us to the development of an effective biopesticide cum biofertilizer for the sustainable production of cotton in arid conditions by combating sooty mold effectively.

Red-Laser Photodynamic Therapy with Toluidine Blue Gel as an Adjuvant to Topical Antifungal Treatments for Onychomycosis in Patients with Diabetes: A Prospective Case Series

Background: Systemic therapy is frequently utilized because of its easy accessibility, low cost, and high efficacy. However, it can be linked with systemic adverse effects and drug-drug interactions, especially in immunocompromised and poly-medicated patients. Topical antifungals, associated with a low risk of systemic adverse effects and drug-drug interactions, have emerged as the most suitable treatment option for patients with diabetic foot disease. However, the duration of topical treatment can extend up to 12 months. Consequently, there is a need to bolster these topical treatments with complementary therapies. Methods: The current study acquired approval from an ethics committee (code 24/241-E) and Clinical Trials (code NCT06485050). No patients were excluded, irrespective of comorbidities or the severity of onychomycosis. Patients included in the study were administered Ciclopirox 8% (consisting of ethyl acetate, 96% ethanol, ketostearyl alcohol, hydroxypropyl chitosan, and purified water) once daily for 6 months. This was supplemented with photodynamic therapy (three sessions in the first 2 months) using toluidine blue gel and a 635 nm diode laser lasting 10 min, as well as monthly debridement of the nail plate. Results: All patients (10/10) included in the study exhibited negative microbiological culture results 6 months after the study began. Of these, 90% (9/10) were clinically cured, and thus, fully cured. No adverse effects or complications secondary to the treatments were observed in any of the cases. The average Onychomycosis Severity Index (OSI) value was initially 18.50 ± 8.947, reduced to 10.30 ± 6.129 at 3 months, and finally fell to 4.10 ± 4.08 at the end of the treatment. Conclusions: The current study demonstrated the clinical improvement, mycological cure, effectiveness, and safety of combination therapy of ciclopirox 8% and photodynamic therapy over 6 months.

Treatment of Onychomycosis and the Drug-Drug Interactions in Patients with Diabetes Mellitus and Diabetic Foot Syndrome: A Systematic Review

Background: This systematic review reports on treatments for onychomycosis in patients with diabetes and the drug interactions with other drugs in regard to the complicated diabetic patient profile. Methods: The recommendations in the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist were applied and the included studies were evaluated using the Consolidated Standards of Reporting Trials (CONSORT) statement and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Searches were conducted in November 2023, using the PubMed (Medline), Scopus, Cochrane Library, and Web of Science databases; studies on antifungal treatments for onychomycosis in patients with diabetes were included. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussions with a third reviewer. This review was registered in PROSPERO (CRD42023442107). Results: The systematic review included 10 studies that met the selection criteria. Mycological cures for mild to moderate onychomycosis were: Ageratina pichinchensis (8.6%), 8% ciclopirox (8.6% 24 weeks and 54.3% 48 weeks), 10% efinaconazole (56.5-58.33%), terbinafine (73-76.6%), itraconazole (88.2%), and laser therapy (43.8%). No serious adverse effects or drug interactions were observed because patients with major complications, such as peripheral vascular disease, diabetic neuropathy, liver and renal dysfunction, poorly controlled diabetes, and severe onychomycosis, were excluded. Conclusions: The antifungal treatments described in the included studies are safe for patients with well-controlled diabetes, but there are currently no studies involving patients with diabetes and multiple complications, such as diabetic foot syndrome or severe onychomycosis. Thus, further research is needed in terms of this patient profile.

Essential Oil Components Incorporated Emulsion Hydrogels for Eradicating Dermatophytosis Caused by Pathogenic Fungi Trichophyton mentagrophytes and Microsporum canis

Dermatophytosis is a prevalent fungal infection and public health burden, majorly caused by the attack of zoophilic fungi genera of Trichophyton and Microsporum. Among them, T. mentagrophytes and M. canis are the dominating pathogens that cause dermatophytosis in humans. Though anti-fungal treatments are available, the widespread drug resistance and minimal efficacy of conventional therapies cause recurring infections. In addition, prolonged anti-fungal medications induce several systemic side effects, including hepatotoxicity and leucopenia. The anti-dermatophytic formulation of biocompatible essential oil components (EOCs) is attractive due to their highly potent anti-dermatophytic action. Herein, two EOCs, Eugenol (EU) and Isoeugenol (IU), incorporated emulsion hydrogel (EOCs-EHG) synthesized from hydroxypropylmethyl cellulose and poly(ethylene glycol) methyl ether methacrylate. The cytocompatibility of the hydrogels is confirmed by treating them with fibroblast and keratinocyte cell lines. The EOCs-EHG demonstrated pH and temperature-responsive sustained release of entrapped EOCs and inhibited fungal spore germination. T. mentagrophytes and M. canis biofilms are eradicated at a minimal inhibitory concentration of 2 µg mL-1 each of EU and IU. The in vivo anti-dermatophytic activity of EOCs-EHG is confirmed in dermatophyte-infected Wistar albino rat models. The topical application of EOCs-EHG demonstrated complete infection eradication and facilitated skin regeneration, emphasizing the therapeutic potential of EOCs-EHG against dermatophytosis.

Antifungal Activity of Tea Tree (Melaleuca alternifolia Cheel) Essential Oils against the Main Onychomycosis-Causing Dermatophytes

Onychomycosis is a common fungal infection that affects the nails and accounts for approximately 50% of all nail diseases. The main pathogens involved include dermatophytes, such as Trichophyton rubrum, members of the T. mentagrophytes complex, and emerging pathogens in this infection, T. schoenleinii and T. tonsurans. Tea tree (Melaleuca alternifolia Cheel) essential oil (EO) has been proposed as a promising natural alternative to traditional treatments due to its antimicrobial properties. Among its more than 100 compounds, terpinen-4-ol is one of the main contributors to the antifungal action of this EO. To determine the antifungal activity of tea tree EO against dermatophytes, we designed an in vitro study using EUCAST-AFST protocols to obtain the values of MIC (minimum inhibitory concentration) and MFC (minimum fungicidal concentration) of several commercial M. alternifolia Cheel EOs against three species of dermatophytes isolated from clinical samples with suspected toenail onychomycosis. The results showed that the microorganism most sensitive to the action of the EO was T. rubrum, which had an MIC value more than 13 times lower than the value obtained for T. schoenleinii (0.4% v/v), the most resistant isolate. No differences in antifungal activity were observed by the analysed EOs or between the MIC and MFC values. These in vitro results suggest that tea tree EO is a viable option for the alternative treatment of onychomycosis, although clinical studies are needed to confirm the long-term antifungal activity, safety and efficacy of the oils studied in a clinical context.

Chemical composition of Artemisia argyi essential oil and its antifungal activity against dermatophytes by inhibiting oxidative phosphorylation and causing oxidative damage

ETHNOPHARMACOLOGICAL RELEVANCE

Dermatophytes are notorious pathogens capable of infecting various mammals skin, posing serious threats to human health and overall life quality worldwide. Artemisia argyi has been recorded and applied for over a thousand years to treat skin itching. Although it has the potential to be developed as a plant-based antifungal agent, it's antifungal activity and action mechanism of active ingredients are still unclear.

AIM OF THE STUDY

The aim of this study was to investigate the chemical composition, antifungal activity against skin fungi, and potential mechanisms of Artemisia argyi essential oil (AEO).

MATERIALS AND METHODS

The chemical composition of AEO was analyzed by gas chromatography-mass spectrometry (GC-MS) firstly. Flat growth restraint and double half dilution tests was performed to evaluate AEO antifungal activity against Microsporum gypseum, Trichophyton mentagrophytes, and Trichophyton rubrum. And then, the physiological mechanism of AEO inhibiting dermatophytes was systematically explored through scanning electron microscopy, relative conductivity, membrane leakage, ROS content, and antioxidant enzyme activity. Finally, the main pathways were screened through transcriptome sequencing, while the related genes expression levels and enzyme activity were validated.

RESULTS

Monoterpenes and sesquiterpenoids were the most highly representative class of AEO. AEO had powerful antifungal activity against M. gypseum, T. mentagrophytes, and T. rubrum, with minimum inhibitory concentration (MIC) values of 0.6, 1.2, and 1.2 μL/mL, respectively. Moreover, AEO can also damage the cell membrane integrity of T. mentagrophytes, resulting in cellular extravasation of intracellular substances. Transcriptome analysis revealed that the main target of AEO is to inhibit electron transfer and oxidative phosphorylation during respiration, ultimately leading to obstruction of normal ATP synthesis and energy metabolism in mitochondria. And a large amount of ROS will generate due to the incompletely catalysis of oxygen under mitochondrial complexes. Coupled with the decrease of antioxidant enzyme (SOD, POD) activity, excessive accumulation of ROS will cause serious oxidative damage to cells and eventually exhibiting antifungal activity against dermatophytes.

CONCLUSIONS

The present study demonstrated that Artemisia argyi was a valuable source of active compounds with antifungal activity. These findings support AEO as a potential agent to inhibit dermatophytes and prevent related dermatophytoses.

Artemisia argyi extract subfraction exerts an antifungal effect against dermatophytes by disrupting mitochondrial morphology and function

Artemisia argyi (A. argyi), a plant with a longstanding history as a raw material for traditional medicine and functional diets in Asia, has been used traditionally to bathe and soak feet for its disinfectant and itch-relieving properties. Despite its widespread use, scientific evidence validating the antifungal efficacy of A. argyi water extract (AAWE) against dermatophytes, particularly Trichophyton rubrum, Trichophyton mentagrophytes, and Microsporum gypseum, remains limited. This study aimed to substantiate the scientific basis of the folkloric use of A. argyi by evaluating the antifungal effects and the underlying molecular mechanisms of its active subfraction against dermatophytes. The results indicated that AAWE exhibited excellent antifungal effects against the three aforementioned dermatophyte species. The subfraction AAWE6, isolated using D101 macroporous resin, emerged as the most potent subfraction. The minimum inhibitory concentrations (MICs) of AAWE6 against T. rubrum, M. gypseum, and T. mentagrophytes were 312.5, 312.5, and 625 μg·mL-1, respectively. Transmission electron microscopy (TEM) results and assays of enzymes linked to cell wall integrity and cell membrane function indicated that AAWE6 could penetrate the external protective barrier of T. rubrum, creating breaches ("small holes"), and disrupt the internal mitochondrial structure ("granary"). Furthermore, transcriptome data, quantitative real-time PCR (RT-qPCR), and biochemical assays corroborated the severe disruption of mitochondrial function, evidenced by inhibited tricarboxylic acid (TCA) cycle and energy metabolism. Additionally, chemical characterization and molecular docking analyses identified flavonoids, primarily eupatilin (131.16 ± 4.52 mg·g-1) and jaceosidin (4.17 ± 0.18 mg·g-1), as the active components of AAWE6. In conclusion, the subfraction AAWE6 from A. argyi exerts antifungal effects against dermatophytes by disrupting mitochondrial morphology and function. This research validates the traditional use of A. argyi and provides scientific support for its anti-dermatophytic applications, as recognized in the Chinese patent (No. ZL202111161301.9).

Dermaceutical Utilization of Nigella sativa Seeds: Applications and Opportunities

Skin diseases have recently become a major concern among people of all ages due to their highly visible symptoms and persistent and difficult treatment, which significantly impact their quality of life. Nigella sativa seeds, also known as "black seeds" or "kalonji," are one of the most commonly used herbal medicines due to their wide range of biological and pharmacological activities. It contains a wide range of bioactive constituents found in both fixed and essential oils. It has been used for hundreds of years as an alternative ethnomedicine to treat a wide range of skin conditions. N. sativa's dermatological applications in skin diseases are attributed to its potent antioxidant, anti-inflammatory, antimicrobial, and immunomodulatory properties, making it an intriguing skincare candidate. Several studies unravelled positive results associated with N. sativa on skin diseases. As N. sativa is the most studied medicinal plant, several preclinical and clinical studies have been conducted to establish its use in the treatment of various skin diseases. Thymoquinone has anti-inflammatory, antioxidant, and antibacterial properties, which mainly contributed to the treatment of skin diseases. In this context, the present review explores all the available studies on the association of N. sativa and its effect on treating skin diseases in light of recent studies and patents supporting its therapeutic applications.

Tea Tree Oil: Properties and the Therapeutic Approach to Acne-A Review

Acne vulgaris is an inflammatory dermatological pathology that affects mostly young people. However, it can also appear in adulthood, mainly in women. It has a high psychosocial impact, not only at the time of active lesions but also due to the consequences of lesions such as scarring and hyperpigmentation. Several factors are involved in the physiopathology of acne and the constant search for active ingredients is a reality, namely phytotherapeutic ingredients. Tea tree oil is an essential oil extracted from Melaleuca alternifolia (Maiden & Betch) Cheel with known antibacterial, anti-inflammatory, and antioxidant properties, making it a candidate for the treatment of acne. This review aims to describe the various properties of tea tree oil that make it a possible ingredient to use in the treatment of acne and to present several human studies that have evaluated the efficacy and safety of using tea tree oil in the treatment of acne. It can be concluded that tea tree oil has good antibacterial, anti-inflammatory, and antioxidant properties that result in a decrease in the number of inflammatory lesions, mainly papules, and pustules. However, given the diversity of study designs, it is not possible to draw concrete conclusions on the efficacy and safety of this oil in the treatment of acne.

Clinical Manifestations of Human Exposure to Fungi

Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.