Fungal nail infection

Current therapeutic insights regarding problematic fingernails and toenails in the Republic of Korea

BACKGROUND

Problematic nails and toenails are infected by germs and increasingly have many causes.

AIMS

To investigate the types and treatment of problematic nails and toenails, we focused on bacteria that may appear in problematic nail toenail symptoms.

METHODS

We have searched for PubMed and Google Scholar and correlated the words Onychomycosis, Tinea ungium, Melanonychia, and ingrown toenail related to symptoms.

RESULTS

To measure onychomycosis, KOH tests and fungal culture tests will be used. Treatment can be treated with full-body treatment using anti-fungal agents and local treatment (laser therapy) that can minimize the side effects. A biopsy should be performed when Melanonychia is diagnosed with brown or black pigments on the patient's fingernail plate. Moreover, ingrown toenail surgical treatment can be improved by acquired lifestyle.

CONCLUSIONS

There are many different types of treatments, but many studies show that problematic nail and toenail improvement periods are long and treatment success rates are low.

Confocal laser scanning microscopy as a new valuable tool in the diagnosis of onychomycosis - comparison of six diagnostic methods

Onychomycosis is common and can mimic several different nail disorders. Accurate diagnosis is essential to choose the optimum antifungal therapy. The aim of this study was to evaluate the use of confocal laser scanning microscopy (CLSM) and optical coherence tomography (OCT) as new non-invasive diagnostic tools in onychomycosis and to compare them with the established techniques. In a prospective trial, 50 patients with suspected onychomycosis and 10 controls were examined by CLSM and OCT. Parallel KOH preparation, culture, PAS-staining and PCR were performed. PCR showed the highest sensitivity, followed by CLSM, PAS and KOH preparation. OCT offered the second best sensitivity but displayed the lowest specificity. CLSM and KOH preparation showed a high specificity and CLSM offered the best positive predictive value, similar to KOH preparation and OCT. Fungal culture showed the lowest sensitivity and the worst negative predictive value, yet culture and PCR are the only techniques able to identify genus and species. In summary, CLSM was comparable to PAS staining and superior to KOH preparation. Due to the low specificity we assess OCT not as appropriate. In the differentiation of species PCR outplays the fungal culture in terms of time and sensitivity.

Dermatologic issues in adult survivors of childhood cancer

INTRODUCTION

Common late effects experienced by childhood cancer survivors include: thyroid disturbances, pulmonary compromise, heart failure, and secondary neoplasms. Dermatologic issues have been largely unexplored.

METHODS

This descriptive study consisted of an 8 item self-reported questionnaire on dermatologic issues and the Dermatology Life Quality Index. Participants reported dermatological issues that presented anytime after their diagnosis of cancer. Over a seven month period, 166 survivors seen in a specialized program for adult survivors of childhood cancer housed within an adult cancer center received a cover letter either through the mail or in the clinic setting which explained the purpose of the study. A total of 78 survivors completed the study with an average age of 29.7 years (range 19-46) and an average time since their diagnosis of 19.2 years (range 6-46).

RESULTS

Dermatological issues were reported by 59.0% of survivors and 50% saw a dermatologist at least once for these concerns. Nine survivors (11.5%) reported a skin cancer and ten (12.82%) were affected by alopecia. Additionally, 26 (33.3%) of survivors reported scars related to cancer therapy as a dermatological issue, and 99% of survivors reporting scars said they did not resolve with time.

DISCUSSION/CONCLUSIONS

There are a range of dermatologic issues experienced by adult childhood cancer survivors. In our non-representative sample, 50% of the survivors sought specialized care from a dermatologist for their concern. Additional research is needed to more clearly understand the extent of dermatologic issues and their impact upon quality of life in childhood cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Childhood cancer survivors may frequently seek care from primary care providers. It is important for these providers to be aware of the risks associated with cancer treatments.

Preventing long term relapsing tinea unguium with topical anti-fungal cream: a case report

Background

The patient was aged 34 when he consulted a dermatologist in Vancouver BC with onychomycosis affecting the right great toenail.

Case presentation

Trichophyton rubrum was cultured from nail clippings. Griseofulvin was taken for 6 months, resulting in clinical and mycological cure. Over the next 27 years there were multiple relapses. Each course of treatment with oral terbinafine (for up to 18 months) or itraconazole resulted in clinical and mycological cure. A dermatological colleague suggested the reason for relapse was likely to be self re-infection.

Conclusion

No clinical relapse has occurred with once-weekly miconazole cream applied to the toenail and webspaces of the right foot over the last four years.