A clinical and mycological study of onychomycosis in HIV infection.

BACKGROUND: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species and resistance to treatment are the characteristics of onychomycosis in HIV. AIM: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. METHODS: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e, 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. RESULTS: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp, Scytalidium hyalinum, Penicillium spp. and Gymnoascus dankaliensis on 1 each. CONCLUSIONS: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Multicenter, open-label, non-comparative study of a combination of polytar and zinc pyrithione shampoo in the management of dandruff.

BACKGROUND: Dandruff is a common condition in clinical practice. We undertook a study to evaluate the efficacy and safety of a combination of zinc pyrithione and polytar in a shampoo base for the treatment of dandruff. METHODS: A combination of polytar (1%) and zinc pyrithione (1%) was used for 4 weeks to treat 954 patients suffering from mild to severe dandruff. Scoring of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at weeks 0, 2, 4 and 6. Follow up was for 2 weeks. RESULTS: There was consistent improvement in dandruff scores over the treatment and the follow up period. There was significant improvement in signs and symptoms such as erythema and itching, with a negligible adverse event profile. The global assessment by investigators showed good-excellent results in the majority of patients and there was high acceptability for the treatment among the patients. CONCLUSION: A combination shampoo of polytar (1%) and zinc pyrithione (1%) offers a safe and effective option in the treatment of dandruff and its associated symptoms.

A comparative clinical study of sisomicin cream versus mupirocin ointment in pyodermas.

This study was designed to compare the efficacy and safety of sisomicin cream (0.1%) or mupirocin ointment (2%) in the treatment of primary or secondary pyodermas requiring topical antibiotic therapy alone. In the evaluable patients (n=290), impetigo was the commonest clinical condition reported. Staphylococcus aureus was the commonest pathogen isolated from the lesions. Both sisomicin and mupirocin treatments produced a steady improvement in the scores of erythema, oedema, vesiculation, pustulation, crusting and scaling but the improvement produced by sisomicin was quicker and more pronounced. The percentage of patients with complete clearing of all lesions was also higher with sisomicin than with mupirocin on days 4, 8 and 14. Patients subjectively rated the sisomicin formulation as excellent in 75% of cases as against 59% with mupirocin. Sisomicin and mupirocin are effective and safe in the management of pyodermas; however sisomicin therapy resulted in faster and greater relief of signs and symptoms.