Effectiveness and safety of topical amphotericin B in 30% dimethyl sulfoxide cream versus 30% dimethyl sulfoxide cream for nondermatophyte onychomycosis treatment: A pilot study

Background: Although topical amphotericin B cream is effective for the treatment of nondermatophyte mold onychomycosis in vitro, studies of its effectiveness and safety in vivo are limited. Objectives: We studied the effectiveness and safety of topical 0.3% amphotericin B in 30% dimethyl sulfoxide cream (amphotericin B cream) in nondermatophyte mold onychomycosis using the vehicle cream 30% dimethyl sulfoxide cream as control. Methods: This randomized controlled study was conducted between January 2019 and November 2020. Patients diagnosed with nondermatophyte mold onychomycosis were randomly divided into two groups of ten patients each: one treated with amphotericin B cream and the other with the vehicle cream. Clinical and mycological cure as well as safety were evaluated. Results: Ten patients each treated with amphotericin B cream and the vehicle cream were included in the study, but only nine patients in the vehicle cream group were available for follow up. All the 19 evaluable patients had distal lateral subungual onychomycosis and the great toenails were affected in 18 (94.7%) of these. Mycological cure was achieved in 8 (80%) patients treated with amphotericin B cream and in 4 (44.4%) patients using the control (vehicle) cream. Clinical cure was achieved in 7 (70%) patients treated with amphotericin B cream, but only in 2 (22.2%) patients on the control cream. No adverse events were observed. Limitations: The small sample size and the fact that PCR fungal identification that provides accurate identification of fungal species was not performed are limitations of our study. Conclusion: Topical amphotericin B cream was both very effective and safe in the treatment nondermatophyte mold onychomycosis. The control (vehicle) cream containing 30% dimethyl sulfoxide also demonstrated some antifungal activity

Skin scrapings versus standardized skin surface biopsy to detect Demodex mites in patients with facial erythema of uncertain cause – a comparative study.

Background: Standardized skin surface biopsy (SSSB) is considered to be the gold standard technique to evaluate the density of Demodex mites for the diagnosis of demodicidosis. Potassium hydroxide (KOH) preparation of skin scrapings is a much simpler procedure that can be used to detect pathogens in the superfi cial skin. Objective: To evaluate the reliability of potassium hydroxide preparation of skin scrapings as compared to the standard skin biopsy technique with regard to capacity to detect Demodex mites, time consumed and technician satisfaction. Methods: One hundred outpatients presenting with facial erythema of uncertain cause were enrolled. Standardized skin surface biopsy and potassium hydroxide preparation of skin scrapings were undertaken in adjacent areas on the patients’ right cheek. Limitation: Patients with normal facial skin were excluded from the study. Results: The accuracy of Demodex mite detection by potassium hydroxide preparation of skin-scrapings when compared to the standard procedure is 82%. The sensitivity, specifi city, positive and negative predictive values of this method are 75%, 84.2%, 60% and 91.43%, respectively. There was no statistically signifi cant difference between the standard and skin scraping techniques (P = 0.238) with regard to mite detection. Mean preparation time while using the skin scraping technique was 6 times less than that of the standard technique. For interpretation also, skin scraping technique (3.6 min) consumed much less time than the biopsy technique (9.8 min). Moreover, experienced technicians were more satisfi ed with skin scraping. Conclusion: Potassium hydroxide preparation of skin scrapings is an effective, time saving and practical technique to detect Demodex mites with accuracy comparable to the standard biopsy method.

Onychomycosis: A study of self-recognition by patients and quality of life.

Background: Onychomycosis accounts for approximately half of all nail disorders and is usually asymptomatic. Objectives: To evaluate patients’ recognition of fungal nail disease, concomitant fungal skin diseases, complications, and quality of life. Methods: Patients from the fungal nail clinic were enrolled between May 2011 and April 2012. Patients’ awareness of diseased nails was evaluated and the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the impact of dermatologic disease on quality of life. Results: A total of 110 patients with onychomycosis were enrolled in the study, of which 64 (58.2%) were female and the mean age was 60.8 years. The number of patients who were able to recognize the presence of onychomycosis was 71 (64.5%), while 32 (29.1%) and 7 (6.4%) were diagnosed by a dermatologist and other physicians, respectively. Multivariate analysis showed that patient recognition of the disease was signifi cantly associated with female sex and young age. The mean DLQI score was 3.6. Limitation: Patient recall bias including the duration of fungal nail infection, long-term past history and previous treatment was a limitation of this study that affected DLQI scores. Conclusion: About half of onychomycosis patients, especially elderly males, could not recognize the disease by themselves. It is important for physicians to educate patients with risk factors for onychomycosis to recognize this condition early to prevent concomitant infection and complications, and to improve patients’ well-being.

Assessment of dermographism at different anatomical regions by dermographometer.

OBJECTIVE: Classic dermographism refers to the ability of the skin to produce a linear wheal with a scratch pressure of 4,900 gm/cm2. The authors manufactured a dermographometer to have precise and consistent measurement and tested it on different body regions to find the best location. MATERIAL AND METHOD: Twenty two patients with dermographism were enrolled. The pressure was applied to the volar aspect of the left forearm using the dermographometer and to the right forearm by the pen head. Then the pressure was applied to the upper back, abdomen, and shin using the dermographometer. The time onset and size of wheal, erythema and flare were recorded. RESULT: The positive yield at the left forearm by the dermographometer was 72.7% and the positive yield at the right forearm by the pen head was 68.2%. The positive yield of back, abdomen and shin were 68.2%, 68.2% and 13.6%, respectively. CONCLUSION: The dermographometer gave a comparable positive yield in diagnosing dermographism with the pen head and the dermographometer. The volar forearm, back and abdomen are the sensitive areas to produce dermographism while the shin is the least sensitive area. The site of the body that is most appropriate in testing is the forearm as it is easy to approach.