An open comparative study of nail drilling as adjunctive treatment for toenail onychomycosis (.).

Introduction Novel treatment regimens are being developed to improve drug penetration through the nail plate. This study investigated the efficacy of nail drilling regimens for the treatment of onychomycosis. Methods Participants were assigned to holes with combination (oral plus topical terbinafine) therapy (Group 1), holes with topical terbinafine (Group 2) or topical terbinafine only (Group 3). Measurement of clear nail and mycology was performed at baseline and at weeks 4, 10, 16, 22 and 28. Mixed linear models were used to compare mean percent clear nail. Mycological cure rates were also tabulated for each group. Tolerability and adverse events were documented. Results Ninety-eight participants were enrolled (106 nails). Both groups with holes had significantly higher percentage of clear nail compared with topical terbinafine alone. Although no significant difference between the two groups where holes were drilled in the nail plate, Group 1 demonstrated improvement over Group 3 earlier than Group 2 (visit 2 versus visit 4). Group 1 also had the highest mycological cure rates. Conclusion Treatment with holes plus topical terbinafine produces significantly greater improvement in toenails' appearance and higher mycological cure rates compared to treating the dorsal aspect of the nail plate with topical terbinafine alone.

Clinical comparison and complete cure rates of Terbinafine efficacy in affected onychomycotic toenails.

BACKGROUND: Clinical studies regarding complete cure rate of onychomycosis using oral Terbinafine have a very broad range (14-90%) based solely on response to treatment on the big toenail. OBJECTIVE: To evaluate the efficacy of Terbinafine in all affected onychomycotic toenails and, furthermore, to evaluate differences in mycological, clinical and complete cure rate between affected onychomycotic toenails. PATIENTS AND METHODS: Inclusion criteria are as follows: distolateralsubungual onychomycotic involvement of the hallux and additional involvement of at least two more toenails of the same foot. Exclusion criteria are as follows: patients with nail traumata and hypersensitivity to Terbinafine. Patients were treated with oral Terbinafine 250 mg/day for 16 weeks. Mycological analysis was performed using direct microscopy and culture. Clinical improvement was assessed using digital photography. RESULTS: Statistically significant difference was found in clinical improvement between the great toenail and all other involved toenails. The rate of complete cure (100% clinical cure and mycological cure) of the big toenail was lower (23%) as compared to the second (65%), third (51%) and the fourth toenail (67%). LIMITATIONS: This is a case series study that was based on a single-centre cohort. CONCLUSIONS: Our results support findings that efficacy of Terbinafine should be based on all involved onychomycotic toenails; the big toenail is not superior in response compared to other affected toenails.

When is onychomycosis onychomycosis? A cross-sectional study of fungi in normal-appearing nails.

BACKGROUND: The presence of fungal organisms in healthy-looking toenails has previously been reported in individuals with a known dermatophyte infection and in those with onycholysis, but has not been extensively studied in individuals who do not present with foot pathology. OBJECTIVES: To determine the prevalence of fungal organisms in the toenails and on the soles of normal-appearing feet. METHODS: Adults who visited a dermatology clinic between June 2012 and February 2013 for concerns unrelated to fungal infection of the nails and feet participated in this study. Participants' feet were clinically examined, and skin and nail samples were collected and sent for potassium hydroxide (KOH) light microscopy and culture. RESULTS: Five hundred and eighty-five individuals with normal-appearing feet and toenails participated in this study. Fungal organisms were detected in 9·2%, 3·9% and 3·1% of participants' toenails by KOH, culture, and a combination of KOH and culture, respectively, while fungal organisms were present on the soles of the feet of 7·0%, 2·9% and 1·4% of participants by KOH, culture and both these methods combined, respectively. A significant association between the presence of fungal organisms in toenails and on the soles of the feet was found (P < 0·01). CONCLUSIONS: The presence of fungal organisms in the nail, even in the absence of clinical signs, may be termed 'subclinical' onychomycosis. The normal-appearing nail plate may act as a reservoir for infectious dermatophyte and nondermatophyte organisms. When left unimpeded by the host's immune system, these organisms are inclined to proliferate to produce clinically apparent disease.

Oxidation of cortisol to hydroxy acid metabolites by liver cytosol.

Cytosols (post-microsomal supernatants) prepared from rat, hamster and mouse livers oxidized cortisol to 11 beta, 17, 20-trihydroxy-3-oxo-pregn-4-en-21-oic acids. Mouse liver enzymes yielded over 90% 20 alpha-hydroxy epimer from cortisol, 21-dehydrocortisol (11 alpha, 17-dihydroxy-3,20-dioxo-pregn-4-en-21-aldehyde), and 20 alpha-isocortisol (11 alpha, 17, 20 alpha-trihydroxy-3-oxo-pregn-4-en-21-aldehyde). The 20 beta-epimer of isocortisol yielded both 20 alpha- and 20 beta-hydroxy acid. Rat and hamster liver cytosols converted, 21-dehydrocortisol and 20 alpha-isocortisol to both 20 alpha and 20 beta-hydroxy acids, with the former predominant. The hamster enzyme oxidized 20 beta-isocortisol mainly to the 20 beta-hydroxy acid. The results support our conclusion that both 17 alpha-hydroxy and 17-deoxy corticosteroids are oxidized to hydroxy acids by similar pathways and that isosteroids are obligatory intermediates.