ABSTRACT
Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review.
Subject(s)
Onychomycosis , Adolescent , Humans , Child , Onychomycosis/diagnosis , Onychomycosis/drug therapy , Antifungal Agents/therapeutic use , Nails , Administration, Oral , EuropeABSTRACT
Onychomycoses are difficult-to-treat fungal infections with a high recurrence rate that relates to the anatomic and pathophysiological conditions in the nail organ and the required extended duration of treatment. Clinical-epidemiological studies demonstrated that non-dermatophyte molds and yeasts are the primary causative agents in 20%-30% of onychomycoses. Mixed infections with dermatophytes are observed as well. Therefore, the causative agents should be determined by fungal culture and the antifungal treatment regimen should reliably cover non-dermatophytes, if appropriate. Systemic-topical combination therapy involving a broad-spectrum, locally applied antifungal may increase the mycological and clinical cure rates compared to monotherapy with systemic drugs.
Subject(s)
Fungi , Onychomycosis , Antifungal Agents/therapeutic use , Arthrodermataceae/drug effects , Arthrodermataceae/pathogenicity , Coinfection/drug therapy , Coinfection/microbiology , Drug Combinations , Fungi/drug effects , Fungi/pathogenicity , Humans , Nails/microbiology , Onychomycosis/drug therapy , Onychomycosis/epidemiology , Onychomycosis/microbiology , Prevalence , Yeasts/drug effects , Yeasts/pathogenicityABSTRACT
Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German-Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence-based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review.
Subject(s)
Antifungal Agents/therapeutic use , Tinea Capitis/diagnosis , Tinea Capitis/drug therapy , Adult , Child , Hair/microbiology , Humans , Scalp/microbiology , TrichophytonSubject(s)
Dermatology/history , Infectious Disease Medicine/history , Preventive Medicine/history , Sexually Transmitted Diseases/history , Skin Diseases, Infectious/history , Societies, Medical/history , Venereology/history , Germany , History, 19th Century , History, 20th Century , History, 21st Century , HumansABSTRACT
GUIDELINE OBJECTIVES: These guidelines aim to enhance patient care by optimizing the diagnosis and treatment of infections due to creeping disease (cutaneous larva migrans) and to raise awareness among doctors of current treatment options. METHODS: S1 guideline, non-systematic literature search, consensus process using a circular letter.
Subject(s)
Albendazole/administration & dosage , Antinematodal Agents/administration & dosage , Dermatology/standards , Ivermectin/administration & dosage , Larva Migrans/diagnosis , Larva Migrans/drug therapy , Practice Guidelines as Topic , Administration, Oral , Administration, Topical , Dose-Response Relationship, Drug , Germany , Humans , Larva Migrans/parasitology , Larva Migrans/pathologySubject(s)
Dermatology/standards , Dermatology/trends , Practice Guidelines as Topic , Rosacea/diagnosis , Rosacea/therapy , Germany , HumansSubject(s)
Candidiasis, Oral/diagnosis , Evidence-Based Medicine , Administration, Oral , Administration, Topical , Adult , Antifungal Agents/therapeutic use , Candidiasis, Oral/drug therapy , Candidiasis, Oral/etiology , Child , Diagnosis, Differential , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Infant , Infant, Newborn , Microbiological Techniques , Opportunistic Infections/diagnosisABSTRACT
Paracoccidioidomycosis is a common deep mycosis in South America. It is caused by the dimorphic fungus Paracoccidioides brasiliensis. We report a case of a 47-year-old Brazilian man with oral lesions due to paracoccidioidomycosis, which was diagnosed by exfoliative cytology without any special staining. We highlight this diagnostic tool as a simple, low-cost, painless, non-invasive and fast method for the diagnosis of paracoccidioidomycosis.