ABSTRACT
The conventional treatment of onychomycosis, a common fungal infection, consists in the use of local and systemic drugs for 4-6 months. This long protocol is often ineffective due to patient compliance, and usually promotes important collateral effects such as liver and kidney failure. As the alternative, Photodynamic Therapy (PDT) has been used as a noninvasive alternative local treatment for onychomycosis due to the reduction of systemic side effects, fact indicates their use for patients undergoing other systemic treatments. In the present article, we evaluated the effectiveness, as well as the safety of PDT mediated by Aluminium-Phthalocyanine Chloride, entrapped in nanoemulsions, as a drug carrier, to treat onychomycosis in a proof of concept clinical trial. To the date, this is the first published clinical trial that uses PDT mediated by nanomedicines to treat onychomycosis. As main results, we can highlight the safety of the clinical protocol and the antifungal effectiveness similar to the conventional treatments. We observed the (1) clinical cure of 60% of treated lesions; (2) the absence of local and systemic adverse effects; (3) from these clinically healed lesions, 40% were negative for fungal infection in laboratorial exams; and (4) nails that presented negative fungal culture were kept without fungal infection for at least four weeks. The innovation of this approach is the absence of collateral effects, due to the local therapeutically treatment, and the possibility to repeat the treatment without inducing fungal resistance, a fact that indicates this approach as a possible alternative protocol for onychomycosis management.
Subject(s)
Aluminum/chemistry , Indoles/chemistry , Nanostructures , Onychomycosis/drug therapy , Photochemotherapy/methods , Photosensitizing Agents/chemistry , Photosensitizing Agents/therapeutic use , Emulsions , Female , Humans , Isoindoles , Male , Middle Aged , Photochemotherapy/adverse effects , Photosensitizing Agents/adverse effects , Treatment OutcomeABSTRACT
Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Biological Factors/adverse effects , Leprosy/chemically induced , Arthritis, Rheumatoid/drug therapy , Biopsy , Humans , Infliximab , Leprosy/pathology , Male , Middle Aged , Recurrence , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil.
Os agentes biológicos são amplamente utilizados em diversas doenças imuno-mediadas, com marcante eficácia no tratamento da Artrite Reumatóide (AR), Psoríase, Artrite Psoriática, Espondilite Anquilosante e Doença de Crohn. No entanto, deve-se atentar quanto aos efeitos adversos de tais terapêuticas, como o risco de reativar doenças infecciosas granulomatosas latentes, como a tuberculose, hanseníase, sífilis, leishmaniose, entre outras. O objetivo deste artigo é descrever um caso de hanseníase em paciente portador de AR em uso de terapia anti-TNF alfa, mostrando, assim, a necessidade de investigação sistematizada de lesões cutâneas sugestivas de hanseníase em pacientes com indicação de terapia anti-TNF alfa, especialmente, em regiões endêmicas como o Brasil.
Subject(s)
Humans , Male , Middle Aged , Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Biological Factors/adverse effects , Leprosy/chemically induced , Arthritis, Rheumatoid/drug therapy , Biopsy , Leprosy/pathology , Recurrence , Tumor Necrosis Factor-alpha/antagonists & inhibitorsABSTRACT
Esclerodermia deriva do grego e significa "pele dura".É uma doença auto-imune do tecido conjuntivo, crônica, na qual ocorre esclerose progressiva da pele, que se torna espessada, lisa e sem elasticidade.A etiologia é desconhecida, mas sabe-se que existe uma produção descontrolada de colágeno, que se acumula na pele e em outros órgãos, com obliterações da microvasculatura cutânea, do pulmão, trato digestivo, rim e coração.A esclerodermia pode ocorrer em qualquer raça e faixa etária, porém é rara em crianças (0,4%).Pode se manifestar de várias formas, entre elas a esclerodermia sistêmica e a localizada ou cutânea.O diagnóstico da esclerodermia cutânea é eminentemente clínico, devendo ser confirmado pelo exame anatomopatológico da lesão cutânea, que revela fibrose intensa da derme e agressão linfocitária, quando o diagnóstico definitivo torna-se possível.A esclerodermia cutânea, por ser uma doença autolimitada, é de difícil avaliação terapêutica e não existe, ainda, um consenso quanto à eficácia das modalidades terapêuticas empregadas para seu tratamento.
