Asymmetric gait nail unit syndrome: the most common worldwide toenail abnormality and onychomycosis.

Asymmetric gait nail unit syndrome (AGNUS) is the result of asymmetric shoe pressure on the toes and foot caused by ubiquitous uneven flat feet that affect the gait. The pressure produces clinical changes in the toenails, which are identical to all clinical types of dermatophyte and opportunistic onychomycosis, yet they are dermatophytes-free. AGNUS produces additional signs that make it easy to identify. Its coexistence with fungal disease has resulted in reports describing new clinical types of onychomycosis, identifying signs of drug resistance, assessing severity index, and defining complete clinical cure when taking a systemic or topical antifungal, as well as "retronychia." These signs are typically seen in the toenails of patients with AGNUS. AGNUS has a mechanical etiology and can coexist with dermatophytosis, which is a hereditary disease. AGNUS can coexist with any other disease affecting the toenails and results in greater clinical severity than each condition individually. AGNUS is and has been the most common worldwide toenail abnormality in shoe-wearing societies.

The asymmetric gait toenail unit sign.

The aim of this investigation was to resolve a diagnostic problem and report toenail unit changes attributable to shoe friction that resemble onychomycosis, but that are fungus-negative, and identify common skeletal causes in patients with an asymmetric walking gait. X-ray and clinical feet inspections were performed to evaluate skeletal components that change normal foot biodynamics. Forty-nine patients, all dermatophyte-negative, were reviewed. All patients were those seen in our private practice who demonstrated skeletal and toenail unit abnormalities such as onycholysis, nail bed keratosis resembling distal subungual onychomycosis, nail plate surface abnormalities, distal toe skin keratosis, a diagnostic nail plate shape, as well as several skeletal abnormalities. The clinical abnormalities of the asymmetric gait syndrome include onycholysis, nail bed keratosis, nail plate surface abnormalities, and a diagnostic nail plate shape. By the patient's history, the skeletal findings that were present worsened with age and, in many patients, they were familial. Onychomycosis does not lead to an asymmetric gait nail problem, asymmetric gait toenail does not favor dermatophyte infection, and not all nail dystrophies are the result of an asymmetric walking gait.

The successful treatment of Trichophyton rubrum nail bed (distal subungual) onychomycosis with intermittent pulse-dosed terbinafine.

BACKGROUND: The standard treatment of Trichophyton rubrum nail bed onychomycosis (or distal subungual onychomycosis [DSO]) with daily terbinafine for 12 weeks involves treating for a fixed period shorter than the time required for complete replacement of the nail bed and overlying nail plate by normal growth. The same total amount of terbinafine pulse-dosed for approximately 12 months would treat the patient until normal replacement of the mycotic nail bed has occurred. OBJECTIVES: To determine the effectiveness of intermittent administration of oral terbinafine (250 mg/d for 7 consecutive days every 2-4 months) to cure DSO and to determine the maximum effective treatment interval. DESIGN: A prospective, nonrandomized, open study of sequential groups of office patients. SETTING: A private dermatology practice. METHODS: A sequence of 4 groups of office patients with DSO (n = 10-20 each) were treated with pulse-dosed terbinafine for 7 consecutive days at intervals of 2, 3, and 4 months, respectively. In each group, treatment was continued until the distally advancing new nail bed and nail had completely removed the mycotic defect or failure of fungistasis was detected. MAIN OUTCOME MEASUREMENT: Results were determined by monthly evaluation. Cure was noted as complete replacement of the mycotic nail bed and overlying nail plate (ascertained by monthly metric measurements of the mycosis-free nail bed and overlying nail place distal to the proximal nail fold). Treatment failure was noted when the mycosis-free proximal portion of the nail bed failed to increase in correspondence with the distally directed movement of the nail bed and overlying nail. RESULTS: Thirty-nine (93%) of the 42 patients in the first 3 groups were cured (95% binomial confidence interval, 67%-100%) with no evidence of decrease in efficacy. However, the group of patients who received the 7-day pulse treatment every 4 months experienced significantly more failures (P<.01), and cures dropped to 10 of 17 cases. CONCLUSION: Terbinafine is an effective treatment for DSO when pulse-dosed for 7 days every 3 months but not every 4 months.

Estado clínico y micológico del síndrome de dermatofitosis crónica de la piel y uñas por Trichophyton mentagrophytes (interdigitale) / Clinical and mycological status of the Trichophyton mentagrophytes (interdigitales) syndrome of chronic dermatophytosis of the skin and nail

El síndrome de tinea podal debido a Trichophyton mentagrophytes (interdigital) puede reconocerse por dos signos que no se observan típicamente en la tinea podal debida a T. rubrum y Epidermophyton floccosum (1): ampollas de más de 2 mm en la piel del arco plantar y a lo largo de los lados del pie y del talón adyacentes al estrato córneo plantar grueso (2), y onicomicosis superficial blanca. Sigue sin explicarse la relación que existe entre el síndrome y el T. mentagrophytes zoofílico (AU)

Clinical and mycological status of the Trichophyton mentagrophytes (interdigitale) syndrome of chronic dermatophytosis of the skin and nails.

The syndrome of tinea pedis caused by human-adapted Trichophyton mentagrophytes (interdigitale) can be recognized by two signs not characteristically seen in tinea pedis caused by T. rubrum and Epidermophyton floccosum:1 bullous > 2 mm vesicles in the thin skin of the plantar arch and along the sides of the feet and heel adjacent to the thick plantar stratum corneum,2 and white superficial onychomycosis. The relationship of the syndrome to zoophilic T. mentagrophytes remains in question.

Single-patient drug trial methodology for allergic rhinitis.

BACKGROUND: Historically, single-patient trials (SPTs) have been specifically designed for each patient, requiring significant time and effort for execution. There has been no previous attempt to standardize an SPT for routine commercial availability. OBJECTIVE: To validate the use of an SPT method to discriminate effectiveness and adverse events while comparing drugs/doses in patients with allergic rhinitis. DESIGN: Double-blind, randomized, 4 paired-period, multiple-crossover SPT. SETTING: Academic and commercial investigative sites. PATIENTS: Thirty-six patients with allergic rhinitis were evaluated for the most appropriate treatment; 6 of these participated in 2 different SPTs. INTERVENTIONS: Treatment of symptoms of allergic rhinitis by comparing either loratadine with chlorpheniramine maleate or loratadine with placebo in a series of SPTs. MEASUREMENTS: Effectiveness endpoints were selected from a modern, Food and Drug Administration (FDA)-approved new drug application. Expected adverse events were directly solicited; unsolicited events were also recorded. Total signs and symptoms cumulatively included sneezing, runny nose, itchy nose, teary eyes, and itchy eyes. Quality of life was measured by the most bothersome symptom and the patient's global evaluation. RESULTS: Of 42 initiated SPTs, 40 (95%) provided complete data and 1 (2%) provided partial data, resulting in 41 (98%) evaluable tests. Thirty-one evaluable SPTs compared loratadine 10 mg/d with chlorpheniramine maleate 12 mg twice daily, and 10 SPTs compared loratadine 10 mg/d with placebo. Four of 31 SPTs (13%) showed significant superiority for loratadine over chlorpheniramine maleate and 5 of 31 (16%) for chlorpheniramine maleate over loratadine. Twenty-two of 31 (71%) showed parity performance between loratadine and chlorpheniramine maleate. Loratadine was significantly superior to placebo in 3 of 10 trials (30%), consistent with rates found in 3 pivotal group trials used for FDA approval (24%, 17%, and 0%). Sleepiness could be discriminated for loratadine versus placebo and for chlorpheniramine maleate versus loratadine. CONCLUSIONS: The allergic rhinitis SPT proved to be acceptable to patients, feasible to administer, and reproducible. It can statistically discriminate effectiveness and adverse events, serving as a useful, prognostic tool in community practice.

Penetraçäo de diferentes antimicóticos na córnea humana: estudo "in vitro" / Penetration of different antifungal agents human corneas: \"in vitro\" study

Este estudo compara a penetraçäo corneana de 6 antimicóticos na câmara anterior e no estroma corneano. Trinta córneas humanas desepitelizadas e recém enucleadas foram colocadas numa câmara de perfusäo e expostas as drogas a serem testadas por 6 horas. Agentes avaliados: anfotericina B 5%, natamicina 5%, diluída em DMSO, miconazol 1%, clotrimazol 5%, tiabendazol 5% e 5-fluorocitosina 1%. Dos antimicóticos avaliados a Natamicina diluída em DMSO, tiabendazol e 5-fluorocitosina apresentaram passagem através da córnea. A anfotericina B apresentou passagem em apenas 1 experimento. Após 5 horas de imersäo da córnea dos antimicóticos, foi possível detectar altas concentraçöes de todos antimicóticos no estroma profundo da córnea. O maior índice de penetraçäo foi o da anfotericina B