The Experts below are selected from a list of 4125 Experts worldwide ranked by ideXlab platform
Aditya K Gupta - One of the best experts on this subject based on the ideXlab platform.
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efficacy and safety of topical terbinafine 10 solution mob 015 in the treatment of mild to moderate distal subungual Onychomycosis a randomized multicenter double blind vehicle controlled phase 3 study
Journal of The American Academy of Dermatology, 2020Co-Authors: Aditya K Gupta, D M Pariser, Maria S Surprenant, Steven Kempers, Kjell Rensfeldt, Amir TavakkolAbstract:Background Onychomycosis is a recalcitrant fungal nail infection. Topical antifungal agents may be preferred over systemic agents due to lack of systemic adverse effects. Objective To investigate the efficacy and safety of topical terbinafine 10% solution (MOB-015) for the treatment of distal and lateral subungual Onychomycosis. Methods In a multicenter, double-blind, phase III, North American study, patients with mild to moderate distal and lateral subungual Onychomycosis involving 20% to 60% of at least 1 great toenail were randomized to once daily application of MOB-015 or matching vehicle for 48 weeks. The primary efficacy variable was complete cure, while the secondary efficacy variables were mycological cure and treatment success. Safety evaluations were also performed. Results At week 52, the mycological cure (negative culture and potassium hydroxide microscopy) rate in the MOB-015 and vehicle groups was 69.9% and 27.7%, respectively (P Limitation The follow-up period after end of treatment may not be sufficient to accurately reflect cure in distal and lateral subungual Onychomycosis. Conclusions MOB-015 is a treatment option for Onychomycosis with an adverse event profile similar to vehicle.
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Global perspectives for the management of Onychomycosis
International journal of dermatology, 2018Co-Authors: Aditya K Gupta, Bianca Maria Piraccini, Avner Shemer, Rachel R Mays, Sarah G Versteeg, Anita Takwale, Meir Babaev, Chander Grover, Nilton Di Chiacchio, Paulo R. O. TabordaAbstract:Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on Onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating Onychomycosis were similar between countries, slight differences in Onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of Onychomycosis provides a framework of success for the committed clinician with appreciation of how Onychomycosis is managed worldwide.
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Onychomycosis in children safety and efficacy of antifungal agents
Pediatric Dermatology, 2018Co-Authors: Aditya K Gupta, Neil H Shear, Rachel R Mays, Sarah G Versteeg, Sheila Fallon FriedlanderAbstract:Onychomycosis is an uncommon condition in childhood, but prevalence in children is increasing worldwide.The objective was to review the efficacy and safety of systemic and topical antifungal agents to treat Onychomycosis in children. Databases (Pubmed, OVID, Scopus, clinicaltrials.gov, Cochrane Library) were searched. Seven studies were selected for inclusion. Only one was a randomized controlled trial. In total, 208 children were administered antifungal agents for the treatment of Onychomycosis. Four reports of mild adverse events were documented (1.9% of treated children), one of which discontinued treatment (0.5%). Limitations of this review are the lack of randomized controlled trials available in pediatric Onychomycosis. These findings suggest that antifungal therapies used to treat Onychomycosis in children are associated with a low incidence of adverse events. Current dosing regimens for antifungal drugs are effective and appear safe to use in children, notwithstanding that the Food and Drug Administration has not approved any of these agents for the treatment of Onychomycosis in children. To our knowledge, this review is the most up-to-date, comprehensive summary of pediatric Onychomycosis treatment.
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the impact of Onychomycosis on quality of life a systematic review of the available literature
Skin Appendage Disorders, 2018Co-Authors: Aditya K Gupta, Rachel R MaysAbstract:Purpose: Onychomycosis is a nail disorder that is increasing in prevalence worldwide. The psychological and social limitations caused by Onychomycosis can potentially undermine the work and social lives of those experiencing these negative effects. This review aimed to evaluate the randomized controlled trials (RCTs) available in the current literature on the impact Onychomycosis has on quality of life (QoL). Methods: A systematic review was performed using the databases PubMed, PsycINFO, Scopus, ClinicalTrials.gov, and Cochrane Library on July 18, 2017. Only RCTs with clinical effects described in English were included for review. Results: Ten RCTs reported QoL outcomes for patients suffering from Onychomycosis. Treatment satisfaction was statistically significant from baseline to end of treatment in 100.0% (4/4) measures which reported on satisfaction with treatment; mental health was also significant in 100.0% (3/3), symptoms index rating in 100.0% (2/2), symptom frequency in 75.0% (3/4), overall problems in 75.0% (3/4), functional activities in 75.0% (6/8), appearance problems in 66.7% (2/3), symptom distress in 57.1% (4/7), and stigma in 40.0% (2/5). The OnyCOE-tTM and the NailQoL were the most used common outcome measures to describe QoL. Conclusion: The study sanctions that Onychomycosis physically and psychologically distresses patients’ lives. Further research should include validated outcome measures to more effectively treat Onychomycosis.
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Onychomycosis in the 21st century an update on diagnosis epidemiology and treatment
Journal of Cutaneous Medicine and Surgery, 2017Co-Authors: Aditya K Gupta, Sarah G Versteeg, Neil H ShearAbstract:Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing Onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of Onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved Onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional Onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.
Richard C. Summerbell - One of the best experts on this subject based on the ideXlab platform.
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the prevalence of unsuspected Onychomycosis and its causative organisms in a multicentre canadian sample of 30 000 patients visiting physicians offices
Journal of The European Academy of Dermatology and Venereology, 2016Co-Authors: Aditya K Gupta, Elizabeth A Cooper, Hem C Jain, Deanne Daigle, Kelly A Foley, Gita Gupta, Charles Lynde, Richard C. SummerbellAbstract:Background Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of Onychomycosis in North American clinic samples have been higher than what has been reported for general populations. Objective A large, multicentre study was conducted to estimate the prevalence of toenail Onychomycosis in the Canadian population. Methods Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients. Results Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail Onychomycosis was estimated to be 6.7% (95% CI, 6.41–6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail Onychomycosis in Canada was 6.4% (95% CI, 6.12%–6.65%). The distribution of fungal organisms in culture-confirmed Onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail Onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years. Conclusion The present data highlights that Onychomycosis may be a growing medical concern among ageing patients.
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utility of inoculum counting walshe and english criteria in clinical diagnosis of Onychomycosis caused by nondermatophytic filamentous fungi
Journal of Clinical Microbiology, 2001Co-Authors: Aditya K Gupta, Richard C. Summerbell, Elizabeth A Cooper, Paul MacdonaldAbstract:Opportunistic Onychomycosis caused by nondermatophytic molds may differ in treatment from tinea unguium. Confirmed diagnosis of opportunistic Onychomycosis classically requires more than one laboratory analysis to show consistency of fungal outgrowth. Walshe and English in 1966 proposed to extract sufficient diagnostic information from a single patient consultation by counting the number of nail fragments positive for inoculum of the suspected fungus. Twenty fragments were plated per patient, and each case in which five or more fragments grew the same mold was considered an infection by that mold, provided that compatible filaments were also seen invading the nail tissue by direct microscopy. This widely used and often recommended method has never been validated. Therefore, the validity of substituting any technique based on inoculum counting for conventional follow-up study in the diagnosis of opportunistic Onychomycosis was investigated. Sampling of 473 patients was performed repeatedly. Nail specimens were examined by direct microscopy, and 15 pieces were plated on standard growth media. After 3 weeks, outgrowing dermatophytes were recorded, and pieces growing any nondermatophyte mold were counted. Patients returned on two to eight additional occasions over a 1- to 3-year period for similar examinations. Onychomycosis was etiologically classified based on long-term study. Opportunistic Onychomycosis was definitively established for 86 patients. Counts of nondermatophyte molds in initial examinations were analyzed to determine if they successfully predicted both true cases of opportunistic Onychomycosis and cases of insignificant mold contamination. There was a strong positive statistical association between mold colony counts and true opportunistic Onychomycosis. Logistic regression analysis, however, determined that even the highest counts predicted true cases of opportunistic Onychomycosis only 89.7% of the time. The counting criterion suggested by Walshe and English was correct only 23.2% of the time. Acremonium infections were especially likely to be correctly predicted by inoculum counting. Inoculum counting could be used to indicate a need for repeat studies in cases of false-negative results from laboratory direct microscopy. Inoculum counting cannot serve as a valid substitute for follow-up study in the diagnosis of opportunistic Onychomycosis. It may, nonetheless, provide useful information both to the physician and to the laboratory, and it may be especially valuable when the patient does not present for follow-up sampling.
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a large scale north american study of fungal isolates from nails the frequency of Onychomycosis fungal distribution and antifungal susceptibility patterns
Journal of The American Academy of Dermatology, 2000Co-Authors: Mahmoud A Ghannoum, Aditya K Gupta, Richard C. Summerbell, Nellie Konnikov, Richard K Scher, Rana Hajjeh, Sabra Sullivan, R Daniel, P Krusinski, Philip FleckmanAbstract:Abstract Background: Onychomycosis, a fungal infection of the nail bed, is responsible for up to 50% of nail disorders. Although several surveys have been conducted in different parts of the world, there have been no multicenter epidemiologic surveys of Onychomycosis in North America. Objective: A 12-center study was undertaken to (1) determine the frequency of Onychomycosis, (2) identify organisms recovered from the nails, and (3) determine the antifungal susceptibility of isolates. Methods: A total of 1832 subjects participated in this study and completed a comprehensive questionnaire, and nail clippings were collected for potassium hydroxide examination and culturing. Results: The frequency of Onychomycosis, as defined by the presence of septate hyphae on direct microscopy and/or the recovery of a dermatophyte, was found to be 13.8%. In general, the dermatophyte isolates were susceptible to the antifungals tested. Conclusion: Because of the limited number of large-scale studies, the baseline incidence is not firmly established. However, the higher frequency of Onychomycosis in this study may confirm the suspected increase in incidence of disease in North America. (J Am Acad Dermatol 2000;43:641-8.).
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prevalence and epidemiology of Onychomycosis in patients visiting physicians offices a multicenter canadian survey of 15 000 patients
Journal of The American Academy of Dermatology, 2000Co-Authors: Aditya K Gupta, Elizabeth A Cooper, Charles W. Lynde, Hem C Jain, Paul Macdonald, Richard C. SummerbellAbstract:A prospective, multicenter study to determine the epidemiology of Onychomycosis was performed in the offices of 3 dermatologists and 1 family physician in Ontario, Canada. In the sample of 15,000 patients, abnormal-appearing nails were observed in 2505 persons (16. 7%). There were 1199 patients (8%) with toenail or fingernail Onychomycosis confirmed on mycologic examination, with 1137 patients (7.6%) who had only pedal Onychomycosis, 40 patients with toenail and fingernail Onychomycosis (0.27%), and 22 patients (0.15%) with only fingernail Onychomycosis. The condition was more common in male patients (P or =75% nail involvement) in 27.6%, 39.9%, and 32.5% of patients, respectively. After adjusting for the age and sex distribution of the general population, the projected rate of Onychomycosis in Canada is 6.5% (95% confidence interval [CI], 6. 1%-6.9%). The organisms causing toenail Onychomycosis were 90.5% dermatophyte, 7.8% nondermatophyte molds, and 1.7% Candida spp. The corresponding organisms causing fingernail Onychomycosis were 70.8%, 0%, and 29.2%, respectively. In a large sample of 15,000 patients, abnormal-appearing nails were present in 17% of the sample with mycologic evidence of toenail or fingernail Onychomycosis in 8%. The projected prevalence of Onychomycosis in Canada is 6.5% (95% CI, 6. 1%-6.9%).
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Combined distal and lateral subungual and white superficial Onychomycosis in the toenails.
Journal of The American Academy of Dermatology, 1999Co-Authors: Aditya K Gupta, Richard C. SummerbellAbstract:Abstract Background: The 5 main types of Onychomycosis are distal and lateral subungual Onychomycosis (DLSO), white superficial Onychomycosis (WSO), proximal subungual Onychomycosis (PSO), Candida Onychomycosis, and total dystrophic Onychomycosis (TDO) (primary or secondary type). In the literature there is infrequent discussion about 2 types of Onychomycosis present in the toenails of the same individual. Objective: We attempted to determine the prevalence and etiologic organisms of DLSO and WSO occurring in the same individual. Methods: We surveyed 4411 subjects presenting to dermatology offices for causes other than the management of Onychomycosis. In each patient the toenails were examined. If they appeared abnormal, nail material was obtained for mycologic evaluation; partitioned sampling was performed when more than one type of Onychomycosis was present. Results: In our series, 39 (0.9%) of 4411 patients had the combination DLSO and WSO, compared with 417 (9.4%) and 111 (2.5%) who had DLSO and WSO, respectively. After controlling for age and sex in the general population, the projected prevalence rates of DLSO, WSO, and combined DLSO and WSO in the province of Ontario, Canada were 7.1%, 1.5%, and 0.5%, respectively. The combination of DLSO and WSO in the toenails of an individual occurred more frequently than that predicted by chance alone ( P Trichophyton mentagrophytes . In the remaining 16 subjects other organisms cultured were T rubrum , Acremonium spp, Aspergillus spp, Fusarium oxysporum , and Onychocola canadensis . In 33 (84.6%) of 39 subjects with the combination of DLSO and WSO on the toenails, the same fungal organism was associated with both the DLSO and WSO. Conclusion: When both DLSO and WSO are concurrently present in the toenails of an individual, partitioned sampling (ie, sampling for each of the two types of Onychomycosis) may provide us with a better understanding of the different organisms associated with the Onychomycosis and the relationship between the two types of Onychomycosis. (J Am Acad Dermatol 1999;41:938-44.)
Bianca Maria Piraccini - One of the best experts on this subject based on the ideXlab platform.
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Global perspectives for the management of Onychomycosis
International journal of dermatology, 2018Co-Authors: Aditya K Gupta, Bianca Maria Piraccini, Avner Shemer, Rachel R Mays, Sarah G Versteeg, Anita Takwale, Meir Babaev, Chander Grover, Nilton Di Chiacchio, Paulo R. O. TabordaAbstract:Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophyte molds, and yeasts. This difficult-to-treat chronic infection has a tendency to relapse despite treatment. This paper aims to offer a global perspective on Onychomycosis management from expert physicians from around the world. Overall, the majority of experts surveyed used systemic, topical, and combination treatments approved in their countries and monitored patients based on the product insert or government recommendations. Although the basics of treating Onychomycosis were similar between countries, slight differences in Onychomycosis management between countries were found. These differences were mainly due to different approaches to adjunctive therapy, rating the severity of disease and use of prophylaxis treatment. A global perspective on the treatment of Onychomycosis provides a framework of success for the committed clinician with appreciation of how Onychomycosis is managed worldwide.
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Onychomycosis in patients with nail psoriasis a point to point discussion
Mycoses, 2017Co-Authors: Dimitrios Rigopoulos, Vasilios Papanagiotou, Ralph Daniel, Bianca Maria PiracciniAbstract:Summary Onychomycosis is the most common nail disease and affects large parts of the population. Psoriasis is a frequently encountered skin disorder with nail involvement being found in up to 80% of the patients at some time of the course of the disease. It has been postulated that Onychomycosis occurs more frequently in patients with nail psoriasis, but the results of studies in the literature are controversial. Moreover, Onychomycosis could exacerbate psoriasis through Koebner phenomenon and the treatment of psoriasis could predispose to Onychomycosis. Finally, the differential diagnosis could be a real challenge due to many same clinical signs, the high prevalence and the possible coexistence of the two diseases. This article attempts to enlighten all these different aspects of a very close relationship.
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Onychomycosis a review
Journal of Fungi, 2015Co-Authors: Bianca Maria Piraccini, Aurora AlessandriniAbstract:Onychomycosis is the most common nail infective disorder. It is caused mainly by anthropophilic dermatophytes, in particular by Trichophyton rubrum and T. mentagrophytes var. interdigitale. Yeasts, like Candida albicans and C. parapsilosis, and molds, like Aspergillus spp., represent the second cause of Onychomycosis. The clinical suspect of Onychomycosis should be confirmed my mycology. Onychoscopy is a new method that can help the physician, as in Onychomycosis, it shows a typical fringed proximal margin. Treatment is chosen depending on the modality of nail invasion, fungus species and the number of affected nails. Oral treatments are often limited by drug interactions, while topical antifungal lacquers have less efficacy. A combination of both oral and systemic treatment is often the best choice.
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Onychomycosis IN CHILDREN
2012Co-Authors: Bianca Maria Piraccini, Francesca Bruni, Michela StaraceAbstract:Onychomycosis in children is rare, with an approximate worldwide prevalence, in children below the age of 18 years, lower than 0.5%. Dermatophytes are responsible for the great majority of the cases, with distal subungual Onychomycosis of one toenail as the most frequent clinical variety. Candida sp. may invade the nails only in predisposed children, usually producing a total Onychomycosis. Care should be taken when diagnosing Onychomycosis in children, as the sole clinical appearance is not enough to establish the diagnosis and mycology is always mandatory
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Treatment of Onychomycosis with oral antifungal agents
Expert Opinion on Drug Delivery, 2005Co-Authors: Matilde Iorizzo, Bianca Maria Piraccini, Giulia Rech, Antonella TostiAbstract:Onychomycosis is the most common nail disease and describes the invasion of the nail by fungi. Different clinical patterns of infection depend on the way and the extent by which fungi colonise the nail: distal subungual Onychomycosis, proximal subungual Onychomycosis, white superficial Onychomycosis, endonyx Onychomycosis and total dystropic Onychomycosis. The type of nail invasion depends on both the fungus responsible and on host susceptibility. Treatment of Onychomycosis depends on the clinical type of the Onychomycosis, the number of affected nails and the severity of nail involvement. The goals for antifungal therapy are mycological cure and a normal looking nail. In this paper the treatment of Onychomycosis with oral antifungal agents will be reviewed.
Antonella Tosti - One of the best experts on this subject based on the ideXlab platform.
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Onychomycosis diagnosis and definition of cure
Journal of The American Academy of Dermatology, 2007Co-Authors: Richard K Scher, Antonella Tosti, Amir Tavakkol, Bardur Sigurgeirsson, Mahmoud A Ghannoum, Philip Fleckman, R J Hay, Warren S Joseph, David Armstrong, Bryan C MarkinsonAbstract:Until now, there has been no agreement on criteria defining resolution of Onychomycosis. Most published reports use clinical and mycological cure, which comprises a completely normal-appearing nail plate, and negative nail culture and microscopy results, as the end point for defining success of therapeutic intervention. Reported here is the definition of Onychomycosis, which delineates both primary and secondary criteria for diagnosis of Onychomycosis and identifies clinical and laboratory parameters to define a resolved fungal nail infection. Onychomycosis cure is defined by the absence of clinical signs or the presence of negative nail culture and/or microscopy results with one or more of the following minor clinical signs: (1) minimal distal subungual hyperkeratosis; and (2) nail-plate thickening. Clinical signs indicative of persistent Onychomycosis at the end of the observation period include (1) white/yellow or orange/brown streaks or patches in or beneath the nail plate; and (2) lateral onycholysis with subungual debris. Although nail appearance will usually continue to improve after cessation of therapy, the nails may have a persistent abnormal appearance even in cases where treatment has been effective.
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Treatment of Onychomycosis with oral antifungal agents
Expert Opinion on Drug Delivery, 2005Co-Authors: Matilde Iorizzo, Bianca Maria Piraccini, Giulia Rech, Antonella TostiAbstract:Onychomycosis is the most common nail disease and describes the invasion of the nail by fungi. Different clinical patterns of infection depend on the way and the extent by which fungi colonise the nail: distal subungual Onychomycosis, proximal subungual Onychomycosis, white superficial Onychomycosis, endonyx Onychomycosis and total dystropic Onychomycosis. The type of nail invasion depends on both the fungus responsible and on host susceptibility. Treatment of Onychomycosis depends on the clinical type of the Onychomycosis, the number of affected nails and the severity of nail involvement. The goals for antifungal therapy are mycological cure and a normal looking nail. In this paper the treatment of Onychomycosis with oral antifungal agents will be reviewed.
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Onychomycosis caused by nondermatophytic molds clinical features and response to treatment of 59 cases
Journal of The American Academy of Dermatology, 2000Co-Authors: Antonella Tosti, Bianca Maria Piraccini, Sandra LorenziAbstract:Abstract Background: Nail invasion by nondermatophytic molds (NDM) is considered uncommon with prevalence rates ranging from 1.45% to 17.6%. Objective: We report the clinical features and response to treatment of Onychomycosis caused by these molds. Methods: From 1995 through 1998 we performed a mycologic study on 1548 patients affected by nail disorders, and we diagnosed 431 cases of Onychomycosis including 59 cases of Onychomycosis caused by molds. These include 17 patients with Onychomycosis caused by Scopulariopsis brevicaulis , 26 patients with Onychomycosis caused by Fusarium sp, 9 patients with Onychomycosis caused by Acremonium sp, and 7 patients with Onychomycosis caused by Aspergillus sp. Results: Onychomycosis caused by S brevicaulis , Fusarium sp, and Aspergillus sp may often be suspected by clinical examination. In fact 38 of 50 patients with Onychomycosis resulting from these molds were affected by proximal subungual Onychomycosis associated with inflammation of the proximal nailfold. In our experience mold Onychomycosis is not significantly associated with systemic diseases or immunodepression. NDM are difficult to eradicate; by using and combining different treatments (systemic itraconazole, systemic terbinafine, topical terbinafine after nail plate avulsion, and ciclopirox nail lacquer) we were able to cure only 69.2% of patients with S brevicaulis Onychomycosis, 71.4% of patients with Acremonium Onychomycosis, and 40% of patients with Fusarium Onychomycosis. Aspergillus Onychomycosis, on the other hand, responded very well to therapy and all our patients were cured after systemic or topical treatment. Eradication of the mold produced a complete cure of the nail abnormalities in all the patients who responded to treatment. Conclusion: Clinical examination usually suggests diagnosis of Onychomycosis resulting from NDM. Topical treatment can be more successful than systemic therapy to cure Onychomycosis caused by S brevicaulis , Fusarium sp, and Acremonium sp. (J Am Acad Dermatol 2000;42:217-24.)
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uncommon clinical patterns of fusarium nail infection report of three cases
British Journal of Dermatology, 1997Co-Authors: Robert Baran, Antonella Tosti, Bianca Maria PiracciniAbstract:Three cases of proximal subungual Onychomycosis due to Fusarium oxysporum, including a patient with a fingernail infection, are described. All patients were immunocompetent and presented with acute paronychia associated with proximal or total leukonychia of the affected nails. Nail avulsion followed by topical treatment produced clinical and mycological cure. The literature on Fusarium Onychomycosis is discussed. The combination of proximal subungual Onychomycosis with subacute or acute paronychia involving fingernails or toenails is highly suggestive of Fusarium sp.
Elizabeth A Cooper - One of the best experts on this subject based on the ideXlab platform.
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the prevalence of unsuspected Onychomycosis and its causative organisms in a multicentre canadian sample of 30 000 patients visiting physicians offices
Journal of The European Academy of Dermatology and Venereology, 2016Co-Authors: Aditya K Gupta, Elizabeth A Cooper, Hem C Jain, Deanne Daigle, Kelly A Foley, Gita Gupta, Charles Lynde, Richard C. SummerbellAbstract:Background Onychomycosis is difficult to treat and a concern for many patients. Prevalence estimates of Onychomycosis in North American clinic samples have been higher than what has been reported for general populations. Objective A large, multicentre study was conducted to estimate the prevalence of toenail Onychomycosis in the Canadian population. Methods Patients were recruited from the offices of three dermatologists and one family physician in Ontario, Canada. Nail samples for mycological testing were obtained from normal and abnormal-looking nails. This sample of 32 193 patients includes our previous published study of 15 000 patients. Results Abnormal nails were observed in 4350 patients. Of these, the prevalence of culture-confirmed toenail Onychomycosis was estimated to be 6.7% (95% CI, 6.41–6.96%). Following sex and age adjustments for the general population, the estimated prevalence of toenail Onychomycosis in Canada was 6.4% (95% CI, 6.12%–6.65%). The distribution of fungal organisms in culture-confirmed Onychomycosis was 71.9% dermatophytes, 20.4% non-dermatophyte moulds and 7.6% yeasts. Toenail Onychomycosis was four times more prevalent in those over the age of 60 years than below the age of 60 years. Conclusion The present data highlights that Onychomycosis may be a growing medical concern among ageing patients.
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recurrences of dermatophyte toenail Onychomycosis during long term follow up after successful treatments with mono and combined therapy of terbinafine and itraconazole
Journal of Cutaneous Medicine and Surgery, 2013Co-Authors: Aditya K Gupta, Elizabeth A Cooper, Maryse PaquetAbstract:Background:The influence of dosing regimens on the recurrence rates of Onychomycosis has not been investigated.Objective:To compare recurrence rates for toenail dermatophyte Onychomycosis between f...
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superficial fungal infections an update on pityriasis versicolor seborrheic dermatitis tinea capitis and Onychomycosis
Clinics in Dermatology, 2003Co-Authors: Aditya K Gupta, Jennifer E Ryder, Karyn Nicol, Elizabeth A CooperAbstract:The recent advances in pityriasis versicolor, seborrheic dermatitis, tinea capitis and Onychomycosis are reviewed. Some highlighted points include the new classification of Malassezia species, and the association of Malassezia species with seborrheic dermatitis. The use of terbinafine, fluconazole, and itraconazole for the treatment of tinea capitis is discussed. The management of Onychomycosis, highlighting the high efficacy rates obtained with terbinafine when used to treat dermatophyte toenail Onychomycosis, is discussed. The use of combination therapies in some circumstances to maximize cure rates is reviewed.
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utility of inoculum counting walshe and english criteria in clinical diagnosis of Onychomycosis caused by nondermatophytic filamentous fungi
Journal of Clinical Microbiology, 2001Co-Authors: Aditya K Gupta, Richard C. Summerbell, Elizabeth A Cooper, Paul MacdonaldAbstract:Opportunistic Onychomycosis caused by nondermatophytic molds may differ in treatment from tinea unguium. Confirmed diagnosis of opportunistic Onychomycosis classically requires more than one laboratory analysis to show consistency of fungal outgrowth. Walshe and English in 1966 proposed to extract sufficient diagnostic information from a single patient consultation by counting the number of nail fragments positive for inoculum of the suspected fungus. Twenty fragments were plated per patient, and each case in which five or more fragments grew the same mold was considered an infection by that mold, provided that compatible filaments were also seen invading the nail tissue by direct microscopy. This widely used and often recommended method has never been validated. Therefore, the validity of substituting any technique based on inoculum counting for conventional follow-up study in the diagnosis of opportunistic Onychomycosis was investigated. Sampling of 473 patients was performed repeatedly. Nail specimens were examined by direct microscopy, and 15 pieces were plated on standard growth media. After 3 weeks, outgrowing dermatophytes were recorded, and pieces growing any nondermatophyte mold were counted. Patients returned on two to eight additional occasions over a 1- to 3-year period for similar examinations. Onychomycosis was etiologically classified based on long-term study. Opportunistic Onychomycosis was definitively established for 86 patients. Counts of nondermatophyte molds in initial examinations were analyzed to determine if they successfully predicted both true cases of opportunistic Onychomycosis and cases of insignificant mold contamination. There was a strong positive statistical association between mold colony counts and true opportunistic Onychomycosis. Logistic regression analysis, however, determined that even the highest counts predicted true cases of opportunistic Onychomycosis only 89.7% of the time. The counting criterion suggested by Walshe and English was correct only 23.2% of the time. Acremonium infections were especially likely to be correctly predicted by inoculum counting. Inoculum counting could be used to indicate a need for repeat studies in cases of false-negative results from laboratory direct microscopy. Inoculum counting cannot serve as a valid substitute for follow-up study in the diagnosis of opportunistic Onychomycosis. It may, nonetheless, provide useful information both to the physician and to the laboratory, and it may be especially valuable when the patient does not present for follow-up sampling.
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prevalence and epidemiology of Onychomycosis in patients visiting physicians offices a multicenter canadian survey of 15 000 patients
Journal of The American Academy of Dermatology, 2000Co-Authors: Aditya K Gupta, Elizabeth A Cooper, Charles W. Lynde, Hem C Jain, Paul Macdonald, Richard C. SummerbellAbstract:A prospective, multicenter study to determine the epidemiology of Onychomycosis was performed in the offices of 3 dermatologists and 1 family physician in Ontario, Canada. In the sample of 15,000 patients, abnormal-appearing nails were observed in 2505 persons (16. 7%). There were 1199 patients (8%) with toenail or fingernail Onychomycosis confirmed on mycologic examination, with 1137 patients (7.6%) who had only pedal Onychomycosis, 40 patients with toenail and fingernail Onychomycosis (0.27%), and 22 patients (0.15%) with only fingernail Onychomycosis. The condition was more common in male patients (P or =75% nail involvement) in 27.6%, 39.9%, and 32.5% of patients, respectively. After adjusting for the age and sex distribution of the general population, the projected rate of Onychomycosis in Canada is 6.5% (95% confidence interval [CI], 6. 1%-6.9%). The organisms causing toenail Onychomycosis were 90.5% dermatophyte, 7.8% nondermatophyte molds, and 1.7% Candida spp. The corresponding organisms causing fingernail Onychomycosis were 70.8%, 0%, and 29.2%, respectively. In a large sample of 15,000 patients, abnormal-appearing nails were present in 17% of the sample with mycologic evidence of toenail or fingernail Onychomycosis in 8%. The projected prevalence of Onychomycosis in Canada is 6.5% (95% CI, 6. 1%-6.9%).
