The Experts below are selected from a list of 135 Experts worldwide ranked by ideXlab platform
Aditya K. Gupta - One of the best experts on this subject based on the ideXlab platform.
-
Types of Onychomycosis.
Cutis, 2001Co-Authors: Aditya K. GuptaAbstract:Onychomycosis may be classified into several types: distal subungual, White Superficial, proximal subungual, endonyx, and total dystrophic. Distal subungual Onychomycosis (DSO), the most common type, involves the nail bed and, subsequently, the nail plate. White Superficial Onychomycosis (WSO) usually manifests as Superficial White patches with distinct edges on the surface of the nail plate. Proximal subungual Onychomycosis results when the fungal organism enters via the cuticle and the ventral aspect of the proximal nail fold. In endonyx Onychomycosis, fungal organisms invade the nail plate without resulting nail bed hyperkeratosis, onycholysis, or nail bed inflammatory changes. In total dystrophic Onychomycosis, complete dystrophy of the nail plate occurs; these changes may be primary or secondary.
-
Epidemiology and prevalence of Onychomycosis in HIV-positive individuals
International Journal of Dermatology, 2000Co-Authors: Aditya K. Gupta, Paulo R. O. Taborda, Valeria B. A. Taborda, Janet Gilmour, Anita Rachlis, Irv Salit, Madhulika A. Gupta, Paul Macdonald, Elizabeth A. Cooper, R.c. SummerbellAbstract:Background Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development of infections including tinea pedis and Onychomycosis. While smaller studies have been reported, there has been no large study evaluating the prevalence of Onychomycosis in HIV-positive individuals, or comparing the development of Onychomycosis in a typical temperate area with that in a typical tropical area. Methods HIV-positive individuals were evaluated at five clinics: four in Ontario, Canada and one in Sao Paulo, Brazil. The subjects were asked questions to determine the epidemiology of Onychomycosis in HIV-positive individuals. The feet were examined and nail material was obtained for mycologic examination to determine the causative organism of Onychomycosis. Results A total of 500 subjects were examined (415 men and 85 women; age (mean ± SE), 39 ± 0.4 years; 400 Canadian, 100 Brazilian). The racial origins of the Canadian patients were: Caucasian, 83.8%; Asian, 4.3%; African–American, 8.1%; Hispanic, 3.3%; American Indian, 0.3%. The Brazilian origins were: Caucasian, 68.7%; African, 18.1%; mixed race, 13.3%. Abnormal appearing nails and mycologic evidence of Onychomycosis were present in 200 (40.0%) and 116 (23.2%), respectively, of 500 subjects. The prevalence of Onychomycosis in the Canadian and Brazilian samples was 24.0% (96 of 400) and 20.0% (20 of 100), respectively. The projected prevalence of Onychomycosis in HIV-positive individuals in Canada was 19.9% (95% CI: 16.0–23.9%) after taking into account the age and sex distribution of HIV-positive individuals in the population. When nails appeared clinically abnormal, the prevalence of Onychomycosis was 50.5% (Canada, 51.3%; Brazil, 45.5%). For comparison, published data indicate that the prevalence of Onychomycosis in immunocompetent individuals living in Canada is 6.9%. The clinical presentation of Onychomycosis for the whole sample (n = 500) was: distal and lateral subungual Onychomycosis (DLSO), 20.0%; White Superficial Onychomycosis (WSO), 3.6%; proximal subungual Onychomycosis (PSO), 1.8% (Canadian and Brazilian samples: DLSO 21.2% vs. 15.0%, WSO 3.3% vs. 5.0%, and PSO 1.5% vs. 3.0%). The distribution of the causative fungal organisms was: dermatophytes : Candida species : nondermatophyte molds, 73 : 2 : 2 (Canadian and Brazilian samples: dermatophytes 95.5% vs. 90.9%, Candida species 3.0% vs. 0%, and nondermatophyte molds 1.5% vs. 9.0%). The use of protease inhibitors, reverse transcriptase inhibitors, or oral antifungal agents did not make a significant difference in the prevalence of Onychomycosis for both the Canadian and Brazilian groups. Patients with Onychomycosis were aware of their abnormal appearing nails (χ2 (1) = 69.7, P
-
Onychomycosis in the Elderly
Drugs & Aging, 2000Co-Authors: Aditya K. GuptaAbstract:Onychomycosis is found more frequently in the elderly, and in more males than females. Onychomycosis of the toes is usually caused by dermatophytes, most commonly Trichophyton rubrum and T. mentagrophytes. The most common clinical presentations are distal and lateral subungual Onychomycosis (which usually affects the great/first toe) and White Superficial Onychomycosis (which generally involves the third/fourth toes). Only about 50% of all abnormal-appearing nails are due to Onychomycosis. In the remainder, trauma to the nail, psoriasis and conditions such as lichen planus should be considered in the differential diagnosis. Therefore, the clinical impression of Onychomycosis should be confirmed by mycological examination, whenever possible. The management of Onychomycosis may include no therapy, palliative treatment with mechanical or chemical debridement, topical antifungal therapy, oral antifungal agents or a combination of treatment modalities. In the US, the only new oral agents approved for treatment of Onychomycosis are terbinafine and itraconazole. Fluconazole is approved for Onychomycosis in some other countries. Ciclopirox nail lacquer has recently been approved in the US for the treatment of Onychomycosis. In some other countries topical agents such as amorolfine are also used. Griseofulvin and ketoconazole are no longer preferred for the treatment of Onychomycosis. The new oral antifungal agents are effective and well tolerated in the elderly. Patient selection should be based on the history (including systems review and medication record), examination and baseline monitoring, if indicated. Laboratory monitoring during therapy for Onychomycosis varies among physicians. A combination of removal of the diseased nail plate or local measures and oral antifungal therapy may be optimal in certain instances, e.g. when lateral Onychomycosis or dermatophytoma are present. For dermatophyte toe Onychomycosis the recommended duration of therapy with terbinafine is 250 mg/day for 12 weeks. For itraconazole (pulse) the regimen is 200mg twice daily for 1 week on, 3 weeks off, repeated for 3 consecutive pulses and with fluconazole the regimen is 150 to 300mg once weekly given for a usual range of 6 to 12 months or until the nail plate has grown out. In some instances, if extra therapy is required, one suggestion is that 4 weeks of terbinafine or an extra pulse of itraconazole are given between months 6 and 9 from the start of therapy. Once cure has been achieved, it is important to counsel patients on the strategies of reducing recurrence of disease.
-
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.)
-
Onychomycosis associated with Onychocola canadensis: Ten case reports and a review of the literature
Journal of The American Academy of Dermatology, 1998Co-Authors: Aditya K. Gupta, Caroline B. Horgan-bell, R.c. SummerbellAbstract:Abstract Background: Onychocola canadensis is a nondermatophyte mold associated with Onychomycosis particularly in temperate climates (eg, Canada, New Zealand, and France). The slow growth rate of O canadensis and lack of resemblance to any other known nail-infecting fungus may have delayed its discovery. We are aware of 23 mycologically confirmed cases of O canadensis in the literature. Objective: We describe 10 previously unreported Canadian patients, specimens from whom grew O canadensis . We also review the literature on infections associated with this organism. Methods: Cases of O canadensis Onychomycosis were diagnosed on the basis of (1) the finding of compatible filaments on direct microscopy of nail and (2) consistent culture from repeated specimens. All patients from whom O canadensis was isolated were followed up, but those in whom outgrowth was not consistent were not accepted as having "authentic" infections. Results: In 10 patients O canadensis was found to be associated with distal lateral subungual Onychomycosis (6 patients), White Superficial Onychomycosis (1 patient), and as an insignificant contaminant in the nails of 3 patients. Less commonly the organism may cause tinea manuum or tinea pedis interdigitalis. O canadensis appears to be more frequent in the elderly, especially females. It is not unusual for a patient with Onychomycosis caused by O canadensis to be a gardener or farmer, suggesting that the infectious inoculum may originate from the soil. The optimal therapy for Onychomycosis caused by this organism remains unclear. Conclusion: O canadensis may be the etiologic agent of distal and lateral subungual or White Superficial Onychomycosis; however, it may sometimes be present in an abnormal-appearing nail as an insignificant finding, not acting as a pathogen. (J Am Acad Dermatol 1998;39:410-7.)
C. Crosti - One of the best experts on this subject based on the ideXlab platform.
-
Unusual clinical features of fingernail infection by Fusarium oxysporum
1997Co-Authors: C. Gianni, A. Cerri, C. CrostiAbstract:Four cases of invasion of fingernails caused by Fusarium oxysporum are described. The typical picture of Onychomycosis by this non-dermatophytic mould is a 'White Superficial Onychomycosis' which usually affects the great toenail. Only few cases of fingernail infections by this organism have been described in the literature and, to our knowledge, there are no reported cases on the pustulous and eczema-like aspect of paronychia by Fusarium oxysporum. We report different and unusual clinical features of this infection successfully treated with systemic antifungals. Two patients were treated with terbinafine, 250 mg daily for 3 months, and two patients with itraconazole, 200 mg daily for 3 months
-
Unusual clinical features of fingernail infection by Fusarium oxysporum
Mycoses, 1997Co-Authors: C. Gianni, A. Cerri, C. CrostiAbstract:Summary. Four cases of invasion of fingernails caused by Fusarium oxysporum are described. The typical picture of Onychomycosis by this non-dermatophytic mould is a ‘White Superficial Onychomycosis’ which usually affects the great toenail. Only few cases of fingernail infections by this organism have been described in the literature and, to our knowledge, there are no reported cases on the pustulous and eczema-like aspect of paronychia by Fusarium oxysporum. We report different and unusual clinical features of this infection successfully treated with systemic antifungals. Two patients were treated with terbinafine, 250 mg daily for 3 months, and two patients with itraconazole, 200 mg daily for 3 months. Zusammenfassung. Es werden vier Falle von Befall der Fingernagel durch Fusarium oxysporum beschrieben. Das typische Krankheitsbild in dieser durch einen Nicht-Dermatophyten erzeugten Onychomykose ist eine ‘weisliche, oberflachliche Onychomykose’, die normalerweise den Nagel der ersten Phalanx des Fuses betrifft. In der Literatur werden nur vereinzelte Falle von Fusarium oxysporum-bedingter Onychomykose beschrieben. Unseres Wissens gibt es keine Berichte uber das durch Pusteln gekennzeichnete und Ekzem-ahnliche Bild der von Fusarium oxysporum verursachten Paronychie. Die ungewohnlichen Manifestationen dieser Infektion wurden mit Erfolg antimykotisch behandelt. Zwei Patienten wurden mit Terbinafin 250 mg/Tag uber drei Monate und zwei Patienten mit Itraconazol 200 mg/Tag uber drei Monate therapiert.
Antonella Tosti - One of the best experts on this subject based on the ideXlab platform.
-
White Superficial Onychomycosis
Onychomycosis, 2017Co-Authors: Stephanie Mlacker, Antonella TostiAbstract:SWO consists of a small subset of Onychomycosis, in which the route of infection occurs via the dorsal aspect of the nail plate. There are two variants of SWO: a Superficial and a deep variant. SWO can rarely be pigmented. Rarely, SWO originates from beneath the proximal nail fold. Deeper nail penetration has been linked to mold infection. SWO is commonly associated with DLSO. SWO can be treated with topical antifungals in most cases.
-
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.
-
White Superficial Onychomycosis: epidemiological, clinical, and pathological study of 79 patients.
Archives of Dermatology, 2004Co-Authors: Bianca Maria Piraccini, Antonella TostiAbstract:Objective To analyze the epidemiology, responsible agents, clinical features, and outcome of White Superficial Onychomycosis (WSO). Design Retrospective study. Setting University hospital. Patients A total of 79 patients with WSO seen at the Department of Dermatology of Bologna University from 1994 to 2002. Responsible agents included Trichophyton interdigitale in 58 cases (73%), Trichophyton rubrum in 4 (5%), Fusarium species in 9 (11%), Aspergillus species in 5 (6%), and Acremonium strictum in 3 (3%). Results White Superficial Onychomycosis may have different clinical and epidemiological features. "Classic" WSO, characterized by Superficial nail plate involvement, is usually due to Trichophyton mentagrophytes (var interdigitale ), although Acremonium strictum or Onychocola canadiensis can sometimes be responsible. A deep and diffuse WSO, characterized by massive penetration of the nail plate by fungi, can be seen in nail infections by molds such as Fusarium species and Aspergillus species, or in nail infections by Trichophyton rubrum in healthy children and in patients infected with human immunodeficiency virus. Conclusions Severity and spread of WSO is the result of complex host-parasite relationships. When dealing with a patient with WSO, we should always consider the causative organism and the host characteristics to choose the best therapeutic approach.
R.c. Summerbell - One of the best experts on this subject based on the ideXlab platform.
-
Epidemiology and prevalence of Onychomycosis in HIV-positive individuals
International Journal of Dermatology, 2000Co-Authors: Aditya K. Gupta, Paulo R. O. Taborda, Valeria B. A. Taborda, Janet Gilmour, Anita Rachlis, Irv Salit, Madhulika A. Gupta, Paul Macdonald, Elizabeth A. Cooper, R.c. SummerbellAbstract:Background Patients who are human immunodeficiency virus (HIV) positive are predisposed to the development of infections including tinea pedis and Onychomycosis. While smaller studies have been reported, there has been no large study evaluating the prevalence of Onychomycosis in HIV-positive individuals, or comparing the development of Onychomycosis in a typical temperate area with that in a typical tropical area. Methods HIV-positive individuals were evaluated at five clinics: four in Ontario, Canada and one in Sao Paulo, Brazil. The subjects were asked questions to determine the epidemiology of Onychomycosis in HIV-positive individuals. The feet were examined and nail material was obtained for mycologic examination to determine the causative organism of Onychomycosis. Results A total of 500 subjects were examined (415 men and 85 women; age (mean ± SE), 39 ± 0.4 years; 400 Canadian, 100 Brazilian). The racial origins of the Canadian patients were: Caucasian, 83.8%; Asian, 4.3%; African–American, 8.1%; Hispanic, 3.3%; American Indian, 0.3%. The Brazilian origins were: Caucasian, 68.7%; African, 18.1%; mixed race, 13.3%. Abnormal appearing nails and mycologic evidence of Onychomycosis were present in 200 (40.0%) and 116 (23.2%), respectively, of 500 subjects. The prevalence of Onychomycosis in the Canadian and Brazilian samples was 24.0% (96 of 400) and 20.0% (20 of 100), respectively. The projected prevalence of Onychomycosis in HIV-positive individuals in Canada was 19.9% (95% CI: 16.0–23.9%) after taking into account the age and sex distribution of HIV-positive individuals in the population. When nails appeared clinically abnormal, the prevalence of Onychomycosis was 50.5% (Canada, 51.3%; Brazil, 45.5%). For comparison, published data indicate that the prevalence of Onychomycosis in immunocompetent individuals living in Canada is 6.9%. The clinical presentation of Onychomycosis for the whole sample (n = 500) was: distal and lateral subungual Onychomycosis (DLSO), 20.0%; White Superficial Onychomycosis (WSO), 3.6%; proximal subungual Onychomycosis (PSO), 1.8% (Canadian and Brazilian samples: DLSO 21.2% vs. 15.0%, WSO 3.3% vs. 5.0%, and PSO 1.5% vs. 3.0%). The distribution of the causative fungal organisms was: dermatophytes : Candida species : nondermatophyte molds, 73 : 2 : 2 (Canadian and Brazilian samples: dermatophytes 95.5% vs. 90.9%, Candida species 3.0% vs. 0%, and nondermatophyte molds 1.5% vs. 9.0%). The use of protease inhibitors, reverse transcriptase inhibitors, or oral antifungal agents did not make a significant difference in the prevalence of Onychomycosis for both the Canadian and Brazilian groups. Patients with Onychomycosis were aware of their abnormal appearing nails (χ2 (1) = 69.7, P
-
Onychomycosis associated with Onychocola canadensis: Ten case reports and a review of the literature
Journal of The American Academy of Dermatology, 1998Co-Authors: Aditya K. Gupta, Caroline B. Horgan-bell, R.c. SummerbellAbstract:Abstract Background: Onychocola canadensis is a nondermatophyte mold associated with Onychomycosis particularly in temperate climates (eg, Canada, New Zealand, and France). The slow growth rate of O canadensis and lack of resemblance to any other known nail-infecting fungus may have delayed its discovery. We are aware of 23 mycologically confirmed cases of O canadensis in the literature. Objective: We describe 10 previously unreported Canadian patients, specimens from whom grew O canadensis . We also review the literature on infections associated with this organism. Methods: Cases of O canadensis Onychomycosis were diagnosed on the basis of (1) the finding of compatible filaments on direct microscopy of nail and (2) consistent culture from repeated specimens. All patients from whom O canadensis was isolated were followed up, but those in whom outgrowth was not consistent were not accepted as having "authentic" infections. Results: In 10 patients O canadensis was found to be associated with distal lateral subungual Onychomycosis (6 patients), White Superficial Onychomycosis (1 patient), and as an insignificant contaminant in the nails of 3 patients. Less commonly the organism may cause tinea manuum or tinea pedis interdigitalis. O canadensis appears to be more frequent in the elderly, especially females. It is not unusual for a patient with Onychomycosis caused by O canadensis to be a gardener or farmer, suggesting that the infectious inoculum may originate from the soil. The optimal therapy for Onychomycosis caused by this organism remains unclear. Conclusion: O canadensis may be the etiologic agent of distal and lateral subungual or White Superficial Onychomycosis; however, it may sometimes be present in an abnormal-appearing nail as an insignificant finding, not acting as a pathogen. (J Am Acad Dermatol 1998;39:410-7.)
C. Gianni - One of the best experts on this subject based on the ideXlab platform.
-
Unusual clinical features of fingernail infection by Fusarium oxysporum
1997Co-Authors: C. Gianni, A. Cerri, C. CrostiAbstract:Four cases of invasion of fingernails caused by Fusarium oxysporum are described. The typical picture of Onychomycosis by this non-dermatophytic mould is a 'White Superficial Onychomycosis' which usually affects the great toenail. Only few cases of fingernail infections by this organism have been described in the literature and, to our knowledge, there are no reported cases on the pustulous and eczema-like aspect of paronychia by Fusarium oxysporum. We report different and unusual clinical features of this infection successfully treated with systemic antifungals. Two patients were treated with terbinafine, 250 mg daily for 3 months, and two patients with itraconazole, 200 mg daily for 3 months
-
Unusual clinical features of fingernail infection by Fusarium oxysporum
Mycoses, 1997Co-Authors: C. Gianni, A. Cerri, C. CrostiAbstract:Summary. Four cases of invasion of fingernails caused by Fusarium oxysporum are described. The typical picture of Onychomycosis by this non-dermatophytic mould is a ‘White Superficial Onychomycosis’ which usually affects the great toenail. Only few cases of fingernail infections by this organism have been described in the literature and, to our knowledge, there are no reported cases on the pustulous and eczema-like aspect of paronychia by Fusarium oxysporum. We report different and unusual clinical features of this infection successfully treated with systemic antifungals. Two patients were treated with terbinafine, 250 mg daily for 3 months, and two patients with itraconazole, 200 mg daily for 3 months. Zusammenfassung. Es werden vier Falle von Befall der Fingernagel durch Fusarium oxysporum beschrieben. Das typische Krankheitsbild in dieser durch einen Nicht-Dermatophyten erzeugten Onychomykose ist eine ‘weisliche, oberflachliche Onychomykose’, die normalerweise den Nagel der ersten Phalanx des Fuses betrifft. In der Literatur werden nur vereinzelte Falle von Fusarium oxysporum-bedingter Onychomykose beschrieben. Unseres Wissens gibt es keine Berichte uber das durch Pusteln gekennzeichnete und Ekzem-ahnliche Bild der von Fusarium oxysporum verursachten Paronychie. Die ungewohnlichen Manifestationen dieser Infektion wurden mit Erfolg antimykotisch behandelt. Zwei Patienten wurden mit Terbinafin 250 mg/Tag uber drei Monate und zwei Patienten mit Itraconazol 200 mg/Tag uber drei Monate therapiert.
