BackgroundTinea pedis is a common skin disease affecting most of the population during their lifetime. Topical and systemic treatments give only temporary relief.ObjectiveTo evaluate the efficacy and safety of a new topical treatment for moderate-to-severe tinea pedis.MethodsFifty patients suffering from tinea pedis were treated in two stages: the active stage - single use of the novel topical solution for 45 min and novel cream twice weekly for 4 weeks; the preventive stage - cream application once weekly for 10 months.ResultsForty-five patients completed the active stage and achieved 76% cure rate. The medication was well tolerated; one patient dropped from the study because of very mild irritation. No other topical or systemic side effects were noted. Another five patients were lost to follow-up during the preventive stage. The total cure rate after the preventive stage was 70%.ConclusionsThis novel treatment was found to be effective, well tolerated and safe in the treatment of moderate and severe tinea pedis during the active and the preventive stages.

BACKGROUND:Toenail manifestations of chronic venous insufficiency (CVI) may often mimic the nail changes of onychomycosis. The current study aims to determine the frequency of toenails deformations in patients with CVI, onychomycosis prevalence among deformed toenails and the outcome of itraconazole treatment.METHODS:Patients with clinical evidence of (CVI) were enrolled. All patients with toenails deformations and proven onychomycosis were treated by itraconazole pulse therapy for 4 months and then followed-up for additional 5 to 6 months.RESULTS:Forty-four patients with CVI entered the study. Thirty-seven patients (84%) had nail deformations; 28 of 37 patients (75%) had onychomycosis; and 24 patients completed the follow-up period. Total cure was achieved in 6 of 24 patients (25%), and 14 patients (58%) had no improvement. Patients' age and CVI duration were significantly correlated to onychomycosis cure rate.CONCLUSIONS:Nail deformations are more prevalent in CVI patients (84%) then in the general elderly population, and 75% of affected nails had also onychomycosis. In these patients, itraconazole achieved only 25% total cure rate compared with the 60% to 70% cure rate commonly cited in the literature, probably due to irreversible nail deformity caused by the CVI and due to the thickened nail that prevented penetrance of itraconazole into the nail plate. Therefore, before antifungal treatment is started for onychomycosis in patients with CVI, especially in older patients, the caregiver must stress out that the final outcome might not be as desirable as in pure onychomycosis patients.

Background Onychodystrophy is a major manifestation of onychomycosis. However, nail trauma may also result in onychodystrophy. The fifth toenail, due to its location, suffers repeated friction/pressure trauma from shoes.Objective To test the hypothesis that treatment failure of fifth toenail onychomycosis is not a marker of treatment failure of other toenails with onychomycosis.Methods Fifty patients who had fifth toenail deformity (with or without onychomycosis) and onychomycosis of the other toenails were treated with oral terbinafine, 250 mg/day, for 4 months.Results Forty-three patients completed the study. Before the study, 26/43 (61%) had callus lateral to the fifth toe (suggesting mechanical pressure in that area). Twenty-one/43 (49%) of the fifth toenails had onychomycosis. At the end of the treatment period, only 4/21 (19%) of the fifth toenails (with initial onychomycosis), compared with 12/21 (57%) of the other toenails, were completely cured (CC). Out of the whole group (n = 43), the clinical cure rate of the fifth toenail was 4/43 (9%) and for the other toenails, 20/43 (47%) (P < 0.05). The mycological cure rates were 11/21 (52%) for the fifth toenail and 25/43 (58%) for the other toenails. Callus lateral to the fifth toe was associated with a poor clinical result (P < 0.01).Conclulsions Clinical improvement of the fifth toenail after systemic antifungal therapy is less favourable and does not correspond with the clinical cure of the other toenails, mostly because of mechanical factors. Therefore, patients should be told to adjust their expectations as to the visual results of their antifungal treatment.

Background: Treatment of onychomycosis has recently been enhanced by the introduction of combination therapies. Objective: To evaluate the efficacy of a combination therapy of ciclopirox nail lacquer and oral terbinafine compared to oral terbinafine monotherapy for the treatment of onychomycosis caused by dermatophytes. Patients and methods: Eighty patients with onychomycosis were randomly assigned to receive either oral terbinafine 250 mg/day for 16 weeks or a combination of oral terbinafine 250 mg/day for 16 weeks and topical ciclopirox nail lacquer once daily for 9 months. Both groups were followed up for 9 months from start of treatment. Results: After 9 months of treatment, the mycological cure rates were 22/34 (64.7%) for the terbinafine-only group and 30/34 (88.2%) for the combination therapy group (p < 0.05). No significant difference was noted in the complete cure rate. Conclusion: Combination therapy of oral terbinafine and ciclopirox nail lacquer is a safe and more effective treatment for onychomycosis than terbinafine alone, especially in younger patients and in shorter-duration onychomycosis.

HYPOTHESIS:Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field.DESIGN:Retrospective analysis.SETTING:Tertiary care referral center.PATIENTS:One hundred forty-one consecutive patients who underwent radical lymph node dissection (RLND) either in the groin or the axilla owing to malignant melanoma were followed up for a median period of 41 months.INTERVENTIONS:All of the 141 patients received either elective or therapeutic RLND. Their medical records were analyzed for demographic data, disease history, previous treatments, recurrence patterns, and survival.MAIN OUTCOME MEASURES:Patterns of first recurrence after RLND and survival.RESULTS:Radical lymph node dissection was performed on 148 lymph node basins (141 patients; 86 axillae and 62 groins). Nineteen patients (13%) received previous open interventions in the lymph node basin (tampering) other than radical dissection. Radical lymph node dissection was performed prophylactically in 38 basins (26%), for palpable disease in 75 (51%), and for a positive sentinel node in 35 (24%). There were 74 failures (52%) of RLND: 51 patients (70%) with systemic disease, 12 (16%) with recurrence in the surgical field, 9 (11%) with in-transit metastases, and 2 (3%) with local recurrence. On multivariate analysis, the only significant predictors of recurrence after RLND were Breslow thickness of greater than 4 mm (P = .02), tampering (P = .01), and lymph node capsular invasion (P = .001). Tampering was the only independent prognosticator of failure in the surgical field, as tampering was noted in 10 (83%) of 12 patients with failure in the surgical field as compared with 6 (10%) of 62 patients with other types of first failures (P<.001). This effect did not translate into a survival difference (P = .54). Failure in the surgical field was not detected in any of the patients who underwent sentinel lymph node biopsy.CONCLUSIONS:Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field, and they should be avoided. Fine-needle aspiration and sentinel node biopsy, performed with strict surgical oncologic techniques, are safe with regard to failure in the surgical field.

Seventy‐one patients (52 patients with psoriasis capitis and 19 with scalp seborrheic dermatitis) enrolled in this open‐label study. All had stable disease for at least 6 months. Patients who were allergic to imidazoles, were pregnant or breastfeeding, or were aged less than 18 years were excluded. Only psoriatic patients with scalp involvement alone or whose body surface area involvement was less than 25% were included. All patients reported incomplete response to previous topical therapies (used alone or in combination: corticosteroids, salicylic acid, tar, anthralin, and ketoconazole shampoo) and had a washout period of at least 1 month.The patients applied 40% urea plus 1% bifonazole in an ointment base nightly. They were instructed to apply a fixed amount (1 cm in length = 0.32 g) of ointment for each 10 cm 2of involved area. Each morning, 1% bifonazole shampoo was applied for 5 min and rinsed with water; 10–20 min later, one drop of 1% bifonazole solution per 10 cm 2area was applied to the scalp. This treatment regimen was repeated daily for 7 days. If clearance was not achieved in the first week, the regimen was continued for one more week.After this initial treatment (for 7 or 14 days), maintenance therapy with once‐weekly application of the regimen was continued for up to 3 months. In addition, during this follow‐up period, the scalp was washed in 2‐day intervals with the shampoo alone, which was left on for 5 min and then washed off.On each visit (weeks 0, 1, 2 and 12), the scalp was evaluated for redness, scaling, and pruritus and each parameter was scored as absent (0), mild 1, moderate 2, or severe 3. On each visit, the scalp's condition was scored as follows: worsening (− 1), no improvement (0), mild (0–25%) improvement 1, moderate (25–50%) improvement 2, marked (50–75%) improvement 3, and (> 75%) cleared 4.

Tinea versicolor is a chronic superficial infection of the skin, caused by Malassezia furfur. The disease is recurrent and hard to eradicate with topical antifungal agents, In this study rye compared the efficacy, safety and tolerability of three regimens of oral treatment for tinea versicolor: itraconazole 200 mg/day for 1 week, itraconazole 100 mg/day for 2 weeks and ketoconazole 800 mg in 2 weekly doses of 400 mg, We randomly assigned 105 patients with extensive tinea versicolor to receive each of the three regimens and followed the patients for 16 weeks (a longer period than usual). At every visit, we checked the presence of tinea versicolor by direct KOH preparation and Wood's lamp, and assigned extensive the presence of signs and symptoms of infection were recorded. Of the 105 patients, 89 completed the study, and no major side-effects were noted with any of the treatment regimens. Our results show that there were no significant differences in efficacy (cure rate), safety and tolerability between the three treatment regimens. The maximal cure rate was achieved after 8 weeks from the start of treatment and decreased slightly afterwards. We also demonstrated a lack of correlation between mycological cure and hypopigmentation at the end of treatment (2 weeks) and the usefulness of Wood's lamp examination in detecting cure of tinea versicolor.

AIMS: This Study aimed to compare the efficacy of four different itraconazole regimens in the treatment of toenail onychomycosis caused by dermatophytes.METHODS: The four treatment regimens were: 3 months and 4 months of continuous treatment (200 mg/day of itraconazole) vs 3 months and 4 months of pulse therapy (400 mg/day of itraconazole for 1 week every month). The follow-up period was for 48 weeks after the end of treatment.RESULTS: A total of 66 patients completed the study. Only three patients (4.5%) had reversible abnormal liver function tests. No significant difference in cure rates was noted between the pulse and the continuous treatment regimens during the follow-up period. At 12 and 24 weeks after the ens of treatment, more patients in the 4-month treatment groups were cured compared with the 3-month treatment groups. However, at the end of the follow-up period the cure rates levelled among the four different regimens.CONCLUSIONS: Itraconazole, in each of the regimens tested, proved to be efficient and safe for the long-term treatment of onychomycosis. Because no difference was noted between the four regimens, the shorter and more tolerable 3-month pulse treatment is preferable.