Avner Shemer

The Koebner phenomenon: review of the literature

First described in 1877 as the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma, the Koebner phenomenon has since been described in numerous diseases. Other authors have tried to implicate either infections or parasitic causes as the pathogenesis of this phenomenon. Subsequent research by many authors have contributed to our poor understanding of this reaction in the hope of understanding the pathogenesis of psoriasis. We present a review of the literature covering the following topics as they relate to the Koebner phenomenon: diseases that koebnerize and their possible causes, predisposing and provoking factors, type, site, depth and degree of trauma, the all or none phenomenon, time lag, site preference, medications, inhibition of koebnerization and reverse koebnerization.

Iontophoretic delivery of terbinafine in onychomycosis: a preliminary study

Backgroundu2002 Onychomycosis is a common disease; topical treatment is usually poorly effective, while systemic treatment is more effective but may be associated with side‐effects. Iontophoretic drug delivery may improve drug penetration through the nail and lead to better therapeutic results.

New criteria for the laboratory diagnosis of nondermatophyte moulds in onychomycosis

Backgroundu2002 Nondermatophyte moulds (NDM) may be found as aetiological agents or as contaminants in onychomycosis. The classic and most used criteria for the diagnosis of NDM are those established by English in 1976.

The Hyper–IgE Syndrome. Two cases and review of the literature

The hyper-IgE syndrome (HIE) is a rare, complex immunoregulatory disorder characterized clinically by hyperimmunoglobulinemia E, recurrent bacterial infections, and chronic eczematoid dermatitis usually manifesting itself early in life. Coarse facies, mild eosinophilia, lymphomas, cryptococcal meningitis, neutrophil chemotactic dysfunction, and mucocutaneous or systemic fungal disease are variable features. ``Jobs syndrome and the Buckley syndrome are subsets of HIE syndrome. The Job syndrome is usually found in women, who in addition to displaying the major features of HIE, develop ``cold staphylococcal abscesses. This subgroup may also have red hair and/or hyperextensible joints. We report two additional cases of HIE and review the literature that to date documents less than 100 cases.

Iontophoretic Terbinafine HCL 1.0% Delivery Across Porcine and Human Nails

BackgroundOnychomycosis is a common disease. Topical treatment is usually not effective due to limitation of trans-nail delivery of antifungal drugs. Successful treatment of deep-seated nail infections remains elusive as the delivery of efficacious levels of antifungal drug to the site of action is very difficult.ObjectivesTo evaluate the influence of several parameters including; the effect of low electrical current, incubation time and the presence of electrolyte (NaCl or KCl) on the penetration of terbinafine through the nail plate into the nail bed, using various formulations and concentrations of terbinafine HCl.MethodsIontophoresis was applied across porcine and human nail in vitro to assess its efficiency in enhancing delivery of terbinafine HCl.ResultsIn this study, we have demonstrated that an optimal electrolyte concentration (1% NaCl or KCl) is required for an effective delivery. There is a significant increase in drug delivery into the nail and into the receiving compartment in the presence of 3% DMSO.ConclusionsThis study demonstrates the efficacy of iontophoresis in enhancing the trans-nail delivery of terbinafine. Clinical studies are needed to evaluate the feasibility, efficacy and safety of iontophoresis of terbinafine in onychomycosis in human.

Collection of fungi samples from nails: comparative study of curettage and drilling techniques

Backgroundu2002 Onychomycosis is a common problem. Obtaining a positive laboratory test before treatment is important in clinical practice because the treatment of onychomycosis requires expensive oral antifungal therapy with potentially serious side‐effects.

Efficacy of a mucoadhesive patch compared with an oral solution for treatment of aphthous stomatitis.

AbstractObjective: The purpose of this study was to evaluate the efficacy and tolerability of a mucoadhesive patch compared with a pain-relieving oral solution for the treatment of aphthous stomatitis.n Methods: Patients with active aphthous stomatitis were randomly treated either once a day with a mucoadhesive patch containing citrus oil and magnesium salts (n = 26) or three times a day with an oral solution containing benzocaine and compound benzoin tincture (n = 22). All patients were instructed to apply the medication until pain had resolved, and completed a questionnaire detailing multiple clinical parameters followed by an evaluation of the treatment.n Results: The mucoadhesive patch was found to be more effective than the oral solution in terms of healing time (mean ± SD: 36.0 ± 22.8 hours vs 134.7 ± 57.7, p < 0.001) and pain intensity after 12 and 24 hours (3.7 ± 2.8 vs 6.3 ± 2.6, p = 0.003, and 2.3 ± 2.7 vs 5.7 ± 2.5, p < 0.001, respectively). Local adverse effects 1 hour after treatment were significantly (p < 0.01) less frequent among the mucoadhesive patch patients compared with the oral solution patients.n Conclusions: The mucoadhesive patch was found to be significantly more effective and better tolerated than the oral solution in the treatment of aphthous stomatitis.

Wells' syndrome: report of a case and review of the literature

A 17‐year‐old woman presented with pruritic papules and plaque wheals on the upper and lower extremities, back, chest, and abdomen, which had appeared 4u2003months previously. Previous medical history revealed two surgical operations for ovarian cysts (the latter was 2u2003weeks prior to admittance to the hospital). There was family (brother) but no personal history of atopy, with no known drug allergies. A prior biopsy demonstrated urticaria.

Comparative study of nail sampling techniques in onychomycosis.

Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

A rationale for systemic treatment in onychomycosis with negative results on fungal examination.

Background.u2002 Fungal infection of the nail affects millions of people worldwide, and has an estimated prevalence of about 10% of the general population. Laboratory confirmation of fungal infection is currently accepted as a requirement before initiation of antifungal treatment in clinical practice.