Giulia Rech

Photodynamic therapy of onychomycosis caused by Trichophyton rubrum

A combination of topical and oral antifungals is widely used to treat onychomycosis, but treatment failure is common and oral drugs may cause toxicity and potential drug interactions. For this reason, new approaches and strategies should be considered. The following case shows that photodynamic therapy (PDT) may represent an alternative noninvasive approach to treatment of onychomycosis.

Nail digital dermoscopy (onychoscopy) in the diagnosis of onychomycosis.

Background  Distal subungual onychomycosis and traumatic onycholysis are the most common causes of toenail abnormalities, and differential diagnosis is often impossible without mycology.

Onychomatricoma : First description in a child

Abstract:  Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4‐year‐old girl.

Partial excision of matrix and phenolic ablation for the treatment of ingrowing toenail: a 36-month follow-up of 197 treated patients.

BACKGROUND Several options for the treatment of ingrowing toenails are available, ranging from simple conservative approaches to extensive surgical procedures. OBJECTIVE To evaluate in a long‐term follow‐up (36 months) the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenails. METHODS AND MATERIALS A total of 197 phenol ablations were performed in 139 patients with stage 2 and 3 disease. Each patient was examined weekly until full wound healing was achieved and was followed for 36 months to assess the long‐term efficacy of the treatment. The healing period after surgery ranged from 2 to 4 weeks; few postoperative complications were seen. RESULTS Only three recurrences were observed (after 2, 4, and 11 months). Short‐term results were excellent. No severe complications occurred during the 36‐month follow‐up period. Cosmetic results were remarkable. The success rate was 98.5%. CONCLUSIONS Phenol cauterization is an excellent surgical method for the treatment of ingrowing toenails, being simple and associated with low morbidity and a high success rate, even over the long term (36 months). The authors have indicated no significant interest with commercial supporters.

Drug-Induced Hair Disorders

Drugs may induce hair loss, stimulate hair growth or, more rarely, induce changes in the hair shape and colour. Drug-induced hair loss is usually completely reversible and is, in most cases, a consequence of a toxic effect of the drug on the hair follicle matrix. In rare cases alopecia may be permanent. Depending on type of drug, dosage and patient susceptibility, hair loss presents as telogen effluvium, anagen effluvium or both. Telogen effluvium is also commonly observed after discontinuation of drugs that prolong anagen, such as topical minoxidil and oral contraceptives. Although a large number of drugs have been occasionally reported to produce hair loss, only for a few drugs the relation between drug intake and hair loss has been proven.

Treatment of onychomycosis with oral antifungal agents

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.

Pityriasis versicolor during anti-TNF-α monoclonal antibody therapy: therapeutic considerations

Anecdotal reports have shown that tumour necrosis factor (TNF)‐α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti‐TNF‐α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re‐evaluated. In patients non‐responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week−1 for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti‐TNF‐α therapy is seldom reported, it is not likely to be rare, but rather under‐reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

Dermoscopic subpatterns of granulomatous skin diseases

the Divisions of Dermatology at the Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a Bologna, and the Ospedale Santa Chiara, Trento, Italy. ing sources: None. licts of interest: None declared. ints not available from the authors. spondence to: Riccardo Balestri, MD, Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a di Bologna, Clinica Dermatologica, Via Massarenti 1, 40138 Bologna, Italy. E-mail: ilsabo@libero.it. J Am Acad Dermatol 2013;69:e217-8. 0190-9622/

Scar reactivation and dry cough.

36.00 a 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.03.030

Dermatophytosis during anti-TNF-α monoclonal antibody therapy

A 52-year-old woman has swelling and redness of seven old scars and a dry cough. What diagnostic test should be performed?