Rina Segal

Treatment of Candida nail infection with terbinafine

BACKGROUND Terbinafine is a highly potent drug against dermatophytes. Data regarding its effectiveness against Candida species are few and variable. OBJECTIVE Our purpose was to evaluate the efficacy and safety of oral terbinafine in patients with Candida nail infection. METHODS In an open-label uncontrolled study, 20 patients completed 16 weeks of treatment with terbinafine, 250 mg/day, and an additional 8 weeks with placebo. Efficacy was assessed clinically and mycologically at weeks 0 (baseline), 4, 8, 16, 24, 36, and 48. Routine laboratory studies were performed at baseline and weeks 4, 8, and 16. RESULTS At the end of the trial 60% of target nails were cured clinically and mycologically; in 10% there was mycologic cure with residual clinical signs, in 25% a moderate improvement (> 50%), and failure in only 5% (one patient). Most nails were infected by Candida parapsilosis. Two of 28 patients showed mild reversible elevation of liver enzymes 1 month after initiation of terbinafine treatment. CONCLUSION The administration of terbinafine for 16 weeks is effective in the treatment of Candida nail infection. Liver enzyme values should be determined during the first month of treatment.

The frequency of Candida parapsilosis in onychomycosis. An epidemiological survey in israel

Candida albicans is regarded as the major pathogen in yeast‐induced onychomycosis. Based on our impression of an increasing prevalence of Candida parapsilosis in this disease, we examined the data of two mycology laboratories in the same geographic location, from 1994 to 1996 in one (centre A) and for 1995 (6 months) in the other (centre B). A total of 954 and 230 toenails and 621 and 190 fingernails, respectively, underwent KOH microscopy and culture studies in each centre. Positive findings were noted in 45 and 65% of the toenails and 44 and 72% of the fingernails, respectively. In the toenails, Candida spp. were found in 22 and 15%, respectively, and in the fingernails, in 77 and 63%, respectively. The most frequent Candida species was C. parapsilosis (39.5% in toenails, 36.7% in fingernails), followed by C. albicans (19.5% in toenails, and 34.4% in fingernails). These results demonstrate a higher frequency of isolation of C. parapsilosis compared with C. albicans in onychomycosis. This might have important therapeutic implications.

Dermoscopy as a diagnostic tool in demodicidosis.

Background  The in vivo demonstration of Demodex infestation is traditionally based on the microscopic identification of Demodex mites, which is time consuming and requires specific equipment and a trained observer.

Report: Dermoscopy as a diagnostic tool in demodicidosis

Background  The in vivo demonstration of Demodex infestation is traditionally based on the microscopic identification of Demodex mites, which is time consuming and requires specific equipment and a trained observer.

CD4+ and CD8+ T cells mediated direct cytotoxic effect against Trichophyton rubrum and Trichophyton mentagrophytes.

Background  The cellular immune system is the most dominant factor in curing acute dermatophytosis. However, the exact immune mechanisms involved in generating this defense are complex and still obscure. The aim of this study was to investigate the fungicidal mechanism of T cells in the normal population versus patients with chronic fungal infections.

Onychomycosis in Israel: epidemiological aspects.

Onychomycosis is a fungal infection treated orally for prolonged periods of treatment, caused primarily by Dermatophytes, Candida species and non‐dermatophyte moulds (NDMs). The prevalence of specific aetiology may differ in dependence of environmental, geographic and demographic factors, and may affect management of the infection. The objective of this survey was to analyse epidemiologic parameters of onychomycosis in Israel. Data of a cohort of 27 093 patients were collected from six centres during a 2‐ and 10‐year period. The diagnosis was based on microscopy of KOH/calcofluor mounts of nail scrapings and culture isolation. A positive result indicates isolation of a fungus in culture. Data were analysed for each centre and expressed as range for the whole cohort, using the spss v18 software. Analysis included three epidemiologic parameters: fungal aetiology in toe‐ and fingernails; association with gender; association with age group. Dermatophytes were the major causative agents and Trichophyton rubrum the most frequent isolate. Candida species were more frequent in women fingernails; frequency increased with age and C. parapsilosis the most frequent species. NDMs were isolated at low rate and Aspergillus terreus was the most frequent isolate. This is a first large cohort of onychomycosis patients from Israel analysed by defined epidemiological parameters.

Insect-bite-like Wells’ syndrome in association with mantle-zone lymphoma

Wells’ syndrome is a multifaceted dermatosis with a wide morphological spectrum, ranging from characteristic cellulitis‐like erythema and wheals to an unusual presentation of vesicles and bullae. We describe a patient in whom Wells’ syndrome presented as an insect‐bite‐like eruption and was associated with underlying mantle‐cell lymphoma. We recommend meticulous investigation of patients diagnosed with Wells’ syndrome manifesting as an insect‐bite‐like eruption.

Report: Dermoscopy as a diagnostic tool in demodicidosis: Dermoscopy for demodicidosis

Background  The in vivo demonstration of Demodex infestation is traditionally based on the microscopic identification of Demodex mites, which is time consuming and requires specific equipment and a trained observer.