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Biomedical subjects

C R Daniel

Publications and source records attributed to C R Daniel.

At least 19 recordsLinked to original sources
PubMed1998

Itraconazole for the treatment of onychomycosis.

BACKGROUND: The broad spectrum of activity of itraconazole in vitro manifests itself clinically with the drug being effective for the treatment of onychomycosis caused by dermatophytes, Candida and some non-dermatophyte molds. The pharmacokinetics of itraconazole in the nail results in drug remaining at therapeutic levels for 6-9 months after completion of therapy. METHODS: An overview of studies where continuous or pulse itraconazole therapy has been used in the treatment of fingernail and toenail onychomycosis. RESULTS: Following continuous therapy at 200 mg/day for 3 months for toenail onychomycosis (n = 1741), the rates of clinical cure, clinical response and mycologic cure were: (meta-average +/- 95% standard error (SE)), 52 +/- 9%, 86 +/- 2%, and 74 +/- 3%, respectively, at follow-up 12 months following start of therapy. In fingernail onychomycosis (n = 211), the duration of therapy was 6 weeks and the corresponding efficacy rates at follow-up, 9 months after start of therapy, were meta-average (+/- S.E.) 82 +/- 5%, 90 +/- 2%, and 86 +/- 3%, respectively. In toenail onychomycosis treated with 3 pulses of therapy (n = 1389), the clinical response, clinical cure and mycologic cure were observed in meta-average (+/- S.E.) 58 +/- 10%, 82 +/- 3%, and 77 +/- 5% patients, respectively, at follow-up 12 months after the start of therapy. In fingernail onychomycosis treated with 2 pulses of therapy (n = 210), at follow-up 9 months after the start of therapy, the corresponding efficacy rates were meta-average (+/- S.E.) 78 +/- 10%, 89 +/- 6%, and 87 +/- 8%, respectively. CONCLUSIONS: Both the continuous and pulse therapy regimens are safe with few adverse effects. Compared to continuous therapy, the pulse regimen has an improved adverse-effects profile, is more cost-effective, and is preferred by many patients.

Antifungal Agents↗
PubMed1998

Factors that may affect the response of onychomycosis to oral antifungal therapy.

With the advent of the newer oral antifungals available to treat onychomycosis, the majority of patients respond to therapy. However, there may be subsets of patients who exhibit poor response or failure. Possible explanations for this may be grouped into categories, including: (i) patient characteristics; (ii) organisms causing or associated with the nail infection; (iii) nail characteristics; and (iv) local diseases involving the nail.

Antifungal Agents↗
PubMed1998

Onychomycosis: strategies to reduce failure and recurrence.

Many patients with onychomycosis of the toes respond satisfactorily to standard treatment regimens using the newer antifungal agents terbinafine and itraconazole. However, in some situations supplemental or "booster" therapy consisting of extra antifungal or adjunctive surgical therapy may be beneficial. We review here some instances in which this is appropriate, as well as strategies to reduce recurrence of onychomycosis.

Adult↗
PubMed1997

A multicenter, placebo-controlled, double-blind study of intermittent therapy with itraconazole for the treatment of onychomycosis of the fingernail.

BACKGROUND: Onychomycosis is the most frequent cause of nail disease and represents 30% of all mycotic infections of the skin. OBJECTIVE: Our purpose was to compare the effectiveness and tolerability of intermittent dosing of itraconazole ("pulse therapy") with placebo in fingernail onychomycosis. METHODS: Seventy-three patients with clinically and mycologically diagnosed fingernail onychomycosis were randomly selected to receive itraconazole, 200 mg twice daily, or placebo for the first week of each month for 2 consecutive months; patients were observed for 19 weeks. Seventy-one patients received the study medication and were included in the safety analysis. Efficacy of treatment was evaluated in 46 patients. RESULTS: A significantly greater proportion of itraconazole-treated patients than placebo-treated patients achieved clinical success (77% vs 0%), mycologic success (73% vs 13%), and overall success (68% vs 0%). No itraconazole-treated patient had a clinical or mycologic relapse during the follow-up period. Ten itraconazole-treated patients (28%) and nine placebo-treated patients (26%) had adverse events. Three patients discontinued treatment for safety reasons. CONCLUSION: Pulse therapy with itraconazole for 2 consecutive months produces significantly greater clinical, mycologic, and overall success than placebo. Short-term itraconazole pulse therapy for fingernail onychomycosis is effective and well tolerated.

Adult↗
PubMed1997

Onychomycosis in children: prevalence and treatment strategies.

BACKGROUND: Onychomycosis is observed less frequently in children than adults. Until recently management of onychomycosis in children included topical formulations, oral griseofulvin, and in some cases deferral of treatment. OBJECTIVE: We attempted to determine the prevalence of onychomycosis in North American children 18 years old or younger attending our dermatology offices (three Canadian, two U.S.) and to report the group's experience using fluconazole, itraconazole, and terbinafine for onychomycosis. METHODS: We undertook a prospective, multicenter survey in which all children, regardless of presenting complaint, were examined for onychomycosis by a dermatologist. In instances of clinical suspicion appropriate nail samples were obtained for light microscopy and culture. RESULTS: A total of 2500 children under age 18 were examined in the five-center survey (1117 males and 1383 females, mean +/- S.E. age: 11.2 +/- 0.1 years). There was one child with fingernail and ten with mycologically confirmed toenail dermatophyte onychomycosis. The overall prevalence of onychomycosis was 0.44%. Considering those children whose primary or referring diagnosis was not onychomycosis or tinea pedis, the prevalence of onychomycosis was 0.16%. Outside the survey we have seen six other children with dermatophyte onychomycosis; these 17 cases form the basis for the remainder of the report. Of the 17 children, eight (47%) had concomitant tinea pedis infection, and in 11 (65%) a sibling, parent, or grandparent had onychomycosis or tinea pedis. Management included topical terbinafine (two patients: one cured, one failed therapy), topical ketoconazole (one patient: clinical improvement), oral fluconazole (two patients: one cured, one had Down's syndrome and was noncompliant), oral itraconazole (four patients: three cured with subsequent recurrence at follow-up in one patient, one lost to follow-up), oral terbinafine (five patients: four cured with subsequent recurrence at follow-up in one patient, one failed therapy). One child received no therapy following discussion with the parents, one was lost to follow-up and one was found to have asymptomatic hepatic dysfunction with hepatitis C at pretherapy bloodwork. CONCLUSION: The prevalence of onychomycosis in our sample of North American children 18 years old or younger was 0.44% (n = 2500). In the subset of children whose primary or referring diagnosis was not onychomycosis, the prevalence of onychomycosis was 0.16%. Children with onychomycosis should be carefully examined for concomitant tinea pedis, and their parents and siblings checked for onychomycosis and tinea pedis. The newer oral antifungal agents fluconazole, itraconazole, and terbinafine may be effective and well-tolerated in the treatment of onychomycosis in this age group. These drugs should be carefully evaluated in a larger cohort of children with onychomycosis.

Adolescent↗
PubMed1997

Two feet-one hand syndrome: a retrospective multicenter survey.

BACKGROUND: The two feet-one hand syndrome is not uncommon; however, there have only been a few reports on this condition. This study was undertaken to obtain a better understanding of the epidemiology of the two feet-one hand syndrome. METHODS: A retrospective chart review was conducted of all the patients seen in our practices over the past 15 years with the diagnosis of two feet-one hand syndrome. RESULTS: A total of 80 patients with mycologically confirmed disease were identified (men, 72 (90%); women, 8 (10%); 77 (96%) Caucasian; 3 (4%) African-American; age (mean +/- standard error (SE)), 55.9 +/- 2.1 years). The mean age of the patients when the physician was first seen for the condition was 51.3 +/- 2.0 years. The mean ages when the symptoms first developed on the feet and hand were 37.1 +/- 2.4 years and 45.7 +/- 2.2 years, respectively. Tinea pedis was found to occur at an earlier age than tinea manuum (t(65) = 6.92, P < 0.01). There was a significant relationship between the hand in which tinea manuum developed, the hand used to excoriate the soles of feet (chi 2(4) = 14.82, P < 0.01), and the hand used to pick toenails (chi 2(4) = 14.82, P < 0.01); however, there was no significant relationship between handedness and the development of tinea manuum in the dominant hand. The occupation of the patient at the time of development of the two feet-one hand syndrome was categorized according to whether the intensity of hand use was high, moderate, or low. Patients with a high intensity of hand use in their jobs were significantly more likely to develop tinea pedis/onychomycosis (r = -0.27, F(1,61) = 4.77, P < 0.05) and tinea manuum (r = -0.30, F(1,62) = 6.31, P < 0.05) at an earlier age. The best multiple predictors of the age at which medical attention was sought were the age of onset of tinea manuum and a family history of tinea infection (r = 0.86, F(2,59) = 86.9, P < 0.01). The age of onset of tinea manuum was the best single predictor, with a correlation of 0.85. CONCLUSIONS: In the two feet-one hand syndrome, the development of tinea pedis/onychomycosis generally preceded the development of tinea manuum. Tinea manuum usually developed in the hand used to excoriate the feet or pick toenails. Patients whose occupation involved a high intensity of use of the hands were more likely to develop the disease at an earlier age. Patients were more likely to seek attention once tinea manuum had developed, particularly if there was a family history of tinea infection.

Adolescent↗
PubMed1997

A higher prevalence of onychomycosis in psoriatics compared with non-psoriatics: a multicentre study.

There is some controversy about the prevalence of onychomycosis in patients with psoriasis compared to non-psoriatics. We therefore measured the prevalence of toenail onychomycosis in psoriatics and non-psoriatics attending dermatologists' offices. None of the patients had a referring diagnosis of onychomycosis. The prevalence of pedal onychomycosis in psoriatics (n = 561) was 13%. The odds of patients with psoriasis having onychomycosis was 56% greater than non-psoriatics of the same age and sex (P = 0.02). In the psoriatics, when the toenails were clinically abnormal, the prevalence of onychomycosis was 27%. The odds of developing onychomycosis increased with age (P < 0.0001) and the odds of men developing onychomycosis was 2.5 times that of women (P = 0.0001). The duration of psoriasis did not significantly affect the odds of developing onychomycosis. The fungal organisms recovered from psoriasis subjects with onychomycosis were similar to those in the normal population with onychomycosis (P = 0.58).

Female↗
PubMed1996

Traditional management of onychomycosis.

The traditional management of onychomycosis includes mechanical, chemical, and surgical approaches, as well as topical and oral antifungal medications. Topical preparations have been consistently disappointing, and the tendency in later years has been to rely on two systemic agents-griseofulvin and ketoconazole-for management of more severe or recalcitrant infections. However, both drugs require a long duration of therapy (4 to 6 months for fingernails, 10 to 18 months for toenails). Even with such prolonged treatment, the overall success rate is only about 15% to 30% for toenail infections and 50% to 70% for fingernail infections. Furthermore, both griseofulvin and ketoconazole have numerous potential side effects and drug/drug interactions. Therefore, laboratory monitoring should be performed during the course of treatment with these agents and they should be used only after evaluation of the patient's current medical status and a review of concomitant medications.

Antifungal Agents↗
PubMed1996

Chronic paronychia and onycholysis: a thirteen-year experience.

We report here on two retrospective studies conducted between 1982 and 1995 in 137 patients with clinical evidence of chronic paronychia or onycholysis. The purpose of the studies was to determine what factors played a role in these nail disorders. The culture results indicated that yeast commonly grew from the cultured material. Significant contact irritant exposure was frequently found. These findings and our experience suggest that the resolution of chronic paronychia and onycholysis depends on avoiding exposure to contact irritants and on appropriate treatment of any underlying fungal infection. To accomplish this latter goal, it is important to select a broad-spectrum antifungal agent that is effective against yeasts as well as other fungal pathogens.

Adolescent↗
PubMed1995

Onychomycosis update.

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AIDS-Related Opportunistic Infections↗
PubMed1994

Cutaneous manifestations of fungal infection.

Fungal infection of the skin and subcutaneous tissue may result from either direct contact or inoculation injury (primary infection) or from hematogenous spread from a primary focus of disease (secondary infection). The parainfectious lesions of erythema nodosum and erythema multiforme are manifestations of the host's immune response to the invading fungus, particularly Histoplasma capsulatum and Coccidiodes immitis. In some patients, skin lesions may be the only sign of a systemic fungal infection, and prompt recognition of these lesions may facilitate early diagnosis and treatment. This article first addresses the pathogenesis, host defenses, and diagnosis of fungal skin infections. The specific cutaneous manifestations of the superficial, cutaneous, subcutaneous, and systemic mycoses are then reviewed.

Antifungal Agents↗
PubMed1992

The spectrum of nail disease in patients with human immunodeficiency virus infection.

There are no known pathognomonic nail signs of human immunodeficiency virus (HIV) infection. However, several presentations should increase the index of suspicion. (1) Proximal white subungual onychomycosis or superficial white onychomycosis, especially of the fingernails, is present. Trichophyton rubrum appears to cause both most commonly in HIV-infected patients. Periungual dermatophyte involvement and involvement of all 10 fingernails is unusual in non-HIV-infected persons. (2) Candida is a primary pathogen of the nail bed and nail plate especially if many nails are involved. (3) A destructive, almost granulomatous-like psoriatic involvement of the nails is present. (4) Squamous cell carcinoma of the nail bed in a young adult. There are no clinical trails to confirm the efficacy of therapy mentioned in this article. The treatment suggestions are empirical and are the personal views of the authors.

Candidiasis, Cutaneous↗