Limits...
Tazarotene as alternative topical treatment for onychomycosis.

Campione E, Paternò EJ, Costanza G, Diluvio L, Carboni I, Marino D, Favalli C, Chimenti S, Bianchi L, Orlandi A - Drug Des Devel Ther (2015)

Bottom Line: Treatment was considered effective when clinical healing and negative mycological culture were obtained.Complete clinical healing and negative cultures were reached in all patients at week 12, with a significant improvement of all clinical parameters of the infected nails.Our results documented a good clinical outcome using topical tazarotene 0.1% gel in distal and lateral subungual onychomycosis and its fungistatic activity of tazarotene in vitro.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Policlinic Tor Vergata, Rome, Italy.

ABSTRACT

Background: Distal and lateral onychomycoses are the most frequent forms of onychomycosis, causing subungual hyperkeratosis that usually limits local penetration of antimycotic drugs. Tazarotene exerts anti-inflammatory and immune-modulating activities toward both infective agents and damaged keratinocytes. Given the well-documented efficacy of tazarotene on hyperkeratotic nail psoriasis, we investigated its therapeutic use in onychomycosis.

Patients and methods: We designed a preliminary open clinical trial in patients affected by distal and lateral subungual onychomycosis of the toenails and verified the fungistatic activity of tazarotene in vitro. Fifteen patients were treated with topical tazarotene 0.1% gel once per day for 12 weeks. Mycological cultures and potassium hydroxide stains of nail samples were performed at the beginning and at the end of the study. Treatment was considered effective when clinical healing and negative mycological culture were obtained. Onycholysis, nail bed discoloration, and subungual hyperkeratosis were measured using standardized methodologies and analyzed by means of Mann-Whitney test and analysis of variance. Fungistatic activity of tazarotene was evaluated by disk diffusion assay.

Results: Six patients (40%) reached a mycological cure on target nail samples already after 4 weeks of treatment. Complete clinical healing and negative cultures were reached in all patients at week 12, with a significant improvement of all clinical parameters of the infected nails. Disk diffusion assay after 48 hours of incubation with tazarotene solution showed a central area of inhibition in all examined fungal cultures.

Conclusion: Our results documented a good clinical outcome using topical tazarotene 0.1% gel in distal and lateral subungual onychomycosis and its fungistatic activity of tazarotene in vitro. The majority of patients appeared cured at a 6-month follow-up. The efficacy and safety of tazarotene must be confirmed on a larger number of patients, although already documented in nail psoriasis patients often affected by onychomycosis.

No MeSH data available.


Related in: MedlinePlus

Semiquantitative evaluation of the clinical effect of topical treatment of tazarotene 0.1% gel.Notes: The clinical effect of topical treatment of tazarotene 0.1% gel on onychomycosis in terms of affected area (A) and percentage of patients (B); (**P<0.001); box plots show the decrease of onycholysis (C), nail bed discoloration (D), and subungual hyperkeratosis as thickening of the subungual region (E) at the end point (12 weeks of topical treatment with tazarotene 0.1% gel); *P<0.04. For (A) and (B) error bars are representative of standard error of mean (SEM); for (C–E) error bars are representative of mean SD.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4338256&req=5

f2-dddt-9-879: Semiquantitative evaluation of the clinical effect of topical treatment of tazarotene 0.1% gel.Notes: The clinical effect of topical treatment of tazarotene 0.1% gel on onychomycosis in terms of affected area (A) and percentage of patients (B); (**P<0.001); box plots show the decrease of onycholysis (C), nail bed discoloration (D), and subungual hyperkeratosis as thickening of the subungual region (E) at the end point (12 weeks of topical treatment with tazarotene 0.1% gel); *P<0.04. For (A) and (B) error bars are representative of standard error of mean (SEM); for (C–E) error bars are representative of mean SD.

Mentions: Mycological cure in target nails (ie, those with mycological confirmation of onychomycosis at baseline) was observed in subungual samples collected at the first follow-up visit (4 weeks) in 40% of patients, and complete cure with complete clinical healing in all patients was observed at the end point (12 weeks). Direct microscopy and in vitro laboratory culture of the sampled material collected after 12 weeks were negative for infections. Representative clinical images of four patients at baseline and end point after tazarotene treatment are reported in Figure 1. Therapeutic results were good, with no side effects except for mild erythema on the perionychia in two patients; nail growth and tropism were also restored. As shown in Figure 2, all examined clinical parameters markedly decreased at the end point. The percentage of affected area and the proportion of affected patients decreased (P<0.001; Figure 2A and B). Onycholysis, subungual hyperkeratosis, and discoloration completely disappeared in all patients at the end point (P<0.04; Figure 2C). The nails were completely healed at the follow-up visits up to 6 months.


Tazarotene as alternative topical treatment for onychomycosis.

Campione E, Paternò EJ, Costanza G, Diluvio L, Carboni I, Marino D, Favalli C, Chimenti S, Bianchi L, Orlandi A - Drug Des Devel Ther (2015)

Semiquantitative evaluation of the clinical effect of topical treatment of tazarotene 0.1% gel.Notes: The clinical effect of topical treatment of tazarotene 0.1% gel on onychomycosis in terms of affected area (A) and percentage of patients (B); (**P<0.001); box plots show the decrease of onycholysis (C), nail bed discoloration (D), and subungual hyperkeratosis as thickening of the subungual region (E) at the end point (12 weeks of topical treatment with tazarotene 0.1% gel); *P<0.04. For (A) and (B) error bars are representative of standard error of mean (SEM); for (C–E) error bars are representative of mean SD.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4338256&req=5

f2-dddt-9-879: Semiquantitative evaluation of the clinical effect of topical treatment of tazarotene 0.1% gel.Notes: The clinical effect of topical treatment of tazarotene 0.1% gel on onychomycosis in terms of affected area (A) and percentage of patients (B); (**P<0.001); box plots show the decrease of onycholysis (C), nail bed discoloration (D), and subungual hyperkeratosis as thickening of the subungual region (E) at the end point (12 weeks of topical treatment with tazarotene 0.1% gel); *P<0.04. For (A) and (B) error bars are representative of standard error of mean (SEM); for (C–E) error bars are representative of mean SD.
Mentions: Mycological cure in target nails (ie, those with mycological confirmation of onychomycosis at baseline) was observed in subungual samples collected at the first follow-up visit (4 weeks) in 40% of patients, and complete cure with complete clinical healing in all patients was observed at the end point (12 weeks). Direct microscopy and in vitro laboratory culture of the sampled material collected after 12 weeks were negative for infections. Representative clinical images of four patients at baseline and end point after tazarotene treatment are reported in Figure 1. Therapeutic results were good, with no side effects except for mild erythema on the perionychia in two patients; nail growth and tropism were also restored. As shown in Figure 2, all examined clinical parameters markedly decreased at the end point. The percentage of affected area and the proportion of affected patients decreased (P<0.001; Figure 2A and B). Onycholysis, subungual hyperkeratosis, and discoloration completely disappeared in all patients at the end point (P<0.04; Figure 2C). The nails were completely healed at the follow-up visits up to 6 months.

Bottom Line: Treatment was considered effective when clinical healing and negative mycological culture were obtained.Complete clinical healing and negative cultures were reached in all patients at week 12, with a significant improvement of all clinical parameters of the infected nails.Our results documented a good clinical outcome using topical tazarotene 0.1% gel in distal and lateral subungual onychomycosis and its fungistatic activity of tazarotene in vitro.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Policlinic Tor Vergata, Rome, Italy.

ABSTRACT

Background: Distal and lateral onychomycoses are the most frequent forms of onychomycosis, causing subungual hyperkeratosis that usually limits local penetration of antimycotic drugs. Tazarotene exerts anti-inflammatory and immune-modulating activities toward both infective agents and damaged keratinocytes. Given the well-documented efficacy of tazarotene on hyperkeratotic nail psoriasis, we investigated its therapeutic use in onychomycosis.

Patients and methods: We designed a preliminary open clinical trial in patients affected by distal and lateral subungual onychomycosis of the toenails and verified the fungistatic activity of tazarotene in vitro. Fifteen patients were treated with topical tazarotene 0.1% gel once per day for 12 weeks. Mycological cultures and potassium hydroxide stains of nail samples were performed at the beginning and at the end of the study. Treatment was considered effective when clinical healing and negative mycological culture were obtained. Onycholysis, nail bed discoloration, and subungual hyperkeratosis were measured using standardized methodologies and analyzed by means of Mann-Whitney test and analysis of variance. Fungistatic activity of tazarotene was evaluated by disk diffusion assay.

Results: Six patients (40%) reached a mycological cure on target nail samples already after 4 weeks of treatment. Complete clinical healing and negative cultures were reached in all patients at week 12, with a significant improvement of all clinical parameters of the infected nails. Disk diffusion assay after 48 hours of incubation with tazarotene solution showed a central area of inhibition in all examined fungal cultures.

Conclusion: Our results documented a good clinical outcome using topical tazarotene 0.1% gel in distal and lateral subungual onychomycosis and its fungistatic activity of tazarotene in vitro. The majority of patients appeared cured at a 6-month follow-up. The efficacy and safety of tazarotene must be confirmed on a larger number of patients, although already documented in nail psoriasis patients often affected by onychomycosis.

No MeSH data available.


Related in: MedlinePlus