Abstract
Onychomycosis is a chronic fungal infection of nails, commonly caused by dermatophyte fungi, primarily species of Trichophyton. Because of the limited drug arsenal available to treat general fungal infections and the frequent failure of onychomycosis treatment, the search for new therapeutic sources is essential, and topical treatment with natural products for onychomycosis has been encouraged. Propolis, an adhesive resinous compound produced by honeybees (Apis mellifera), has shown multiple biological properties including significant antifungal and anti-biofilm activities in vitro. In spite of promising in vitro results, in vivo results have not been reported so far. This study assessed an ethanol propolis extract (PE) as a topical therapeutic option for onychomycosis, including its characterization in vitro and its applicability as a treatment for onychomycosis (from bench to clinic). The in vitro evaluation included analysis of the cytotoxicity and the antifungal activity against the planktonic cells and biofilm formed by Trichophyton spp. We also evaluated the capacity of PE to penetrate human nails. Patients with onychomycosis received topical PE treatments, with a 6-month follow-up period. The results of the in vitro assays showed that PE was non-toxic to the cell lines tested, and efficient against both the planktonic cells and the biofilm formed by Trichophyton spp. The results also showed that PE is able to penetrate the human nail. The results for PE applied topically to treat onychomycosis were promising, with complete mycological and clinical cure of onychomycosis in 56.25% of the patients. PE is an inexpensive commercially available option, easy to obtain and monitor. Our results indicated that PE is a promising natural compound for onychomycosis treatment, due to its ability to penetrate the nail without cytotoxicity, and its good antifungal performance against species such as Trichophyton spp. that are resistant to conventional antifungals, both in vitro and in patients.
Highlights
Onychomycosis, part of the dermatomycosis group, is a chronic fungal infection of the nails
We demonstrated that propolis extract (PE) was able to significantly reduce the biofilm formed in vitro by T. rubrum and T. interdigitale, both in total biomass and in the number of viable cells (Figure 3)
The results of the current study indicate that PE represents a very promising alternative for treatment of onychomycosis, including cases caused by the genus Trichophyton
Summary
Onychomycosis, part of the dermatomycosis group, is a chronic fungal infection of the nails. This kind of mycosis is a frequent disorder that causes approximately 50% of all human nail diseases, in the literature this prevalence seems to be underestimated (Sigurgeirsson and Baran, 2014). A few recent studies, with populations of all ages, show prevalences between 1 and 8% in the United States (Bodman and Krishnamurthy, 2017), 14% in Italy (Papini et al, 2015), and 16% in Greece (Maraki and Mavromanolaki, 2016). Onychomycosis is significantly higher in the elderly population than in children and younger adults (Maraki and Mavromanolaki, 2016; Dubljanin et al, 2017)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
