Topical Antifungal Medications Research Articles

Incidence of Angular Cheilitis among Patients Visiting Private Dental Hospital in Chennai: An Institutional Study

Introduction: Angular cheilitis is defined as the localised inflammation of the lip commissure. The angles of the mouth are more prone to inflammation as they serve as the points of interface between the squamous epithelium and oral mucosa. It is a multifactorial disease and occurs due to varied etiology. It can be due to microbial infections, poor dentures, or can be due to smoking and pan chewing habits, Nutritional deficiency or Generalised Immunosuppression. Most of the lesions respond well to the topical antifungal medications and steroids.
 Aim: The current study aims to assess the Incidence of Angular cheilitis among patients visiting the Out patient department of a private dental hospital setting
 Materials and Methodology: The study was performed in the Out patient department of saveetha dental college, under a university setting. The study was a retrospective study and the data required were procured by reviewing patient records dating between June 2019 and March 2021 and the sample size was n =125. The data thus collected were sorted and tabulated in the excel sheet. The sorted data were then entered in the IBM SPSS software and descriptive analysis was performed. The results were interpreted in the form of pictorial graphs.
 Results: n = 125 patient records who had been diagnosed with Angular cheilitis had been retrieved. Our results show that the majority of them i.e 52% of the people were Females and 48% of them were Males.Our results also show that the people of age group 41 to 50 were the most affected with 31.20% and people with 20 to 30 years of age group were the least affected with 12.80%.
 Conclusion: Within the limitations of the study, it can be concluded that Angular cheilitis has got a predominant Female predilection and more commonly affects people of 41 to 50 years of age.
 There is also a positive correlation between the Gender of the population and smoking and pan chewing habits; and Gender of the population and Iron deficiency anemia induced Angular cheilitis.

A case of facial skin ulcer caused by Mycolicibacterium mageritense after tennis ball bruising

A 69-year-old Japanese woman with untreated rheumatoid arthritis was hit on her left cheek by a tennis ball in November 20XX. Later, an ulcer gradually appeared on her left cheek. She presented to Komaki Municipal Hospital on September, 20(XX+1). Dermatological and histopathological findings are shown in Figures 1 and 2, respectively. The patient was administered topical and oral antifungal medications, however the ulcer region did not improve.

Uremic Stomatitis: A Case Report

Uremic stomatitis is a rarely reported oral mucosal disorder associated with renal disorder. It is mostly seen in cases of end stage renal disease or undiagnosed or untreated chronic renal failure. Its frequency has diminished due to the advent of renal dialysis. Clinically uremic stomatitis is characterised by the presence of painful plaques and crusts that are usually distributed on the buccal and labial mucosa, dorsal or ventral surface of the tongue, gingiva and the floor of the mouth. Ultimate treatment consists of improvement of blood urea concentration and underlying renal failure is supported by enhancement of oral hygiene with antiseptic mouthwashes and antimicrobial/ antifungal agents, if necessary. Here we report a case of a 50 year old Male patient who reported to the department with the complaint of inability to open mouth due to ulcers present intra-orally, who was a kidney patient undergoing dialysis, who was then treated with topical steroid and antifungal medications with follow up made once in a week.

Collagen cross-linking with riboflavin-induced aggravation of polymicrobial keratitis

A 21-years-old female presented with pain, redness, watering, and diminished vision in right eye (OD). Slit lamp biomicroscopy revealed infective keratitis and microbiological tests revealed mixed infection of bacteria and fungus. The patient was treated with a combination of topical (antibacterial and antifungal) medication and oral itraconazole. The patient showed no response. Tab voriconazole was added. Observing no response after another week, collagen cross-linking was performed. On day two, sudden worsening of corneal infiltrates involving total cornea was observed. Topical colistin 0.19% drops were added. The patient did not respond to treatment and a therapeutic graft was performed. The postoperative period was uneventful and no recurrence was observed.

Subacute postoperative endophthalmitis secondary to sutureless self-sealing corneal wound infection at both main cornea and side port wounds

Corneal wound infection following cataract surgery is rare. We describe a case of wound infection at both the main wound and the side port wound following uncomplicated phacoemulsification. Candida albicans was isolated, and the condition worsened with progression to endophthalmitis. Vitrectomy was done, and the infection was controlled after 3 months of topical and systemic antifungal medications.

Atypical oral candidiasis in a psoriatic patient during targeted immunotherapy with an interleukin 17 inhibitor (secukinumab)

BackgroundSecukinumab is a human monoclonal antibody immunoglobulin that neutralises interleukin (IL)-17A, and as such, is effective in the treatment of psoriasis. However, as IL-17A is essential in protection against fungal infections, patients treated with this drug may develop candidiasis. This report presents a case of atypical oral candidiasis occurring during targeted drug immunotherapy with an interleukin 17 (IL-17) inhibitor (secukinumab), with the aim of emphasisinge the necessity of periodical oral health assessment and monitoring. It provides a rational clinical approach to therapeutic protocol in the treatment of side effects associated with novel medications for autoimmune diseases.Case presentationSymptomatic tongue lesions were observed in a 50-year-old female patient on a monthly systemic treatment of 300 mg of secukinumab, which appeared after 60 days of using the medication. Two inconclusive biopsies and an unsuccessful application of oral corticosteroids made the diagnostic process challenging. Papillae on the back of the tongue were atrophied, forming a well-defined erythema and white non-detachable plaques on the lateral border of the tongue. Cytopathological and histopathological exam results were compatible with a diagnosis of oral candidiasis. Topical antifungal medication led to subsequent regression of the tongue lesions. During asymptomatic period and follow up for 7 months, a reduced monthly dose 150 mg of secukinumab was administered.ConclusionsPatients undergoing treatment with IL-17 blockers, such as secukinumab, should be carefully monitored in order to avoid oral side effects resulting from the use of this medication.

Topical azole treatments for otomycosis.

Otomycosis is a fungal infection of the outer ear, which may be treated with topical antifungal medications. There are many types, with compounds belonging to the azole group ('azoles') being among the most widely used. To evaluate the benefits and harms of topical azole treatments for otomycosis. The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The search date was 11 November 2020. We included randomised controlled trials (RCTs) in adults and children with otomycosis comparing any topical azole antifungal with: placebo, no treatment, another type of topical azole or the same type of azole but applied in different forms. A minimum follow-up of two weeks was required. We used standard Cochrane methods. Our primary outcomes were: 1) clinical resolution as measured by the proportion of participants with complete resolution at between two and four weeks after treatment (however defined by the authors of the studies) and 2) significant adverse events. Secondary outcomes were 3) mycological resolution and 4) other less serious adverse effects. We used GRADE to assess the certainty of evidence for each outcome. We included four studies with 559 participants from Spain, Mexico and India. Three studies included children and adults; one included only adults. The duration of symptoms was not always explicitly stated. Mycological resolution results were only reported in one study. The studies assessed two comparisons: one type of topical azole versus another and the same azole but administered in different forms (cream versus solution). A. Topical azoles versus placebo None of the studies assessed this comparison. B. Topical azoles versus no treatment None of the studies assessed this comparison. C. One type of topical azole versus another type of topical azole i) Clotrimazole versus other types of azoles (eberconazole, fluconazole, miconazole) Three studies examined clotrimazole versus other types of azoles. The evidence is very uncertain about the difference between clotrimazole and other types of azole in achieving complete clinical resolution at four weeks (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.59 to 1.07; 3 studies; 439 participants; very low-certainty evidence). The anticipated absolute effects are 668 per 1000 for clotrimazole versus 835 per 1000 for other azoles. One study planned a safety analysis and reported no significant adverse events in either group. The evidence is therefore very uncertain about any differences between clotrimazole and other types of azole (no events in either group; 1 study; 174 participants; very low-certainty evidence). Clotrimazole may result in little or no difference in mycological resolution at two weeks follow-up (RR 1.01, 95% CI 0.96 to 1.06; 1 study; 174 participants; low-certainty evidence) or in other (less serious) adverse events at two weeks follow-up (36 per 1000, compared to 45 per 1000, RR 0.79, 95% CI 0.18 to 3.41; 1 study; 174 participants; very low-certainty evidence). ii) Bifonazole cream versus bifonazole solution One study compared bifonazole 1% cream with solution. Bifonazole cream may have little or no effect on clinical resolution at two weeks follow-up when compared to solution, but the evidence is very uncertain (RR 1.07, 95% CI 0.73 to 1.57; 1 study; 40 ears; very low-certainty evidence). Bifonazole cream may achieve less mycological resolution compared to solution at two weeks after the end of therapy, but the evidence for this is also very uncertain (RR 0.53, 95% CI 0.29 to 0.96; 1 study; 40 ears; very low-certainty evidence). Five out of 35 patients sustained severe itching and burning from the bifonazole solution but none with the bifonazole cream (very low-certainty evidence). We found no studies that evaluated topical azoles compared to placebo or no treatment. The evidence is very uncertain about the effect of clotrimazole on clinical resolution of otomycosis, on significant adverse events or other (non-serious) adverse events when compared with other topical azoles (eberconazole, fluconazole, miconazole). There may be little or no difference between clotrimazole and other azoles in terms of mycological resolution. It may be difficult to generalise these results because the range of ethnic backgrounds of the participants in the studies is limited.

English

BACKGROUND Treatment of fungal ulcers is one of the most challenging tasks. Various topical antifungal drugs have poor corneal stromal penetration. Voriconazole is a broad spectrum drug and is an effective agent for the treatment of fungal keratitis as a topical preparation. It is potent against a broad range of clinically significant fungal infections both in the eye as well systemically. In tropical climatic conditions filamentous fungi commonly cause eye infections and are associated with poor visual outcomes. The treatment options for mycotic ulcers are limited, therefore direct intrastromal injections are helpful in the management of these deep mycotic keratitis. We wanted to evaluate the role of intrastromal injection of voriconazole in the management of deep fungal keratitis not responding to conventional therapy. METHODS This an interventional case series study done at a tertiary care centre in south India from the year April 2019 to August 2020. Eight eyes of eight patients with microbiologically proven deep stromal recalcitrant mycotic keratitis not responding to topical antifungal medications were evaluated. Voriconazole 50 microgram / 0.1 ml was injected around the infiltrate in the corneal stroma as an adjunctive to the topical antifungal treatment. Main outcome measure was a reduction of the size of the infiltrate and ulcer and decrease in infection on regular follow ups. RESULTS Before injecting voriconazole, all the cases were of either gradually worsening of lesions on topical treatment, or not responding to topical treatment. After the injection a rapid decrease in the size of corneal ulcer, hypopyon, and infiltration was seen within 3 weeks. CONCLUSIONS Targeted delivery of intrastromal voriconazole may be a safe and effective way in the management of deep seated fungal ulcers which respond poorly to conventional treatment procedures, thus reducing the need for further surgical treatment. KEYWORDS Intrastromal Injection, Voriconazole, Fungal Keratitis, Deep Mycotic Keratitis

Management of incontinence-associated dermatitis with topical antibiotics and antifungal medication

The primary goals of managing incontinence-associated dermatitis (IAD) are to control the incontinence and to stop the progress of dermatitis. This study evaluated the effectiveness of using a combination of topical antibiotic and topical antifungal medication to manage IAD. Patients with grade 2 IAD treated with a combination of topical antibiotic Biomycin (CBC Biotechnological and Pharmaceutical, Taiwan) and antifungal clotrimazole (Sinphar Group, Taiwan) between January 2017 and January 2019 were included in this retrospective study. Data collected included patients' age, sex, diagnosis, body mass index, comorbidities and surface area involved. Patients were reviewed fortnightly until the wounds had healed, the patient was discharged or had died. A total of 76 patients were included. There were 39 men and 37 women with a mean age of 74 years. In 58 (76%) patients, the surface area involved was >50cm2, in 13 (17%) patients the involved area was 20-50cm2 and in five (7%) patients the area involved was <20cm2. The mean number of days treated was 10.3 (range: 1-53). A total of 46 (61%) patients showed total healing of their IAD, 17 (22%) patients showed improvement of >50% of the involved area, seven (9%) patients showed improvement of 0-50%, five (7%) patients showed no improvement and one (1%) patient showed an increase in the area involved. This combination of treatment was effective in the management of IAD. It was cheap, easy to apply, easy to remove and easily accessible. It could be used efficiently by the hospital staff and the patient's family.

The relationship between the number of available therapeutic options and government payer (medicare part D) spending on topical drug products.

The cost of prescription drugs has increased at rates far exceeding general inflation in recent history, with topical drugs increasing at a disproportionate rate compared to other routes of administration. We assessed the relationship between net changes in the number of therapeutic options, defined as any approved drug or therapeutic equivalent on the market, and prescription topical drug spending. Drugs were divided based on the category of use through pairing of Medicare Part D Prescriber Public Use and Food and Drug Administration (FDA) approved drug products databases. Across drug classes, we modeled the log of the ratio of total spending per unit in 2015 to total spending per unit in 2011 as a linear function of net number of topical therapeutic options over this time period. Primary outcomes include total Medicaid Part D spending on topical drugs and net change in the number of available therapeutic options within each category of use. Total spending on topical drugs increased by 61%, while the number of units dispensed increased by only 18% from 2011-2015. The greatest total spending increases were in categories with few new therapeutic options, such as topical corticosteroid and antifungal medications. Each net additional therapeutic option during 2011-2015 was associated with an reduction in how much relative spending per unit increased (95% CI 2.5%-14.4%, p = 0.013). Stimulating greater competition through increasing the net number of therapeutic options within each major topical category of use may place downward pressure on topical prescription drug spending under medicare Part D.

Management of Hairy Tongue With Oral Candidiasis In Active Smokers

Hairy tongue is an abnormal lengthening of the filiform papillae of the tongue, clinically the dorsum of the tongue looks hair-coated. The etiology of hairy tongue is idiopathic. Predisposing factors for hairy tongue are poor oral hygiene, antibiotics, excessive smoking, oral candidiasis, alcohol consumption, radiation therapy. Candidiasis is an opportunistic infection of the oral cavity caused by Candida albicans (C. albicans). This fungus can cause a pathogenic condition, and is the most common fungal infection found in the human oral cavity. Predisposing factors for oral candidiasis are the use of dentures, xerostomia, stress, and smoking habits. Objective: To demonstrate the management of a case of hairy tongue with oral candidiasis on the dorsum of the tongue. Case: A 54-year-old male patient came to the Dental Hospital of Jember University for treatment with a complaint of feeling thick and yellowish-brown color on the back of the tongue with clinical features of an extension of the papillae filiformis in the posterior third of the dorsum of the tongue, and a white-yellowish white plaque, could be scraped, but not sick. The patient had complained it since ± 3 years ago. The patient claimed to have never had his tongue scraped off and never treated it. In addition, he smoked a pack of cigarette a day and consumed coffee every morning and evening. Conclusion: The final diagnosis in the patient was hairy tongue with oral candidiasis on the dorsum of the tongue. Therapy provided to the patient i.e. Nystatin oral suspension functions as a topical antifungal medication, Becomzet multivitamin (Vitamin B complex, A, C, E, and Zinc) as a multivitamin and Tongue cleaner as a tongue cleaner. Dental and oral health education was conducted for preventing hairy tongue.&#x0D; &#x0D; Keywords: hairy tongue; oral candidiasis; active smokers

Atypical Tinea Corporis Revealing a Human Immunodeficiency Virus Infection

Dermatophytes are fungi that commonly cause superficial skin infections. While these rashes are typically benign and easily treated with topical antifungal medications, extensive presentations can indicate a more serious underlying immunodeficiency. We report on a teenage girl whose extensive rash led to a diagnosis of human immunodeficiency infection.

Onychodystrophy as the only sign of congenital candidiasis.

Congenital candidiasis infection often presents as a skin rash with variable involvement of nails and mucous membranes. Isolated nail involvement is rare, may present late, and can often be managed with topical antifungal medication. We report a case of congenital candidiasis limited to the fingernails that resolved completely within 3months with topical treatment.

Clinical outcome after air-assisted manual deep anterior lamellar keratoplasty for fungal keratitis poorly responsive to medical treatment.

PurposeFungal keratitis remains an important disorder because of difficulty in its diagnosis, and some patients do not respond to medical treatment using antifungal local and systemic agents. This study was carried out to determine the therapeutic value of air-assisted manual therapeutic deep anterior lamellar keratoplasty (TDALK) in the treatment of fungal keratitis not curable by antifungal chemotherapy.MethodsSeventeen patients (18 eyes) who were referred to Fukuoka University Hospital and treated surgically from January 2006 to April 2018, in whom a diagnosis of fungal keratitis was confirmed by typical clinical findings and microbiological or histological analysis of corneal specimens, and who were poorly responsive to topical and systemic antifungal medication, whereas the lesion had not resulted in corneal perforation, were enrolled in this study and were treated by air-assisted manual TDALK. Clinical outcomes including treatment course, therapeutic success rate, visual acuity outcomes and graft clarity rate were analyzed.ResultsThe most common pathogen was Fusarium, followed by Candida and Aspergillus. Beneficial therapeutic results (a clear or translucent graft) were achieved in 15 of 18 eyes (83%). There was no recurrence of infection and resulting visual acuity ≤0.15 logarithm of minimal angle of resolution unit was achieved in 15 eyes (83%). Intraoperative microperforation of Descemet’s membrane (DM) was not observed in any patients.ConclusionAir-assisted manual TDALK can be effective for treating severe fungal keratitis. In addition, air-assisted manual TDALK might be an alternative procedure to big-bubble DALK, because it can provide ambulatory vision and can preserve potentiality of vision with less risk of intraoperative perforation of DM.

Designing and enhancing the antifungal activity of corneal specific cell penetrating peptide using gelatin hydrogel delivery system.

BackgroundFungal keratitis is a major cause of corneal blindness accounting for more than one-third of microbiologically proven cases. The management of fungal keratitis is through topical or systemic antifungal medications alone or in combination with surgical treatment. Topical medications such as natamycin and voriconazole pose major challenges due to poor penetration across the corneal epithelium. To address the issue various carrier molecules like nanoparticles, lipid vesicles, and cell penetrating peptides were explored. But the major drawback such as non-specificity and lack of bioavailability remains.PurposeIn this study, we have attempted to design corneal specific cell penetrating peptide using subtractive proteomic approach from the published literature and tried to improve its bioavailability through gelatin hydrogel delivery system.Material and MethodsUsing subtractive proteomic approach two peptides VRF005 and VRF007 were identified on the basis of solubility, cell permeability and amphipathicity. The peptides were modeled for three-dimensional structure and simulated for membrane penetration. The peptides were characterized using circular dichroism spectroscopy, dynamic light scattering and native polyacrylamide gel electrophoresis. Further uptake studies were performed on primary corneal epithelial cells and the stability was analyzed in corneal epithelial tissue lysates. Insilico prediction of peptides showed it to have antifungal activity which was further validated using colony forming assay and time killing kinetics. The duration of antifungal activity of peptide was improved using gelatin hydrogel through sustained delivery.ResultsVRF005 and VRF007 showed α-helical structure and was within the allowed region of Ramachandran plot. The simulation study showed their membrane penetration. The peptide uptake was found to be specific to corneal epithelial cells and also showed intracellular localization in Candida albicans and Fusarium solani. Peptides were found to be stable up to 2 hours when incubated with corneal epithelial tissue lysate. Dynamic light scattering, and native polyacrylamide gel electrophoresis revealed aggregation of peptides. VRF007 showed antifungal activity up to 24 hour whereas VRF005 showed activity up to 4 hours. Hence gelatin hydrogel-based delivery system was used to improve the activity. Actin staining of corneal epithelial cells showed that the cells were attached on gelatin hydrogel.ConclusionWe have designed corneal specific cell penetrating peptides using subtractive proteomic approach. Bioavailability and delivery of peptide was enhanced using gelatin hydrogel system.

Sinonasal aspergillosis: Outcome after topical treatment in dogs with cribriform plate lysis.

BackgroundCribriform lysis has been considered a contraindication for topical treatment of sinonasal aspergillosis (SNA) because of concerns about drug extravasation with resultant neurologic signs or death.Objective/HypothesisTo describe dogs with SNA and cribriform plate lysis treated with topical antifungal medications. Our hypothesis was that the conventional dogma that topical therapy should be avoided in these cases is incorrect.AnimalsNine client‐owned dogs with SNA and lysis of the cribriform plate, lysis of the floor of a frontal sinus or both detected by computed tomography (CT).MethodsA retrospective review of medical records was performed. Dogs that met inclusion criteria (ie, SNA confirmed by at least 1 laboratory test, braincase affected on CT, and topical treatment applied) were included. Size of lesions, ancillary diagnostic test results, topical therapy, and adjuvant PO treatments were recorded. Outcome was determined by phone calls.ResultsFour dogs were alive at the time of the manuscript submission with follow‐up ranging from 188 to 684 days without neurological signs observed. All dogs were discharged without major complication 1‐7 days postoperatively. One dog that had presented with a history of seizures experienced seizure activity 2 months after treatment.Conclusions and Clinical ImportanceTopical therapy did not result in complications in these dogs in which lytic regions as large as 16 × 22 mm2 were noted. Sinonasal aspergillosis associated lysis of the cribriform plate; lysis of the floor of a frontal sinus or both detected on CT is not necessarily a contraindication to topical therapy.

Dermatophytosis Caused by Microsporum canis in a Free-Living Maned Wolf (Chrysocyon brachyurus).

Background: Chrysocyon brachyurus is a South American wild canid considered a species near threatened by the International Union for Conservation of Nature and is classified as vulnerable in the National List of Endangered Species. With the increase of the contact between domestic animals, human population and wild animals, there was a greater exposure of the maned wolf to pathogens. Due to the importance of its conservation, the knowledge of emerging infectious diseases that affect this species becomes essential. This report aims to describe the first diagnosed case of dermatophytosis caused by Microsporum canis in a maned wolf.Case: A free-living female maned wolf (Chrysocyon brachyurus), approximately 60 days old, was rescued with presence of alopecia, non-pruritic lesions, one of circular shape located in the nasal plane and the other with signs of scaling and crusts in the region of the left pina. The animal was active, in good general condition and without other significantchanges to clinical examination. Skin scraping was performed for mycological culture of both lesions. Fungal growth on Sabouraud’s agar identified Microsporum canis. Topical therapy with ketoconazole ointment and cleaning of lesions with 0.2% chlorhexidine was instituted. After 20 days of treatment, remission of clinical signs and repilation of affected areas were observed. New mycological cultures of both areas were carried out, which were negative for Microsporum canis.Discussion: Although Microsporum canis is described as causing dermatophytosis in several animal species, it has apparently not yet been reported in maned wolves. Microsporum canis is one of the most isolated zoophilic dermatophytes in domestic cats and is also cited in reports of symptomatic wild felids, such as tigers, in which it has been identified as either the only agent of infection or in association with Trichophyton mentagrophytes. The occurrence is also high in domestic dogs. In the wild canids, Microsporum gypseum has been described in the gray wolf, Trichophyton mentagrophytes in wild foxes, and Microsporum canis in red fox, among others. The finding of zoophilic and geophilic dermatophyte fungi in healthy, free-living and captive wild animals confirms their role as carriers, probable reservoirs and disseminators of these organisms in the environment, and the potential risk they represent as causes of zoonoses. Zoophilic dermatophytes are usually transmitted by contact between individuals and contaminated fomites. In the case of M. canis in the red fox the contact was an asymptomatic domestic cat. In the present case the transmission was not determined, since the animal was rescued from the wild. Regarding the age group, young animals are more susceptible to dermatophytes than adults, probably related to the greater immunity of adults due to previous contacts or even the immaturity of the immune system of the young. The dermatophytosis diagnosis is generally based on anamnesis, physical examination of the lesion, Wood’s lamp examination, microscopic skin scraping, fungal culture, or even histology and PCR tests. In the present case, the final diagnosis was based upon by fungal culture in Sabouraud agar, which allowed to identify the dermatophyte species and,thus, the possible source of infection. Dermatophyte infections can be treated with systemic or topical antifungal medications. Because it was a young animal, it was chosen in the present case only for topical use, which proved to be adequate, probably due to the action of the drug in the areas of alopecia skin and the improvement of the systemic condition of theanimal. Knowing that the maned wolf is considered as a vulnerable species, it is important to know the diseases that affect this species, in order to carry out, when necessary, disease monitoring programs, preventive and therapies, which is essential for its preservation.Keywords: wild animal, disease, skin, dermatophyte.

Study of base influence on the active pharmaceutical ingredients releasing from combined ointments with antimycotic action

Questions of mycotic diseases therapy keep staying in focus of clinical dermatology interest that is caused first of all by their considerable prevalence for international population. At the same time the dominating pathologies in this area are foot mycosis including skin, foot web space and nail plate affections. Etiotropic pharmacotherapy of foot skin and web spaces is carried out using topical antifungal medications effective against dermatomycetes. Also taking into account the frequent mixt infections, medicines with antibacterial action are desirable. Also topical antifungal medicines for therapy of foot skin mycosis have to satisfy the next requirements as rapid absorbance, safety and usability besides efficacy. Domestic dermatology for these aims has a great pharmacotherapeutical arsenal proposed by 34 semisolid dosage forms, 15 from them are made in Ukraine and the remainder are imported in our country. At the heart of practically all antimycotic medicines for topical therapy of smooth foot skin (as imported so domestic) imidazole and triazole derivatives are used and because of their high value they limit the therapeutical potential of population with low profit. 2-mercaptobenzothiazole is interesting as biologically active component of ointments not only because of broad spectrum of antifungal and antibacterial action but also exceptional hydrophobic characteristics which provide long adhesion even after washing during hygienic procedures. In this connection creating of semisolid dosage forms for the topical treatment of skin integument and interdigital folds with biologically active substances from the group of nonspecific antifungal matters (2-mercaptobenzothiazole, chinosolum) on the base of domestic technologies is actual for modern pharmaceutical and medical science. During creating of semisolid dosage forms for the external use one of the main experimental fragments is a selection of base which provides high consumer characteristics of medicine and its efficacy. The aim of this work is biopharmaceutical validation of rational composition of semisolid dosage form for external use containing the combination of 2-mercaptobenzothiazole and chinosolum. Materials and methods. As a delivery vehicle for developing pharmacotherapeutical medicine the bases widely used in manufacturing of semisolid dosage forms, providing easy “wipe-off effect after application, non-allergic and non-sensibilic after tracing, available for national producer and described in literature were studied. As the active pharmaceutical ingredients for antimycotic ointment 2-mercaptobenzothiazole and chinosolum in concentration 1% and 1% accordingly providing with suitable level of antifungal activity were used. Taking into account the advisability of high dispersion degree of medical substances in semisolid dosage forms for external use and physical-chemical properties of active pharmaceutical ingredients 2-mercaptobenzothiazole was added in all bases after preliminary dissolution in polyethylenoxyde 400 with heating and chinosolum was added after dissolution in prescribed or minimal amount of water. 2-mercaptobenzothiazole and chinosolum releasing from ointment compositions was studied with equilibrium dialysis method by Kruvchinsky at the temperature 32±0,5˚С through the semipermeable film “Kuprofan” in the Franz cell apparatus (producer PermeGear, Inc., USA). As a dialysis medium taking into account 2-mercaptobenzothiazole solubility we used solution containing methanol and water 1:1 and chinosolum releasing was carried out into water. Concentration of active pharmaceutical substances released from experimental ointments after 30 min was determined by spectrophotometric method. Results . The obtained results indicate significant advantage of the hydrophilic ointment bases, which provide an optimal level of release of 2-mercaptobenzothiazole and chinosolum from the experimental composite soft dosage forms for external use. Based on the obtained data, ointment compositions with 2-mercaptobenzothiazole and chinosolum on the basis of sodium carboxymethylcellulose (prescription №1) and methylcellulose (prescription №2) glycerogel were selected for further research. Conclusions. It was established that the sort of base significantly influences on 2-mercaptobenzothiazole and chinosolum releasing from the antimycotic formulations of semisolid dosage forms for external use. Variance analysis of results revealed that delivery vehicles on the base of sodium carboxymethylcellulose and methylcellulose glycerogel provide optimal 2-mercaptobenzothiazole and chinosolum releasing.

Laser Therapies for Onychomycosis in Japan

Various treatment methods other than oral and topical antifungal medications have been employed to treat onychomycosis. Treatment methods include mechanical removal of the affected part of the nail plate by using a toenail cutter or grinder and chemical removal by using occlusive dressing therapy with salicylic acid plaster or urea cream. In recent years, laser therapies have received attention as modalities for treatment of onychomycosis. Favorable outcomes in patients with onychomycosis have been reported in Japan from treatment combining carbon dioxide laser and topical antifungal drug, treatment with photodynamic therapy, and treatment with Nd:YAG laser. However, irradiation conditions, number of irradiation sessions, and efficacy evaluation methods vary among institutions and studies; thus, there is no established evidence to support these outcomes. In addition, a study reported that a combination of Nd:YAG laser and external antifungal drugs was more effective than each of the treatments alone. Future studies are required to provide clinical evidence on the effectiveness of laser therapies, on the enhancement of effect from the combination of laser and external antifungal drugs, and on the possibility of shortening treatment duration using laser therapies in the management of patients with onychomycosis.

Effects of coadministration of vaginal miconazole nitrate on the pharmacokinetics andabsorption of the nestorone and ethinyl estradiol contraceptive vaginal ring

To assess potential interactions of a topical vaginal antifungal medication (miconazole nitrate) on release, pharmacokinetics and absorption of Nestorone (NES) and ethinyl estradiol (EE) from an investigational long-acting (1-year) contraceptive vaginal ring (CVR). A secondary objective was to evaluate safety of the CVR in the presence of antimycotic co-medication.