clobetasol and Onychomycosis

Despite the important nail alterations caused by onychomycosis and psoriasis few studies have characterized the microstructure of the diseased nail plate and the diffusion and penetration of drugs through this altered structure. This work aimed to characterize the microstructure of the healthy, onychomycotic and psoriatic human nail using Raman spectroscopy, scanning electron microscopy, optical microscope profilometry and mercury intrusion porosimetry followed by analysis of the structure with PoreCor® software. The results showed that onychomycotic nails have higher porosity and lower amounts of disulphide bonds compared to healthy nails. This suggests that the presence and action of fungi on the nail plate makes this structure more permeable to water and drugs. Psoriatic nails had increased porosity compared to healthy nails but lower than fungal infected specimens. In vitro permeation studies showed that diseased nails were more permeable to ciclopirox (onychomycosis) and clobetasol (psoriasis) although drug permeation was highly variable and likely to be influenced by the degree of alteration of the nail structure. On the whole, this work provides new and valuable information about the microstructure and porosity of diseased nails and a plausible explanation of the increased drug permeability observed in this work and elsewhere.

Topics: Administration, Topical; Adult; Antifungal Agents; Ciclopirox; Clobetasol; Foot Dermatoses; Healthy Volunteers; Humans; Image Processing, Computer-Assisted; Microscopy, Electron, Scanning; Middle Aged; Nails; Onychomycosis; Permeability; Porosity; Psoriasis; Pyridones; Software; Spectrum Analysis, Raman

Terbinafine, a systemic antifungal commonly prescribed for onychomycosis (fungal infection involving the nails) has been reported to cause various cutaneous adverse effects. We describe an overlap syndrome between cutaneous lupus and erythaema multiforme induced by this medication with a review of other reported cases.

Topics: Aged, 80 and over; Anti-Inflammatory Agents; Antifungal Agents; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Erythema Multiforme; Female; Humans; Lupus Erythematosus, Cutaneous; Naphthalenes; Ointments; Onychomycosis; Syndrome; Terbinafine; Treatment Outcome

Acute generalized exanthematous pustulosis (AGEP) is a febrile pustular drug eruption. Terbinafine, an allylamine fungicidial agent, is the most common anti-mycotic associated with AGEP. Here, we report a case of terbinafine-induced AGEP that was recalcitrant to oral corticosteroid but responsive to high-dose intravenous corticosteroid.

Topics: Acute Generalized Exanthematous Pustulosis; Anti-Inflammatory Agents; Antifungal Agents; Clobetasol; Diphenhydramine; Fatigue; Female; Humans; Immunosuppressive Agents; Infusions, Intravenous; Methylprednisolone; Middle Aged; Naphthalenes; Onychomycosis; Pain; Prednisone; Terbinafine