Skip to main content
SpringerLink
Log in

Onychomycosis Due to Neoscytalidium Treated with Oral Terbinafine, Ciclopirox Nail Lacquer and Nail Abrasion: A Pilot Study of 25 Patients

  • Published:
Mycopathologia Aims and scope Submit manuscript

Abstract

Background

Onychomycosis by Neoscytalidium constitutes chronic infection of the nails, and its frequency has increased in recent decades. Currently, no effective standard treatment exists and literature data remain scarce. This work aimed to conduct a pilot project of combined treatment for this infection.

Methods

Thirty patients were divided into three treatment groups: oral terbinafine plus ciclopirox nail lacquer twice a week; ciclopirox nail lacquer twice a week; and ciclopirox nail lacquer 5 days a week, all associated with nail abrasion when required, for 12 months, with 6 months posttreatment follow-up. Clinical and mycological criteria were used for evaluation.

Results

Twenty-five patients completed the study. Significant clinical lesion reduction in disease occurred in all three treatment groups: 21 patients (84 %) entered the study with more than 50 % of diseased nail plate, at the end of treatment, and at 6-month follow-up, 84 and 96 %, respectively, presented less than 25 % nail lesion. Negative microscopy was observed in 36 % of the patients at the end of treatment and in 24 % of the patients at 6-month follow-up. At treatment completion (12 months), culture was negative in 21 patients (84 %) and in 18 (72 %) at follow-up. It was not possible to establish any clinical or mycological statistical differences between groups (p > 0.05). Global medical evaluation upon treatment completion revealed that one patient (4 %) presented complete cure, 8 (32 %) presented partial cure, 16 (64 %) presented therapeutic failure. At the end of follow-up period, 6 patients (24 %) were considered to have recurrence/reinfection.

Conclusions

The results obtained at the 6-month period of follow-up showed marked improvement (96 % of clinical improvement and 72 % of negative culture) of the patients treated for onychomycosis caused by Neoscytalidium in the three tested groups with no statistical differences between them. Multicentric studies with greater number of patients enrolled are necessary to confirm these results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ellis DH, Marley JE, Watson AB, Williams TG. Significance of non-dermatophyte moulds and yeast in onychomycosis. Dermatology. 1997;194:40–2.

    Article  PubMed  Google Scholar 

  2. Gupta AK, Jain HC, Lynde CW, MacDonald P, et al. Prevalence and epidemiology of onychomycosis in patients visiting physicians offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol. 2000;43:244–8.

    Article  PubMed  CAS  Google Scholar 

  3. Ellis DH, Watson AB, Marley JE, Williams TG. Non-dermatophyte in onychomycosis of the toenails. Br J Dermatol. 1997;136:490–3.

    Article  PubMed  CAS  Google Scholar 

  4. Pavlovic MD, Bulajic N, Huntley AC. Great toenail onychomycosis caused by Syncephalastrum racemosum. Dermatol Online J. 2006;12(1) From Dermatology Online Journal www.medscape.com Accessed: 03 Feb 2006.

  5. Lacroix C, Kac G, Dubertret L, Morel P, et al. Scytalidiosis in Paris. France J Am Acad Dermatol. 2003;48:852–6.

    Article  Google Scholar 

  6. Araújo AJG, Bastos OMP, Sousa MAJ, Oliveira JC. Occurrence of onychomycosis among patients attended in dermatology offices in the city of Rio de Janeiro. An Bras Dermatol. 2003;78(3):445–55.

    Article  Google Scholar 

  7. Crous PW, Slippers B, Wingfield MJ, Rheeder J, et al. Phylogenetic lineages in the Botryosphaeriaceae. Stud Mycol. 2006;55:235–53.

    Article  PubMed  Google Scholar 

  8. Madrid H, Ruíz-Cendoya M, Cano J, Stchigel A, Orofino R, Guarro J. Genotyping and in vitro antifungal susceptibility of Neoscytalidium dimidiatum isolates from different origins. Int J Antimicrob Agents. 2009;34:351–4.

    Article  PubMed  CAS  Google Scholar 

  9. Tosti A, Peraccini BM, Lorenzi S. Onychomycosis caused by non-dermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217–24.

    Article  PubMed  CAS  Google Scholar 

  10. Elewski BE, Greer DL. Hendersonula toruloidea and Scytalidium hyalinum. Arch Dermatol. 1991;127:1041–4.

    Article  PubMed  CAS  Google Scholar 

  11. Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of non-dermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;66:494–502.

    Article  PubMed  Google Scholar 

  12. Di Chiachio N, Kadunc BV, De Almeida ART, Madeira CL. Nail abrasion. J Cosmet Dermatol. 2003;2:150–2.

    Article  Google Scholar 

  13. Cursi IB, Freitas LBCR, Neves MLP, Silva IC, Orofino-Costa R. Onychomycosis due to Scytalidium spp.: a clinical and epidemiologic study at a University Hospital in Rio de Janeiro. An Bras Dermatol. 2011;86(4):689–93.

    Article  PubMed  Google Scholar 

  14. Belloeuf L, Boisseau-Garsaud AM, et al. Nail disease due to Scytalidium in martinique (French West Indies). Ann Dermatol Venereol. 2004;13:245–9.

    Article  Google Scholar 

  15. Baran R, Kaoukhov A. Topical antifungal drugs for the treatment of onychomycosis: an overview of current strategies for monotherapy and combination therapy. J Eur Acad Dermatol Venereol. 2004;19:21–9.

    Article  Google Scholar 

  16. Simonnet C, Berger F, Gantier JC. Epidemiology of superficial fungal diseases in French Guiana: a three-year retrospective analysis. Med Mycol. 2011;49:608–11.

    PubMed  Google Scholar 

  17. Lacroix C, de Chauvin MF. In vitro activity of amphotericin B, itraconazole, voriconazole, posaconazole, caspofungin and terbinafina against Scytalidium dimidiatum and Scytalidium hyalinum clinical isolates. J Antimicrob Chemother. 2008;61:835–7.

    Article  PubMed  CAS  Google Scholar 

  18. Dunand J, Paugam A. In vitro susceptibility of isolates of Scytalidium spp. from superficial lesions against posaconazole. Pathol Biol (Paris). 2008;56:268–71.

    Article  CAS  Google Scholar 

  19. Elinav H, Izhar U, Benenson S, Admon D, Hidalgo-Grass C, Polacheck I, Korem M. Invasive Scytalidium dimidiatum infection in an immunocompetent adult. J Clin Microbiol. 2009;47(4):1259–63.

    Article  PubMed  Google Scholar 

  20. Ikram A, Hussain W, Satti ML, Wiqar MA. Invasive infection in a young immunocompetent soldier caused by Scytalidium dimidiatum. J Coll Physicians Surg Pak. 2009;19(1):64–6.

    PubMed  Google Scholar 

  21. Ruíz-Cendoya M, Madrid H, Pastor FJ, Mayayo E, Mariné M, Guarro J. Development of murine models of disseminated infection by Neoscytalidium dimidiatum. Med Mycol. 2010;48:681–6.

    Article  PubMed  Google Scholar 

  22. Gupta AK, Ryder JE, Summerbell RC. The diagnosis of non-dermatophyte mold onychomycosis. Int J Dermatol. 2003;42:272–3.

    Article  PubMed  Google Scholar 

  23. Arrese JE, Piérard-Franchimont C, Piérard GE. Scytalidium dimidiatum melanonychia and scaly plantar skin in four patients from the Maghreb: imported disease or outbreak in a Belgian mosque? Dermatology. 2001;202:183–5.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflict of interest

Authors have no relationship with industry for this study.

Author information

Authors and Affiliations

  1. Dermatology Department, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Avenida 28 de Setembro, 87, 2° andar Vila Isabel, Rio de Janeiro, RJ, CEP: 20551-030, Brazil

    Ígor B. Cursi, Roberta Teixeira Silva, Isabella Brasil Succi, Andréa R. Bernardes-Engemann & Rosane Orofino-Costa

Authors
  1. Ígor B. Cursi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberta Teixeira Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Isabella Brasil Succi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andréa R. Bernardes-Engemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rosane Orofino-Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rosane Orofino-Costa.

Additional information

This study was conducted at Medical Mycology Laboratory, Pedro Ernesto University Hospital, Universidade do Estado do Rio de Janeiro.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cursi, Í.B., Silva, R.T., Succi, I.B. et al. Onychomycosis Due to Neoscytalidium Treated with Oral Terbinafine, Ciclopirox Nail Lacquer and Nail Abrasion: A Pilot Study of 25 Patients. Mycopathologia 175, 75–82 (2013). https://doi.org/10.1007/s11046-012-9580-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11046-012-9580-5

Keywords

Search

Navigation