• 1

    Saner MV, Kulkarni AD, Pardeshi CV: Insights into drug delivery across the nail plate barrier. J Drug Target 22: 769, 2014.

  • 2

    Kaur R, Kashyap B, Bhalla P: Onychomycosis—epidemiology, diagnosis and management. Indian J Med Microbiol 26: 108, 2008.

  • 3

    Gupta AK, Drummond-Main C, Cooper EA, et al.: Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 66: 494, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Sigurgeirsson B, Baran R: The prevalence of onychomycosis in the globalpopulation—a literature study. J Eur Acad Dermatol Venereol 28: 1480, 2013.

  • 5

    Lipner SR, Scher RK: Onychomycosis: clinical overview and diagnosis. J Am Acad Dermatol 80: 835, 2019.

  • 6

    Bunyaratavej S, Leeyaphan C, Rujitharanawong C, et al.: Efficacy of 5% amorolfine nail lacquer in Neoscytalidium dimidiatum onychomycosis. J Dermatolog Treat 27: 359, 2016.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Bunyaratavej S, Wanitphakdeedecha R, Ungaksornpairote C, et al.: Randomized controlled trial comparing long-pulsed 1064-Nm neodymium: yttrium-aluminum-garnet laser alone, topical amorolfine nail lacquer alone, and a combination for nondermatophyte onychomycosis treatment. J Cosmet Dermatol 19: 2333, 2020.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Muthupalaniappen L, Nizam T, Adawiah J: Common microorganisms causing onychomycosis in tropical climate. Sains Malaysiana 41: 697, 2012.

    • Search Google Scholar
    • Export Citation
  • 9

    Leeyaphan C, Phaitoonwattanakij S, Kiratiwongwan R, et al.: Survey and comparison of clinical and laboratory findings among subjects with fingernail and toenail onychomycosis. Southeast Asian J Trop Med Public Health 51: 528, 2020.

    • Search Google Scholar
    • Export Citation
  • 10

    Bunyaratavej S, Limphoka P, Kiratiwongwan R, et al.: Eclipsed phenomenon: the relationship between nail and foot infections in patients presenting with nondermatophyte infections after dermatophyte infections in onychomycosis. Br J Dermatol 183: 158, 2020.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Ungpakorn R, Lohaprathan S, Reangchainam S: Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand. Clin Exp Dermatol 29: 87, 2004.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Gupta AK, Simpson FC: New therapeutic options for onychomycosis. Expert Opin Pharmacother 13: 1131, 2012.

  • 13

    Di Chiacchio N, Kadunc BV, de Almeida AR, et al.: Nail abrasion. J Cosmet Dermatol 2: 150, 2003.

  • 14

    Aggarwal R, Targhotra M, Kumar B, et al.: Treatment and management strategies of onychomycosis. J Mycol Med 30: 100949, 2020.

  • 15

    Lee JI, Lee YB, Oh ST, et al.: A clinical study of 35 cases of pincer nails. Ann Dermatol 23: 417, 2011.

  • 16

    Tinley PD, Eddy K, Collier P: Contaminants in human nail dust: an occupational hazard in podiatry? J Foot Ankle Res 7: 15, 2014.

  • 17

    Abramson C, Wilton J: Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984. JAPMA 82: 111, 1992.

    • Search Google Scholar
    • Export Citation
  • 18

    Burrow JG, McLarnon NA: World at work: evidence based risk management of nail dust in chiropodists and podiatrists. Occup Environ Med 63: 713, 2006.

  • 19

    Leelavathi M, Tzar M: Brief report: nail sampling technique and its interpretation. Malays Fam Physician 6: 58, 2011.

  • 20

    Olander L, Conroy L, Kulmala I, et al.: “Local ventilation,” in Industrial Ventilation Design Guidebook, edited by H Goodfellow, E Tähti, p 807, Academic Press, San Diego, 2001.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Centers for Disease Control and Prevention: “Primary Containment for Biohazards: Selection, Installation and Use of Biological Safety Cabinets,” in Biosafety in Microbiological and Biomedical Laboratories, 5th Edition, edited by D Wilson, L Chosewood, p 290, Washington, DC, National Institutes of Health, 2009.

    • Search Google Scholar
    • Export Citation
  • 22

    Donaldson C, Carline T, Brown D, et al.: Toenail dust particles: a potential inhalation hazard to podiatrists? Ann Occup Hyg 46: 365, 2020.

  • 23

    Purkiss R: An assessment of the airborne dust in podiatric treatment areas, and its relevance to the use of respiratory protective equipment. J Br Podiatr Med 52: 129, 1997.

    • Search Google Scholar
    • Export Citation
  • 24

    Coggins MA, Hogan VJ, Kelly M, et al.: Workplace exposure to bioaerosols in podiatry clinics. Ann Occup Hyg 56: 746, 2012.

  • 25

    Hassan Al-abdalall A, Abdullah Al-dakheel S, Abdulhadi Al-Abkari H: “Impact of Air-Conditioning Filters on Microbial Growth and Indoor Air Pollution,” in Energy-Efficient and Sustainable Buildings, London, UK, IntechOpen, 2019.

    • Search Google Scholar
    • Export Citation
  • 26

    Paramonova E, Zerfoss EL, Logan BE: Measurement of biocolloid collision efficiencies for granular activated carbon by use of a two-layer filtration model. Appl Environ Microbiol 72: 5190, 2006.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Efficacy of a Newly Developed Inward Airflow Safety Cabinet to Prevent the Spread of Infected Nail Dust Particles During Mechanical Nail Reduction in Onychomycosis

View More View Less
  • 1 Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, Thailand.
Restricted access

Background: Nail thickening is a poor prognostic factor in onychomycosis. Mechanical reduction by micromotor nail grinding is an alternative treatment for onychomycosis. However, this treatment introduces a large amount of infected nail dust particles into the air and can adversely affect other patients and health-care providers. The innovative recirculating airflow safety cabinet (ASC) was developed to prevent the spread of these generated infected nail dust particles. The aim of this study was to determine the efficacy of the ASC in patients with onychomycosis or traumatic onychodystrophy.

Methods: The ASC was used during the nail-grinding process in 50 patients, including 36 onychomycosis patients and 14 traumatic onychodystrophy patients. For each patient, five Sabouraud dextrose agar plates with chloramphenicol were positioned within the working space of the ASC, and the other five plates were positioned near the area of air exit after the carbon filters within the cabinet. A total of 500 plates were incubated at 25°C and evaluated every 7 days. The results of fungal cultures were analyzed.

Results: In the traumatic onychodystrophy group, all fungal cultures of nail dust particles from both before and after filtration from the ASC were negative in all 14 patients. In the onychomycosis group, 52 fungal cultures (28.9%) from nail particles within the ASC working area tested positive; however, the results of fungal cultures of nail dust particles after filtration were all negative.

Conclusions: The newly developed ASC was found to be effective for preventing the spread of infected nail dust particles generated by micromotor nail grinding to mechanically reduce nail thickness in patients with onychomycosis.

Corresponding author: Waranyoo Prasong, BSc, Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700 Thailand. (E-mail: waranyoo.ps@hotmail.com)