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- Author or Editor: Maureen B. Jennings x
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Confirmation of Dermatophytes in Nail Specimens Using In-Office Dermatophyte Test Medium Cultures
Insights from a Multispecialty Survey
Using data from a multicenter nationwide multispecialty survey, the authors investigated the efficacy of in-office dermatophyte test medium (DTM) and central laboratory cultures used to confirm onychomycosis across samples collected by podiatric, dermatologic, and primary-care physicians. The samples collected by podiatric physicians were both positive or both negative in 43% and 27% of patients, respectively. Samples harvested by dermatologists were both positive in 37% of patients and both negative in 32%, while the samples collected by primary-care physicians were both positive in 28% of patients and both negative in 38%. The accuracy of DTM and central laboratory tests is dependent on the proper collection of nail samples, and the accuracy of mycologic test results varied significantly across nail specimens harvested by podiatric, dermatologic, and primary-care physicians. DTM culture was found to be an effective and convenient method of confirming dermatophyte infections in patients with signs of onychomycosis. The data presented here indicate that the special expertise of podiatric physicians in treating foot-related illnesses translates into more accurate mycologic testing. (J Am Podiatr Med Assoc 93(3): 195-202, 2003)
Background: Heel pain, bunion pain, and other forms of foot pain syndromes are one of the more common reasons a patient visits a podiatrist. Numerous methods are currently available to attempt to achieve pain relief, including pharmaceuticals, magnets, heat, and electrical stimulation. A textile company developed Pain Checker socks (Pain Checker Health Wear, Cresskill, New Jersey), which contains a material that may counter the circuit of pain and oppose the effect, thereby stopping the conduction of pain.
Methods: The purpose of this placebo-controlled, double-blind clinical trial was to evaluate the safety and efficacy of Pain Checker socks in the treatment of mild-to-moderate foot pain. Fifty patients were enrolled, half on active and half on placebo socks. The subjects were evaluated at baseline, 2, 4, and 6 weeks of treatment.
Results: There was no statistically significant difference in disability, pain, or activity scales between treatment groups, although only 5% of the treatment group received no pain relief on visual analog scale during the trial, while 38% of the placebo group received no pain relief.
Conclusion: Although there was no difference in pain relief, the Pain Checker socks were found to be safe and scored high in patient satisfaction. The unique fiber content and construction of the socks may have contributed to the placebo analgesia. (J Am Podiatr Med Assoc 98(4): 278–282, 2008)
Treatment of Toenail Onychomycosis with Oral Terbinafine Plus Aggressive Debridement
IRON-CLAD, a Large, Randomized, Open-Label, Multicenter Trial
This study was conducted to investigate the efficacy of oral terbinafine with and without aggressive debridement for the treatment of toenail onychomycosis. Onychomycosis patients aged 18 to 75 years received 12 weeks of terbinafine, 250 mg/day, alone (n = 255) or with aggressive debridement (n = 249). Both groups showed marked improvement from baseline at all time points. At week 48, complete, mycologic, and clinical cure rates were higher in the terbinafine plus debridement group compared with the terbinafine alone group, although significance was reached only for clinical cure (59.8% versus 51.4%; P = .023). Although approximately 39% of the patients received at least one antidiabetic, antihypertensive, or cholesterol-lowering agent concomitantly, including statins, the incidence of treatment-emergent adverse events was low and the adverse events were generally mild to moderate in severity. No clinically significant changes in liver transaminase levels were observed 6 weeks after treatment or after 12 weeks in those tested. These results support the well-established safety and efficacy of terbinafine for treatment of onychomycosis. (J Am Podiatr Med Assoc 96(6): 465–473, 2006)
Onychomycosis, by definition, is a mycotic infection of the keratinized tissue of the nail plate. Although it is commonly considered to be caused by one of the dermatotropic fungi, a variety of other organisms have been implicated as etiologic agents in the disease, including some bacteria and yeasts. When it is caused by a fungus, any or all of three types of organisms can be involved: dermatophytes, yeasts, and nondermatophyte organisms. The purpose of this study was to identify the microorganisms found in fungal cultures of clinically suspected onychomycosis in the patient population of the Foot Clinics of New York in New York City, the largest foot clinic in the world. Of the 1,800 medical charts reviewed, 214 had culture results, of which 120 were positive. Trichophyton rubrum was the most prevalent pathogen, found in 67% of positive cultures. The most remarkable risk factor was age, with 80% of affected individuals older than 35 years. False-negatives may account for the high percentage (44%) of negative cultures in this study. (J Am Podiatr Med Assoc 92(6): 327-330, 2002)
Treatment for Simple Plantar Verrucae
Monochloroacetic Acid and 10% Formaldehyde versus 10% Formaldehyde Alone
Verrucae are small, benign, highly vascular epithelial neoplasms that occur singly or in a multiple presentation. Plantar verrucae are usually caused by infection with human papillomavirus types 1, 2, and 4. A clinical trial was conducted to assess the safety and efficacy of monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone in the treatment of simple plantar verrucae. Of 57 patients enrolled in the study, 26 were in the monochloroacetic acid and 10% formaldehyde group and 31 were in the 10% formaldehyde alone group. The overall cure rate for this population was 61.4%. There was no statistically significant difference in the cure rate between treatment groups. (J Am Podiatr Med Assoc 96(1): 53–58, 2006)
Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before initiation of antifungal therapy. Potassium hydroxide preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent studies have suggested that nail plate biopsy with periodic acid–Schiff stain may be a very sensitive technique for the diagnosis of onychomycosis. In this article, we review the literature on the utility of histopathologic analysis in the evaluation of onychomycosis. Many of these studies indicate that biopsy with periodic acid–Schiff is the most sensitive method for diagnosing onychomycosis. We propose that histopathologic examination is indicated if the results of other methods are negative and clinical suspicion is high; therefore, it is a useful complementary technique in the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 95(3): 258–263, 2005)
Xerotic skin is a pattern of reaction to a variety of disorders that have abnormalities of desquamation in common. This double-blind, randomized clinical trial investigated the effect of Lactinol (Pedinol Pharmaceuticals, Farmingdale, New York) versus Lac-Hydrin 12% (Bristol-Myers Squibb, Princeton, New Jersey) lotion in mild to moderate foot xerosis. Clinical assessment of xerosis was performed at baseline visit, and the designated sites were evaluated at 2 and 4 weeks after treatment began. Of the 53 patients enrolled, 18 were excluded from analysis. Although both treatment groups had significantly improved xerosis scores after 2 and 4 weeks of treatment, no statistically significant difference was observed. Of the 44% of patients who did express a preference, 72% preferred Lactinol, which may account for the 20% increase in its overall use in the study. (J Am Podiatr Med Assoc 92(3): 143-148, 2002)
Background: The purpose of this study was to ascertain public perception of the terms podiatry and DPM.
Methods: We distributed a survey to 847 people in ten states across the United States. It was hypothesized that most respondents would be less familiar with the DPM degree than the term podiatrist. It was also expected that people would choose MD over DPM for more complex procedures.
Results: The majority of respondents selected a podiatrist and a DPM as a foot specialist, almost one-half selected DPM for foot surgery, but only one-third stated they would have foot surgery done by a DPM if they had a heart problem. In addition, it was hypothesized that respondents would choose the contrived PMD over DPM simply because PMD looks more like MD; this was not shown to be true.
Conclusions: Although there are gaps in the public knowledge, our study revealed a greater familiarity with podiatry and the DPM degree than originally thought. (J Am Podiatr Med Assoc 99(3): 223–231, 2009)
