Search Results (74)

Toenail onychomycosis causes significant problems in public health and is more common among the elderly and immune-compromised populations. A previous culture-based survey of communal finely ground toenails from the east coast of Australia isolated 125 T. interdigitale but only one T. rubrum. This paucity of T. rubrum was surprising because it is one of the most common dermatophytes isolated worldwide. Our aim was to find out if T. rubrum was present but not cultured. DNA was extracted from ground toenails from the same samples. New specific primers were designed for the ITS region of T. rubrum that excluded T. interdigitale and vice versa. PCR with these new primers found T. rubrum as well as T. interdigitale in all ground toenail samples. This suggests that T. rubrum was present and common in the ground toenails. It was possibly missed by culture because it grows slowly and was overgrown by T. interdigitale and non-dermatophyte moulds. Alternatively, its viability may have declined earlier, during collection, treatment, or storage of the ground toenails. This has implications for studies of clinical materials, especially nails, as infection by T. rubrum (the most common dermatophyte) may be missed by culture, the main method used in pathology laboratories. Full article

Giant Paleogene groundbirds named Gastornis have long been known from Europe, with similar fossils from North America being placed in the genus Diatryma. A more recent discovery in China is evidence that these birds had wide geographic distribution. The name Gastornis is now generally considered to be the name that has historical precedence. Historically, Gastornis has been interpreted as being a fierce predator, but anatomical and isotopic evidence suggests that the giant birds were herbivores. Gastornithid tracks preserved in Lower Eocene fluvial sediments of the Chuckanut Formation in northwest Washington State, USA, support the herbivore interpretation. These tridactyl footprints preserve broad triangular toenails rather than talons. The Chuckanut Formation gastornithid tracks have been given the ichnotaxonomic name Rivavipes giganteus Mustoe et al. (2012). In 2024, two important new discoveries were made. These are a trackway that preserves three adult tracks, and two tracks left by a gastornithid chick.The adult bird trackway has stride and pace distances that are consistent with the short lower limb bones (tarsometatarsals) observed in Gastornis skeletal remains. The reproductive strategies of gastornithids remain enigmatic; the evidence consists of numerous egg shell fragments found at sites in France and the newly discovered Chuckanut tracks. Full article

Onychomycosis is a fungal nail infection which has a considerable impact on the quality of life of patients. The aim of this study was to analyze onychomycosis cases with respect to fungal species, infection sites, and patient demographics such as age and sex. Furthermore, we assessed whether simple clinical and demographic data could predict positive results for mycological culture. A retrospective analysis of 2722 patients who had nail samples investigated with direct microscopy and mycological culture was performed. The fungi most frequently identified were Trichophyton rubrum in the toenails and Candida albicans in the fingernails, with a detailed incidence varying by age and sex. Predictive models, including logistic regression and k-nearest neighbors, did not provide clinically useful accuracy. Therefore, it is necessary to perform confirmatory diagnostics before starting antifungal treatment. Full article

Background/Objectives: Selumetinib, a MEK1/2 inhibitor, is commonly used for treating neurofibromatosis type 1 (NF1) and is associated with cutaneous side effects such as paronychia and periungual granulomas. These complications can be painful and difficult to manage, often leading to the discontinuation of treatment. The objective of this study was to evaluate the effectiveness of photodynamic therapy (PDT) as a novel treatment for MEKi-induced paronychia in a patient with NF1. Methods: We present a case report of an 18-year-old patient with NF1 who developed painful periungual granulomas on the toenails after 12 months of Selumetinib therapy. PDT was administered using methyl aminolevulinate (METVIX^®) as the photosensitizing agent, followed by treatment with a red LED light source (630 nm, 37 J/cm² for 8 min and 30 s). The patient was followed up for two months post-treatment and then at two years. Results: After a single PDT session, the patient exhibited complete clinical remission of the periungual granulomas and associated pain. No recurrence of the lesions was noted during the two-year follow-up. The patient tolerated the procedure well, reporting only mild discomfort during treatment. Conclusions: PDT appears to be an effective, minimally invasive treatment for Selumetinib-induced paronychia and periungual granulomas. This case demonstrates that PDT can provide a complete resolution of symptoms with a single treatment session, offering an alternative to more invasive procedures. Further studies with larger cohorts are needed to establish PDT as a standard treatment option for this condition. Full article

Huelva is a city in SW Spain with 150,000 inhabitants, located in the proximity of two heavy chemical industry complexes, the highest naturally occurring radioactive material (NORM) waste (phosphogypsum) stacks of Europe and a highly polluted estuary, with elevated cardiovascular disease and cancer mortality rates. This study analyses the association between cumulated exposure levels to 16 metal(loid)s (Al, As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Se, Tl, U, V, and Zn) measured in the toenail of a sample (n = 55 participants) of the general control population of Huelva City who were involved in the MCC-Spain study and the spatial proximity patterns to the local polluting sources. Residents of the city of Huelva have higher levels of Fe, Ni, Cr, Se, As, and Co in their toenails compared to the levels found in populations with similar characteristics living in non-polluted areas. Moreover, the highest concentrations of As, Pb, Cd, Mo, and Se were found in toenails of participants living near the NORM waste stack, while the highest Cu, Zn, and Al contents corresponded to people residing near the industrial area. The spatial distribution of most of the metal(loid)s studied appears to be mainly controlled by anthropogenic factors. Full article

Background/Objectives: In an 18- to 24-month Treatment Phase with once-daily efinaconazole 10% solution, subjects with onychomycosis showed an increased rate of cure at Month 24 versus the phase III trials. In order to further improve efficacy, we initiated an extended intermittent efinaconazole Maintenance Phase with use 2–3 times weekly for an additional 24 months from Month 24 to Month 48. These are the first data presented for a 48-month efinaconazole use period. Methods: For patients completing 18–24 months of once-daily efinaconazole, the target great toenail from the Treatment Phase was graded as ‘Clinical Cure’ (≤10% affected area) or ‘No Clinical Cure’ (>10% affected area) at Month 24. Mycological and clinical outcomes were assessed every 4 months from Month 24 to Month 48. There were 35 patients who enrolled in the extension and continued intermittent efinaconazole use to Month 48. Patients with ‘Clinical Cure’ at M24 were reviewed for sustained cure at M48; patients with ‘No Clinical Cure’ were reviewed for development of ‘Cure’ at M48. All patients were reviewed at all visits for adverse events that may be related to efinaconazole use. Results: ‘Clinical Cure’ was found in 6 of 35 enrolled patients at Month 24, and clinical cure status was sustained to Month 48 with intermittent efinaconazole maintenance use. For 29 patients with ‘No Clinical Cure’, 3/29 achieved ‘Clinical Cure’ status at Month 48 with intermittent efinaconazole. Effective Cure and Complete Cure rates improved over the maintenance period to Month 48 in subjects without clinical cure at Month 24. Younger patients showed higher cure rates over the maintenance period, but age group cure differences did not reach statistical significance in this dataset, and 49% of the ≥70-year population had at least a 20% reduction in nail area with maintenance therapy to Month 48. There was only 1 case of possible efinaconazole application site reaction in the Intermittent Maintenance Period to Month 48; prolonged efinaconazole use to Month 48 does not appear to increase the risk of reaction. Efinaconazole use periods are associated with very low positive culture rates in this dataset, including typical contaminant organisms, suggesting efinaconazole presence in the nail plate is providing prophylactic therapy. Conclusions: Intermittent efinaconazole may provide suitable prophylaxis of onychomycosis relapse. Prolonged efinaconazole therapy to Month 48 appears to be safe for all ages and can continue to provide prophylaxis of onychomycosis with Intermittent Maintenance use beyond Month 24 to Month 48. Full article

Human nails have recently become a sample of interest for toxicological purposes. Multiple studies have proven the ability to detect various analytes within the keratin matrix of the nail. The analyte of interest in this study is fentanyl, a highly dangerous and abused drug in recent decades. In this proof-of-concept study, ATR–FTIR was combined with machine learning methods, which are effective in detecting and differentiating fentanyl in samples, to explore whether nail samples are distinguishable from individuals who have used fentanyl and those who have not. PLS-DA and SVM-DA prediction models were created for this study and had an overall accuracy rate of 84.8% and 81.4%, respectively. Notably, when classification was considered at the donor level—i.e., determining whether the donor of the nail sample was using fentanyl—all donors were correctly classified. These results show that ATR–FTIR spectroscopy in combination with machine learning can effectively differentiate donors who have used fentanyl and those who have not and that human nails are a viable sample matrix for toxicology. Full article

Onychomycosis is a common fungal infection that affects the nails and accounts for approximately 50% of all nail diseases. The main pathogens involved include dermatophytes, such as Trichophyton rubrum, members of the T. mentagrophytes complex, and emerging pathogens in this infection, T. schoenleinii and T. tonsurans. Tea tree (Melaleuca alternifolia Cheel) essential oil (EO) has been proposed as a promising natural alternative to traditional treatments due to its antimicrobial properties. Among its more than 100 compounds, terpinen-4-ol is one of the main contributors to the antifungal action of this EO. To determine the antifungal activity of tea tree EO against dermatophytes, we designed an in vitro study using EUCAST-AFST protocols to obtain the values of MIC (minimum inhibitory concentration) and MFC (minimum fungicidal concentration) of several commercial M. alternifolia Cheel EOs against three species of dermatophytes isolated from clinical samples with suspected toenail onychomycosis. The results showed that the microorganism most sensitive to the action of the EO was T. rubrum, which had an MIC value more than 13 times lower than the value obtained for T. schoenleinii (0.4% v/v), the most resistant isolate. No differences in antifungal activity were observed by the analysed EOs or between the MIC and MFC values. These in vitro results suggest that tea tree EO is a viable option for the alternative treatment of onychomycosis, although clinical studies are needed to confirm the long-term antifungal activity, safety and efficacy of the oils studied in a clinical context. Full article

Prostate cancer is a common cancer among males in the US, but little is known about its risk factors, including trace elements. The primary aim of this study was to examine prostate cancer and its association with arsenic and selenium in toenails. We conducted a small, nested case-control study of men residing in Iowa within the Agricultural Health Study cohort, where we also collected toenail samples to test for arsenic and other trace elements. Toenail samples were sent for neutron activation analysis aimed at long-lived trace elements, including arsenic. Logistic regression was used to estimate odds ratios (ORs) for trace element exposures and prostate cancer. A total of 66 prostate cancer cases and 173 healthy controls returned questionnaires, over 99% of which included toenail samples. An increased risk was seen for the highest levels of arsenic (OR = 3.4 confidence interval (CI) of 1.3–8.6 and OR = 2.2, 95% CI of 0.9–5.6) and the highest level of selenium (2.0, 95% CI of 1.0–4.0). These data also show detectable levels of over 50% for 14 of 22 elements detected in the toenails. The association seen here with arsenic and prostate cancer further supports ecological studies finding an association with community levels of arsenic and prostate cancer incidence and mortality. Full article

Introduction: We assessed the impact on metal levels of seafood, mollusk and fish consumption (SMFc) before urine and toenail sample donation among workers exposed to metals. Methods: This is a cross-sectional epidemiological study with 101 workers from the chemical and metal industry and 40 unexposed workers from the services sector. We measured urinary (As, Ba, Be, Cd, Co, Cu, Hg, Li, Mo, Pb, Se, Sr, Tl, V, W and Zn) and toenail (same plus Al, Cr, Fe, Mn, Ni and U) metal levels. Results: Urinary arsenic levels were higher among workers eating seafood or mollusks (102 ppm vs. 55.4 ppm; p = 0.042) or fish (109 ppm vs. 48 ppm; p = 0.007) 8 h before sample donation. Urinary mercury was associated with consumption of blue fish (11.865 ppm) and canned sardines (19.125 ppm) (p = 0.028). With respect to toenails, fish consumption was associated with aluminum (17 ppm vs. 8.6 ppm; p = 0.012) and beryllium (5 ppb vs. 1 ppb; p = 0.017). Arsenic urinary levels were associated with numbers of hours prior to sample collection since latest SMFc (p = 0.001). Conclusion: Among workers exposed to metals, seafood, mollusk and fish consumption is an important determinant of urinary arsenic levels, as sea fish for urinary mercury, but not for other metals. Full article

Introduction: Efinaconazole 10% topical solution labeling for onychomycosis describes phase III trials of 12 months of treatment; the slow growth of onychomycotic nails suggests a longer treatment period may increase efficacy. We present here the first evaluation of extended use of efinaconazole 10% topical solution for up to 24 months. Materials and Methods: Enrolled patients (n = 101) had one target great toenail with mild to moderate distal lateral subungual onychomycosis and applied efinaconazole 10% topical solution to all affected toenails once daily for 18 months (EFN18) or 24 months (EFN24). Efficacy and safety were evaluated at each visit by visual review and mycology sampling. Results: Regarding the target toenail for patients treated for 24 months (EFN24), mycological cure (negative microscopy and culture) was 66.0% at Month 12, increasing to 71.7% at Month 24; effective cure (mycological cure and ≤10% affected nail) was 13.2% at Month 12, rising to 22.6% at Month 24. Mild to moderate application site reactions (symptoms of erythema/scaling) were the only efinaconazole-related reactions, in eight patients (7.9%). No systemic efinaconazole events or drug interactions were found. Patients aged 70 years or more had similar efficacy to younger patients at all time periods and did not show any increased treatment risks. Thinner nails exhibited better clearance versus thicker nails. A higher proportion of patients with Trichophyton mentagrophytes complex infection experienced application site reactions (35.7%), and a higher effective cure was found at Month 24 versus T. rubrum patients. Conclusion: There is a trend of increasing mycological cure and effective cure beyond Month 12 to Month 24, without an increased safety risk. The enrolled population in this trial was significantly older than in the phase III trials, with a greater degree of onychomycosis severity; however, increased age did not appear to reduce the chance of efficacy to Month 24 in this study. Our data suggest that lack of ability to clear nail dystrophy remains a significant problem for patients, rather than any lack of efinaconazole action over long-term treatment periods. Full article

Deviation of the nail plate in the transverse plane has traditionally been regarded as a postoperative complication following the definitive surgical treatment of ingrown toenails, particularly when only a single nail fold is addressed. The quantification and longitudinal comparison of the operated versus non-operated nail folds could elucidate potential transverse deviations of the nail plate. The objective of this study was to assess the presence or absence of transverse nail plate deviation following ingrown toenail surgery on a single nail fold. Methods: A cohort of 11 patients (three males, eight females) with recurrent ingrown toenails undergoing unilateral partial matricectomy were included in this study. Preoperative measurements were compared to those taken at 7, 14, 21, 28, and 35 days postoperatively. Results: The analysis revealed no statistically significant differences in measurements between the operated and non-operated nail folds, nor were there significant changes in the measurements over time within each group (p > 0.05). Conclusions: Despite the absence of visible deviations in the orientation of the nail plate, the angular measurements post-surgery at 35 days showed no statistically significant alterations. The angular values observed across all time points appeared to be influenced by the intrinsic morphological characteristics of each nail plate. Full article

Introduction: It has long been accepted that trauma is one of the most important and frequent predisposing factors for onychomycoses. However, the role of direct trauma in the pathogenesis of fungal nail infections has only recently been elucidated in a series of 32 cases of post-traumatic single-digit onychomycosis. The importance of repeated trauma due to foot and toe abnormalities was rarely investigated. Aimof the study: This is a multicenter single-author observational study over a period of 6 years performed at specialized nail clinics in three countries. All patient photographs taken by the author during this period were screened for toenail alterations, and all toe onychomycosis cases were checked for whether they contained enough information to evaluate potential foot and toe abnormalities. Particular attention was paid to the presence of hallux valgus, hallux valgus interphalangeus, hallux erectus, inward rotation of the big toe, and outward rotation of the little toe, as well as splay foot. Only cases with unequivocal proof of fungal nail infection by either histopathology, mycologic culture, or polymerase chain reaction (PCR) were accepted. Results: Of 1653 cases, 185 were onychomycoses, proven by mycologic culture, PCR, or histopathology. Of these, 179 involved at least one big toenail, and 6 affected one or more lesser toenails. Three patients consulted us for another toenail disease, and onychomycosis was diagnosed as a second disease. Eight patients had a pronounced tinea pedum. Relatively few patients had a normal big toe position (n = 9). Most of the cases had a mild to marked hallux valgus (HV) (105) and a hallux valgus interphalangeus (HVI) (143), while hallux erectus was observed in 43 patients, and the combination of HV and HVI was observed 83 times. Discussion: The very high percentage of foot and toe deformations was surprising. It may be hypothesized that this is not only a pathogenetically important factor but may also play an important role in the localization of the fungal infection, as no marked hallux deviation was noted in onychomycoses that affected the lesser toes only. As the management of onychomycoses is a complex procedure involving the exact diagnosis with a determination of the pathogenic fungus, the nail growth rate, the type of onychomycosis, its duration, and predisposing factors, anomalies of the toe position may be important. Among the most commonly mentioned predisposing factors are peripheral circulatory insufficiency, venous stasis, peripheral neuropathy, immune deficiency, and iatrogenic immunosuppression, whereas foot problems are not given enough attention. Unfortunately, many of these predisposing and aggravating factors are difficult to treat or correct. Generally, when explaining the treatment of onychomycoses to patients, the importance of these orthopedic alterations is not or only insufficiently discussed. In view of the problems encountered with the treatment of toenail mycoses, this attitude should be changed in order to make the patient understand why there is such a low cure rate despite excellent minimal inhibitory drug concentrations in the laboratory. Full article

Background: Long-distance running is popular but associated with a high risk of injuries, particularly toe-related injuries. Limited research has focused on preventive measures, prompting exploration into the efficacy of raised toe box running shoes. Purpose: This study aimed to investigate the effect of running shoes with raised toe boxes on preventing toe injuries caused by distance running. Methods: A randomized crossover design involved 25 male marathon runners (height: 1.70 ± 0.02 m, weight: 62.6 + 4.5 kg) wearing both raised toe box (extended by 8 mm along the vertical axis and 3 mm along the sagittal axis) and regular toe box running shoes. Ground reaction force (GRF), in-shoe displacement, and degree of toe deformation (based on the distance change between the toe and the metatarsal head) were collected. Results: Wearing raised toe box shoes resulted in a significant reduction in vertical (p = 0.001) and antero–posterior (p = 0.015) ground reaction forces during the loading phase, with a notable increase in vertical ground reaction force during the toe-off phase (p < 0.001). In-shoe displacement showed significant decreased movement in the forefoot medial (p < 0.001) and rearfoot (medial: p < 0.001, lateral: p < 0.001) and significant increased displacement in the midfoot (medial: p = 0.002, lateral: p < 0.001). Impact severity on the hallux significantly decreased (p < 0.001), while impact on the small toes showed no significant reduction (p = 0.067). Conclusions: Raised toe box running shoes offer an effective means of reducing toe injuries caused by long-distance running. Full article

Onychomycosis is an under-recognized healthcare burden. Despite the risk of misdiagnosis, confirmatory laboratory testing is under-utilized. Histopathologic examination with polymerase chain reaction (PCR) is currently the most effective diagnostic method; it offers direct detection and identification of a fungal invasion. In this retrospective cohort study, we assessed confirmatory testing results, with matching clinical diagnoses, in 96,293 nail specimens submitted during a 9-month period from 2022 to 2023. Toenail specimens were examined using fungal culture, histopathology and/or PCR. Clinical diagnoses were identified using the International Classification of Diseases 10th Revision codes. For clinically diagnosed onychomycosis patients, the overall positivity rate was 59.4%; a similar positivity rate (59.5%) was found in patients with clinically diagnosed non-fungal nail dystrophy. Performing a histopathologic examination with PCR was more likely to provide pathogen identification results than using fungal culture. Male patients had a higher rate of onychomycosis overall; however, female patients had more non-dermatophyte mold onychomycosis caused by Aspergillus. Clinically diagnosed onychomycosis patients with a co-diagnosis of tinea pedis were more likely to test positive for onychomycosis by PCR (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.7–6.4), histopathology (OR: 2.5; 95% CI: 2.0–3.1) and fungal culture (OR: 3.2; 95% CI: 1.5–6.6). Our results support the use of confirmatory laboratory testing when there is a clinical diagnosis of onychomycosis. Full article