[en] Despite improvements in antifungal strategies, the outcome of treating onychomycoses often remains uncertain. Several factors account for treatment failure, of which the pharmacokinetics and pharmacodynamics of the antifungal are of importance. The taxonomic nature and ungual location of the fungus cannot be neglected, besides the type of nail and its growth rate. In addition, the biological cycle of the fungus and the metabolic activity of the pathogen likely play a marked influence in drug response. The presence of natural antimicrobial peptides in the nail is also probably a key feature controlling the cure rates. There are many outstanding publications that cover the full spectrum of the field. The purpose of this review is to put in perspective some facets of activity of the topical treatment using amorolfine nail laquer. The antifungal activity of the drug is likely less pronounced in onychomycosis than that expected from conventional in vitro studies. However, the nail laquer formulation should reduce the propensity to form antifungal-resistant spores and limit the risk of reinfection.
Disciplines :
Dermatologie
Auteur, co-auteur :
Flagothier, Caroline ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Pierard, Claudine ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Pierard, Gérald ; Centre Hospitalier Universitaire de Liège - CHU > Dermatopathologie
Langue du document :
Anglais
Titre :
New insights into the effect of amorolfine nail lacquer.
Arrese JE, Piérard-Franchimont C, Piérard GE. Facing up to the diagnostic uncertainty and management of onychomycoses. Int J Dermatol 1999; 38: S1-6.
Arrese JE, Piérard-Franchimont C, Piérard GE. A plea to bridge the gap between antifungals and the management of onychomycosis. Am J Clin Dermatol 2001; 2: 281-4.
Polak AM. Preclinical date and mode of action of amorolfine. Clin Exp Dermatol 1992; 1: 8-12.
Polak AM, Dixon DM. Antifungal activity of amorolfine in vitro and in vivo. In: Fromtling R (ed.), Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents. Barcelona: JR Prous Science Publications, 1987: 555-73.
Favre B, Hofbauer B, Hildering KS, Ryder NS. Comparison of in vitro activities of 17 antifungal drugs against a panel of 20 dermatophytes by using a microdilution assay. J Clin Microbiol 2003; 41: 4817-9.
Arrese JE, De Doncker P, Odds F, Piérard GE. Reduction in the growth of non-dermatophyte molds by itracoanzole: evaluation by the corneofungimetry bioassay. Mycoses 1998; 41: 461-5.
Takasuka T. Amino acid- or protein-dependent growth of Trichophyton metagrophytes and Trichophyton rubrum. FEMS Immunol Med Mic 2000; 29: 241-5.
Osborne CS, Leitner I, Favre B, Ryder NS. Antifungal drug response in a in vitro model of dermatophyte nail infection. Med Mycol 2004; 42: 159-63.
Mensing H, Polak-Wyss A, Splanemann V. Determination of the subungual antifungal activity of amorolfine after 1 month's treatment in patients with onychomycosis: comparison of two nail lacquer formulations. Clin Exp Dermatol 1992; 17: S29-32.
Polak A. Kinetics of amorolfine in human nails. Mycoses 1993; 36: 101-3.
Lauharanta J. Comparative efficacy and safety of amorolfine nail lacquer 2% versus 5% once weekly. Clin Exp Dermatol 1992; 1: 41-43.
Reinel D, Clarke C. Comparative efficacy and safety of amorolfine nail lacquer 5% in onychoycosis, once weekly versus twice-weekly. Clin Exp Dermatol 1992; 1: 44-49.
Zaug M, Bergstrasser M. Amorolfine in the treatment of onychomycoses and dermatomycoses (an overview). Clin Exp Dermatol 1992; 18: 61-70.
Zaug M. Amorolfine nail lacquer: clinical experience in onychomycosis. J Eur Acad Dermatol Venereol 1995; 4: S23.
Maleszka R, Ratajczak V, Turek-Krainska K. The use of amorolfine in the treatment of dermatophyte onychomycosis. Prz Dermatol 2002; 89: 493.
Nizet V, Ohtake T, Lauth X et al. Innate antimicrobial peptide protects the skin from invasive bacterial infection. Nature 2001; 414: 454-7.
Gallo RL, Murakami M, Ohtake T, Zaiou M. Biology and clinical relevance of naturally occurring antimicrobial peptides. J Allergy Clin Immunol 2002; 110: 823-31.
Janeway Jr CA, Medzhitov R. Innate immune recognition. Annu Rev Immunol 2002; 20: 197-216.
Zasloff M. Antimicrobial peptides of multicellular organisms. Nature 2002; 415: 389-95.
Dorschner RA, Lopez-Garcia B, Massie J, Kim C, Gallo RL. Innate immune defense of the nail unit by antimicrobial peptides. J Am Acad Dermatol 2004; 50: 343-8.
Schröder JM. Peptides epithéliaux antimicrobiens. Molécules de défenses constitutionnelles locales. Ann Dermatol Venereol 2004; 31: 411-6.
Arrese JE, Piérard GE. Treatment failures and relapses in onychomycosis: a stubborn clinical problem. Dermatology 2003; 207: 255-60.
Arrese JE, Quatresooz P, Piérard-Franchimont C, Piérard GE. Histomycologie unguéale. Ann Dermatol Venereol 2003; 130: 1254-9.
Piérard GE, Arrese JE, Quatresooz P. Histomycologie de la biodiversité des onychomycoses. In: Baran R, Piérard GE (eds), Onychomycoses. Paris: Publ. Abrégés Masson, 2004: 91-104.
Rurangirwa A, Piérard-Franchimont C, Piérard GE. Culture of fungi on cyanoacrylate skin surface strippings. A quantitative bioassay for evaluating antifungal drugs. Clin Exp Dermatol 1989; 14: 425-8.
Aljabre SH, Richardson MD, Scott EM, Shankland GS. Germination of Trichophyton mentagrophytes on human stratum corneum in vitro. J Med Vet Mycol 1992; 30: 145-52.
Piérard GE, Arrese JE, De Doncker P. Antifungal activity of itraconazole and terbinafine in human stratum corneum: a comparative study. J Am Acad Dermatol 1995; 32: 429-35.
Arrese JE, Fogouang L, Piérard-Franchimont C, Piérard GE. Euclidean and racial computer-assisted corneofungimetry. A comparison of 2% ketoconazole and 1% terbinafine topical formulations. Dermatology 2002; 204: 222-7.
Piérard GE, Arrese JE, Piérard-Franchimont C. Itraconazole corneofungimetry bioassay on Malassezia species. Mycoses 2004; 47: 418-21.
Piérard GE, Arrese JE, Pierre S et al. Diagnostic microscopique des onychomycoses. Ann Dermatol Venerol 1994; 121: 25-29.
Kronauer C, Gfesser M, Ring J, Abeck D. Transonychial water loss in healthy and diseased nails. Acta Dermatol Venereol 2001; 81: 175-7.
Piérard GE, Piérard-Franchimont C, Arrese JE. The boosted antifungal topical treatment (BATT) for onychomycosis. Med Mycol 2000; 38: 391-2.