Abstract:
BACKGROUND:Onychomycosis is a prevalent infection of the nail caused primarily by dermatophytes. Fluconazole is active in vitro against the most common pathogens, penetrates into the nail bed, and is clinically effective in the treatment of a wide variety of fungal infections. OBJECTIVE:The purpose of this study was to assess the safety and efficacy of oral fluconazole 150, 300, and 450 mg administered once weekly compared with placebo in the treatment of distal subungual onychomycosis of the fingernail caused by dermatophytes. METHODS:This was a multicenter, randomized, double-blind, placebo-controlled study enrolling 349 patients with onychomycosis of the fingernails. Clinical and mycologic efficacy as well as measures of safety were assessed monthly for a maximum of 9 months of treatment, with additional safety visits occurring at weeks 2 and 6. For inclusion, patients were required to have clinically and mycologically documented onychomycosis of the fingernail caused by dermatophytes with at least 25% involvement of the target fingernail. After end of therapy, patients with improved or cured fingernails entered a blinded 6-month follow-up without drug treatment during which efficacy was assessed every 2 months. Efficacy was assessed by clinical (visual) and mycologic (microscopic and culture) measures. Clinical measures included assessments of the percentage of target nail involvement, measurement of the distance from the nail fold to the proximal onychomycotic border, and signs and symptoms of onychomycosis. RESULTS:Fluconazole was significantly superior to placebo in eradicating clinical and mycologic symptoms of onychomycosis, both at the end of active treatment and at 6 months after treatment (p=0.0001 for all efficacy measures). At the end of therapy, 91% to 100% of patients in the fluconazole groups were judged clinical successes, defined as reduction of the affected area of the target nail to less than 25% or cure, compared with 8% for placebo. Clinical cure rates at end of therapy were 76%, 85%, and 90% for fluconazole 150, 300, and 450 mg, respectively, compared with 3% for placebo. These clinical success and cure rates were largely maintained or improved during follow-up. Clinical relapse in cured patients during the follow-up period was very low (1.5% to 3.3%). Fluconazole demonstrated mycologic eradication rates of 89% to 100% at the end of treatment and 90% to 99% at the end of follow-up; for placebo the rates were 8% and 12%, respectively. CONCLUSION:Fluconazole administered once weekly is safe and effective in eradicating distal subungual onychomycosis of the fingernail caused by dermatophytes.
journal_name
J Am Acad Dermatoljournal_title
Journal of the American Academy of Dermatologyauthors
Drake L,Babel D,Stewart DM,Rich P,Ling MR,Breneman D,Scher RK,Martin AG,Pariser DM,Pariser RJ,Ellis CN,Kang S,Katz HI,McDonald CJ,Muglia J,Savin RC,Webster G,Elewski BE,Leyden JJ,Bucko AD,Tschen EH,Hanifin JM,doi
10.1016/s0190-9622(98)70491-8subject
Has Abstract,Author List Incompletepub_date
1998-06-01 00:00:00pages
S87-94issue
6 Pt 2eissn
0190-9622issn
1097-6787pii
S0190-9622(98)70491-8journal_volume
38pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:Annular lichen planus (ALP) is a long-recognized clinical variant of lichen planus, but is often considered uncommon in occurrence. The typical distribution and presentation of this variant have not been well described. OBJECTIVE:We sought to better define the sites affected and clinical characteristics of ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2003.08.011
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:Needle puncture and infiltrational anesthesia is generally required for minor cutaneous surgical procedures and may be associated with anxiety, fear, discomfort, and pain. The use of topical anesthetics such as eutectic lidocaine/prilocaine 5% cream may provide an alternative means of delivering anesthesia. ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0190-9622(96)90608-8
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:In response to the increasing rate of skin cancer, particularly melanoma in the United States, the Environmental Protection Agency, the National Weather Service, the Centers for Disease Control and Prevention, National Association of Physicians for the Environment, and the American Academy of Dermatology, de...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/s0190-9622(97)70068-9
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:Small open studies of patients at high risk for squamous cell carcinoma (SCC) of the skin suggest that oral retinoid use reduces the risk of these tumors. Among patients at lower risk, randomized trials of low doses of retinoids did not demonstrate significant chemopreventive effects. Patients with psoriasis...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1067/s0190-9622(03)01587-1
更新日期:2003-10-01 00:00:00
abstract::We present further evidence that granuloma annulare and autoimmune thyroiditis may be associated. Only 11 cases have been previously reported with this association as far as we know. It may be advantageous to consider checking the thyroid-stimulating hormone and/or antithyroid antibodies before administering medicatio...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND:It is important for dermatologists and other physicians in refugee-receiving countries to acquire knowledge of forensic dermatology to identify lesions from torture. OBJECTIVE:Review forensic dermatology in cases of torture. RESULTS:In providing medical assessment and care to refugees and migrants, chronic...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2020.09.031
更新日期:2020-09-15 00:00:00
abstract::Forty-two adults with psoriasis vulgaris were treated total body thrice weekly with both ultraviolet B (UVB) and psoralens and ultraviolet A (PUVA) with the use of protocols shown to be effective with either treatment alone. Patients previously difficult to manage with either UVB or PUVA and at least 25% psoriasis wer...
journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章
doi:10.1016/s0190-9622(84)80098-5
更新日期:1984-03-01 00:00:00
abstract::Histoplasma capsulatum and Trichosporon inkin may cause disseminated disease in immunocompromised patients. Disseminated T inkin, the causative agent of white piedra, is rare and difficult to diagnose. We report the case of a 28 year-old man with newly diagnosed HIV infection who developed asymptomatic lesions on his ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2007.08.027
更新日期:2008-08-01 00:00:00
abstract::Hutchinson's sign, periungual extension of brown-black pigmentation from longitudinal melanonychia onto the proximal and lateral nailfolds, is an important indicator of subungual melanoma. However, experience has demonstrated that Hutchinson's sign, although valuable, is not an infallible predictor of melanoma. Periun...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/s0190-9622(96)90839-7
更新日期:1996-01-01 00:00:00
abstract::A tense yellow vesicle was noted on the back parietal scalp of a female newborn. This proved to be a bullous variant of aplasia cutis congenita. Only 16 cases of this apparently rare disorder have been previously reported. Histologic evaluation of such lesions reveals a distinct pattern containing fibrovascular stroma...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1067/mjd.2003.150
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Intertriginous and facial involvement are manifestations of psoriasis that require a different approach than is used for typical plaque psoriasis on other skin areas. Topical corticosteroids are the primary treatment for psoriasis; however, the side effects of corticosteroids are magnified on intertriginous ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jaad.2004.07.011
更新日期:2004-11-01 00:00:00
abstract::Topical photodynamic therapy (PDT) is used to treat nonmelanoma skin cancers, such as actinic keratoses, Bowen's disease, and basal cell carcinoma (superficial and nodular). This article presents up-to-date, practical, evidence-based recommendations on the use of topical PDT using 5-aminolevulinic acid or methyl amino...
journal_title:Journal of the American Academy of Dermatology
pub_type: 共识发展会议,杂志文章,实务指引
doi:10.1016/j.jaad.2006.06.006
更新日期:2007-01-01 00:00:00
abstract::An intensely pruritic dermatosis that occurred in a woman during the third trimester of pregnancy is described. The clinical manifestations included red follicular papules symmetrically distributed on the skin of the forearms, abdomen, thighs, and legs. The histopathologic findings were not specific. However, immunopa...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/s0190-9622(88)70059-6
更新日期:1988-02-01 00:00:00
abstract::Current classifications for hidradenitis suppurativa (HS), such as the Hurley staging system, are not very specific. The absence of rigorous classifications is incongruous with the clinical variability of the condition. There is no pathognomonic sign for HS that leads to a diagnosis that is unquestionable. Consequentl...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2015.07.047
更新日期:2015-11-01 00:00:00
abstract::Hydrogen peroxide (H2O2) is an endogenous reactive oxygen species that contributes to oxidative stress directly as a molecular oxidant and indirectly through free radical generation. Topically applied 1% to 45% H2O2 can be used for a range of clinical purposes, which will be reviewed here in addition to its safety. In...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2019.05.030
更新日期:2019-12-01 00:00:00
abstract::The deep penetrating nevus (DPN), also known as the plexiform spindle cell nevus, is a pigmented lesion that commonly arises on the head and neck in the first few decades of life. Histopathologically, the DPN is wedge-shaped and contains melanocytes that exhibit deep infiltration into the dermis. Given these features,...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2014.07.026
更新日期:2014-12-01 00:00:00
abstract:BACKGROUND:The development of autoimmune sequelae is one of the characteristic features of drug reaction with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome; however, the incidence of sequelae and prognosis of patients with DRESS are unknown. OBJECTIVE:We sought to investigate the...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2012.08.009
更新日期:2013-03-01 00:00:00
abstract::Chemical peeling, or chemexfoliation, has been used for centuries to improve signs of ultraviolet light-induced sun damage. Over the last 30 years, the science behind chemical peeling has evolved, increasing our understanding of the role of peeling ingredients and treatment indications. The depth of peels is directly ...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2018.10.079
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Spironolactone is used off-label for androgenic alopecia because of its ability to arrest hair loss progression and long-term safety profile. However, little is known about the safety of spironolactone in breast cancer (BC) survivors. Because spironolactone has estrogenic effects, there is a theoretical risk...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2020.05.081
更新日期:2020-10-01 00:00:00
abstract::Dermatomyositis (DM) is an idiopathic inflammatory myopathy. The mainstay of treatment for DM is oral corticosteroids. However, the dose and length of treatment is debated. Adding to the confusion, there have been no randomized controlled studies comparing the use of various corticosteroid doses and taper rates, and n...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2008.02.043
更新日期:2008-07-01 00:00:00
abstract:BACKGROUND:Access to dermatologists is low among Medicaid-insured patients. Higher clinic nonattendance among Medicaid-insured patients might affect provider decisions to accept these patients. OBJECTIVE:To determine the effect of different scheduling policies on the attendance among children seen at a pediatric derma...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2019.02.018
更新日期:2019-08-01 00:00:00
abstract:BACKGROUND:Psoriasis is a systemic inflammatory condition that is associated with a higher risk of cardiovascular (CV) disease. Tofacitinib is being investigated as a treatment for psoriasis. OBJECTIVE:We sought to evaluate the effects of tofacitinib on CV risk factors and major adverse CV events (MACEs) in patients w...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2016.06.012
更新日期:2016-11-01 00:00:00
abstract::When treating psoriasis, various topical emollients exist that can affect the penetration of ultraviolet radiation in phototherapy. Compared with normal-appearing skin with a reflectance of 4% to 5%, psoriatic skin has higher reflectance as a result of its increased air-to-corneocyte interfaces. Studies have tested th...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/j.jaad.2012.05.034
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:Mouse studies show that tumor-derived prostaglandins and platelets promote melanoma progression and immune evasion. OBJECTIVE:Determine whether aspirin confers longer survival in patients with melanoma. METHODS:A retrospective cohort study of 1522 patients at Indiana University Health who had melanoma diag...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2017.12.076
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Carney complex (CNC) is an autosomal dominant disorder associated with multiple neoplasms. OBJECTIVE:We report a case of a 40-year-old Caucasian man with a sporadic form of CNC. METHODS:This is a clinicopathologic description and molecular biological study with an emphasis on histopathologic findings. RES...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2008.11.015
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Drug cutaneous reaction and isolated cases of parotitis induced by terbinafine have been reported. OBSERVATION:We report a case of drug reaction with eosinophilia and systemic symptoms induced by terbinafine associated with a severe sialadenitis and a complete sicca syndrome. Evolution was protracted with a...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2004.06.023
更新日期:2004-11-01 00:00:00
abstract:BACKGROUND:Acne is a multifactorial disease in which androgens appear to play an important role. A low-dose oral contraceptive containing 20 microg of ethinyl estradiol and 100 microg of levonorgestrel (EE/LNG) has been shown to improve biochemical markers of androgenicity. Lowering bioavailable androgens may improve a...
journal_title:Journal of the American Academy of Dermatology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1067/mjd.2002.122192
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVES:Our aim was to compare 20% with 10% to 5% incremental regimens in narrowband UVB phototherapy. STUDY PATIENTS:The study included patients with psoriasis (N = 191) with Fitzpatrick skin phototypes II and III. RESULTS:Occurrence of erythema as well as maximum and cumulative doses were higher with 20% escalat...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/j.jaad.2006.04.019
更新日期:2006-08-01 00:00:00
abstract::From the origin of civilization the pursuit of beauty has exemplified the highest order of the human being's quest for achievement, and from the beginning, this pursuit has focused, in part, on perfecting the human form. Freed from much of the time-consuming burden of attending to elemental needs, the present generati...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章,评审
doi:10.1016/s0190-9622(89)70340-6
更新日期:1989-12-01 00:00:00
abstract::Angiosarcoma that develops in areas of chronic lymphedema is also called Stewart-Treves syndrome. It usually appears in areas of lymphedema several years after mastectomy for breast carcinoma. Only 10% of these angiosarcomas occur in areas of chronic lymphedema as a result of another cause. We present a patient with e...
journal_title:Journal of the American Academy of Dermatology
pub_type: 杂志文章
doi:10.1016/s0190-9622(99)70385-3
更新日期:1999-08-01 00:00:00