BACKGROUND: Plantar warts, caused by human papillomavirus (HPV) infection, are a common skin condition on the plantar surface. Despite the availability of various treatments, achieving satisfactory outcomes remains elusive. This study explores a novel therapeutic approach combining traditional Chinese medicine (TCM) soaking therapy with cryotherapy to address this challenge.
METHODS: This study focuses on 3 patients who presented with multiple and giant plantar warts, each with a disease duration exceeding 2 years. These patients had undergone numerous unsuccessful cryotherapy treatments, leaving them with persistent and troublesome warts.
METHODS: All 3 patients were diagnosed with multiple and giant plantar warts caused by HPV infection.
METHODS: Following unsuccessful cryotherapies, the patients were administered TCM soaking therapy as an adjunct treatment.
RESULTS: Remarkably, all 3 patients achieved complete remission of their plantar warts within 2 to 4 months after combining cryotherapy with TCM soaking therapy.
CONCLUSIONS: Our findings suggest that relying solely on cryotherapy is insufficient for effectively treating plantar warts. The key to successful treatment lies in inhibiting wart proliferation and continuously thinning them, which can be achieved through soaking in TCM. This study demonstrates the potential of combining cryotherapy with TCM soaking as a novel and effective therapeutic approach for treating multiple and giant plantar warts.

Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%-10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real-world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well-established oral medication, experienced a substantial decrease in prescription volume. The sex- and age-adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019-2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first-line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost-effective treatment strategies. This study provides valuable insights into the real-world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.

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UNASSIGNED: Multiple pathophysiologic and biomolecular processes lead to bullae, including disruption of adhesion molecules, accumulation of cell injury, and traumatic injury. Blistering disorders of the foot can cause symptoms such as pruritus, pain, and drainage and significantly impact quality of life. Microbiologic and histopathologic examination of tissue specimens should be considered for concerns regarding atypical etiology.This retrospective case series describes patients seen in a community hospital outpatient wound center in southeastern Wisconsin between January 2021 and June 2023 for atypical blistering disorders of the foot. The cases herein describe the history, clinical presentation, and treatment of three atypical blistering disorders of the foot. An 86-year-old man presented complaining of intensely pruritic blistering lesions to both feet. Histopathologic findings indicated eosinophilic infiltrate, and the patient was treated for an eosinophilic drug reaction. A 65-year-old man presented complaining of multiple painful blisters to the plantar aspect of both feet. Histopathologic examination of unroofed blister indicated bullous tinea. Finally, a 44-year-old man with long-standing type 1 diabetes presented complaining of a several-week history of a single blister to his anterior right foot of unknown etiology. The patient was diagnosed with bullosis diabeticorum.Blistering disorders of the foot are diagnostic challenges; diagnostic clarity is assisted by thorough history, clinical presentation, treatment response, microbial analysis, and histopathologic findings.

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Onychomycosis, a fungal nail infection, is primarily caused by dermatophytes, yeasts, and non-dermatophyte moulds (NDMs). The incidence of this disease and the predominance of specific pathogens vary across different regions and evolve. This study aimed to elucidate the epidemiology of onychomycosis and the pattern of causative pathogens in Beijing, and to ascertain the in vitro antifungal susceptibility profiles of Trichophyton rubrum against itraconazole (ITR), terbinafine (TER), and fluconazole (FLU). Involving 245 patients of onychomycosis with positive fungal culture results, the study implemented internal transcribed spacer (ITS) sequencing of ribosomal DNA (rDNA) on all collected samples. The mean age of the participants was 37.93 ± 13.73 years, with a male-to-female ratio of 1.53:1. The prevalence of toenail infections was significantly higher than that of fingernails. Distal and lateral subungual onychomycosis (DLSO) were the most frequent clinical classifications. PCR results indicated that dermatophytes were the most prevalent pathogens, followed by yeasts and NDMs, among which T. rubrum was the most dominant dermatophyte. TER demonstrated high sensitivity to T. rubrum. However, in clinical settings, some patients with onychomycosis exhibit a poor response to TER treatment. The relationship between in vitro antifungal sensitivity and clinical effectiveness is complex, and understanding the link between in vitro MIC values and clinical efficacy requires further investigation.

Onychomycosis is a fungal infection of the nail unit and one of the common nail diseases that occurs commonly in diabetic patients. It poses a threat of diabetic foot complications to diabetics and negatively affects the quality of life of the patients.
The overall aim of the study was to determine the prevalence and clinical features of onychomycosis in diabetics, as well as the spectrum of causative fungi in Nigeria as compared with age and sex-matched controls.
This was a hospital-based, comparative cross-sectional study. One hundred and fifty consecutive adult diabetics and 150 healthy controls (accompanied persons and staff) matched for age and sex were recruited from the Diabetic Clinics and the Dermatology Clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. The participants were interviewed using a pre-tested structured questionnaire, nail scrapings were collected for fungal studies, and clippings for nail histopathology using Periodic Acid Schiff.
The prevalence of onychomycosis among DM subjects was 45.3% vs. 35.3% in controls, which was not statistically significant (P value 0.078). Distal-lateral subungual onychomycosis was the most common clinical type in both study groups and presented mainly with nail discolouration, onycholysis, and subungual hyperkeratosis. The most common fungi isolated were dermatophytes (Trichophyton soudanense), non-dermatophytes (Aspergillus spp.), and Candida species (Candida albicans).
Onychomycosis in diabetics is a very common nail disorder in the South-Eastern part of Nigeria with a high prevalence. The presence of foot ulcers was associated with onychomycosis in diabetics, and they were more likely to have non-dermatophytic onychomycosis.
L\'onychomycose est une infection fongique de l\'unité de l\'ongle et l\'une des maladies des ongles les plus courantes chez les patients diabétiques. Elle pose une menace de complications du pied diabétique et affecte négativement la qualité de vie des patients.
L\'objectif général de l\'étude était de déterminer la prévalence et les caractéristiques cliniques de l\'onychomycose chez les diabétiques, ainsi que le spectre des champignons causaux au Nigeria par rapport à un groupe témoin apparié selon l\'âge et le sexe.
Il s\'agissait d\'une étude transversale comparative réalisée en milieu hospitalier. Cent cinquante diabétiques adultes consécutifs et 150 témoins sains (personnes accompagnatrices et personnel) appariés selon l\'âge et le sexe ont été recrutés dans les cliniques de diabète et la clinique de dermatologie de l\'Hôpital Universitaire du Nigeria à Ituku-Ozalla. Les participants ont été interrogés à l\'aide d\'un questionnaire structuré pré-testé, des échantillons de grattage d\'ongles ont été prélevés pour des études fongiques, et des échantillons pour l\'histopathologie des ongles utilisant l\'acide périodique de Schiff.
La prévalence de l\'onychomycose chez les sujets atteints de diabète était de 45,3 % contre 35,3 % chez les témoins, ce qui n\'était pas statistiquement significatif (valeur de p 0,078). L\'onychomycose sousunguéale distale-latérale était le type clinique le plus courant dans les deux groupes d\'étude et se manifestait principalement par une décoloration des ongles, une onycholyse et une hyperkératose sousunguéale. Les champignons les plus couramment isolés étaient les dermatophytes (Trichophyton soudanense), les non-dermatophytes (Aspergillus spp.) et les espèces de Candida (Candida albicans).
L\'onychomycose chez les diabétiques est un trouble des ongles très courant dans le sud-est du Nigeria avec une prévalence élevée. La présence d\'ulcères du pied était associée à l\'onychomycose chez les diabétiques, et ils étaient plus susceptibles de présenter une onychomycose non-dermatophytique.
Onychomycose, Diabète sucré, Prévalence, Champignons, Nigeria.

OBJECTIVE: To assess the effectiveness of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser 1064 nm in the management of onychomycosis.
METHODS: Descriptive observational study. Place and Duration of the Study: Department of Dermatology, PNS Shifa Hospital, Karachi, Pakistan, from December 2022 to May 2023.
METHODS: Thirty patients, of either gender, aged between 20 and 60 years, with a clinical diagnosis and a positive KOH test for onychomycosis. Long-pulsed 1064-nm Nd:YAG laser therapy was administered to patients. On the basis of nail plate thickness, laser therapy was given once a week for a month at a speed of 25 mm/sec and a spot diameter of 4 mm, with fluencies ranging from 40 - 60 J/cm2. Before and six months\' post-treatment, the patients\' photos were taken and were evaluated based on dermoscopic results and clinical improvement.
RESULTS: The patients\' average age was 40.20 ± 15.85 years, and their average duration of disease was 3.0 ± 1.41 years. Six (20%) were males and 24 (80%) cases were females. The most prevalent clinical type was distolateral subungual onychomycosis 22 (73%). Fourteen (46.6%) cases showed excellent improvement, 6 (20%) cases showed good improvement, and 10 (33.3%) cases showed mild improvement.
CONCLUSIONS: Long-pulsed Nd:YAG laser is a safe and efficient option for onychomycosis because of its high clinical cure rates, lack of side effects, and clinical therapeutic efficacy.
BACKGROUND: Onychomycosis, Nd:YAG laser 1064-nm, Dermatology, Nail, Lasers in dermatology.