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Open AccessArticle

Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light

1
Department of Radiotherapy, Erasmus Medical Centre, P.O. Box 2040, Office Ee-1683, 3000-CA Rotterdam, The Netherlands
2
Department of Dermatology and Venereology, Erasmus Medical Centre, P.O. Box 2040, Office Ee-1683, 3000-CA Rotterdam, The Netherlands
*
Author to whom correspondence should be addressed.
Academic Editor: Theodore Rosen
J. Fungi 2015, 1(2), 138-153; https://doi.org/10.3390/jof1020138
Received: 10 June 2015 / Revised: 15 July 2015 / Accepted: 21 July 2015 / Published: 27 July 2015
(This article belongs to the Special Issue Cutaneous Fungal Diseases)
Onychomycosis is predominantly caused by the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Trichophyton tonsurans. The main treatment obstacle concerns low nail-plate drug permeability. In vitro antifungal photodynamic treatment (PDT) and nail penetration enhancing effectiveness have been proven for multifunctional photosensitizer 5,10,15-tris(4-N-methylpyridinium)-20-(4-(butyramido-methylcysteinyl)-hydroxyphenyl)-[21H,23H]-porphine trichloride (PORTHE). This study investigates single PORTHE green laser/LED PDT of varying degrees of ex vivo onychomycoses in a human nail model. T. mentagrophytes, T. rubrum, T. tonsurans onychomycoses were ex vivo induced on nail pieces at 28 °C (normal air) and 37 °C (6.4% CO2) during 3 to 35 days and PDTs applied to the 37 °C infections. All dermatophytes showed increasingly nail plate invasion at 37 °C between 7 and 35 days; arthroconidia were observed after 35 days for T. mentagrophytes and T. tonsurans. Using 81 J/cm2 (532 nm) 7-day T. mentagrophytes onychomycoses were cured (92%) with 80 µM PORTHE (pH 8) after 24 h propylene glycol (PG, 40%) pre-treatment and 35-day onychomycoses (52%–67%) with 24 h PORTHE (40–80 µM)/40% PG treatment (pH 5). 28 J/cm2 LED light (525 ± 37 nm) improved cure rates to 72%, 83% and 73% for, respectively, T. mentagrophytus, T. rubrum and T. tonsurans 35-day onychomycoses and to 100% after double PDT. Data indicate PDT relevance for onychomycosis. View Full-Text
Keywords: arthroconidia; onychomycosis; photodynamic; porphyrin; photosensitizer; trichophyton; dermatophytes; laser; LED arthroconidia; onychomycosis; photodynamic; porphyrin; photosensitizer; trichophyton; dermatophytes; laser; LED
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Hollander, C.D.; Visser, J.; De Haas, E.; Incrocci, L.; Smijs, T. Effective Single Photodynamic Treatment of ex Vivo Onychomycosis Using a Multifunctional Porphyrin Photosensitizer and Green Light. J. Fungi 2015, 1, 138-153.

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