Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 98  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CASE REPORT
Year : 2018  |  Volume : 63  |  Issue : 6  |  Page : 515-517
Propolis for the treatment of onychomycosis


1 Department of Clinical Analysis and Biomedicine; Student At Postgraduation program of Health Sciences, State University of Maringá, Paraná, Brazil
2 Department of Clinical Analysis and Biomedicine; Student At Postgraduation program of Biosciences and Physiopathology, State University of Maringá, Paraná, Brazil
3 Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil

Date of Web Publication2-Nov-2018

Correspondence Address:
Dr. Melyssa Negri
Department of Clinical Analysis and Biomedicine, State University of Maringá. Colombo Avenue, 5790, CEP: 87020-900, Maringá, Paraná
Brazil
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_365_17

Rights and Permissions

   Abstract 


Onychomycosis is a fungal nail infection, considered as a public health problem because it is contagious and it interferes with the quality of life. It has long and difficult treatment, with many side effects and high cost. Propolis extract (PE) is a potential alternative to conventional antifungal agents because it has low cost, accessibility, and low toxicity. Herein, we report the favorable response of PE in onychomycosis in three elderly patients.


Keywords: Antifungal, onychomycosis, propolis extract


How to cite this article:
Veiga FF, Costa MI, Cótica ES, Svidzinski TI, Negri M. Propolis for the treatment of onychomycosis. Indian J Dermatol 2018;63:515-7

How to cite this URL:
Veiga FF, Costa MI, Cótica ES, Svidzinski TI, Negri M. Propolis for the treatment of onychomycosis. Indian J Dermatol [serial online] 2018 [cited 2018 Dec 11];63:515-7. Available from: http://www.e-ijd.org/text.asp?2018/63/6/515/244819





   Introduction Top


Onychomycosis is a nail infection caused by fungi that feed on keratin.[1] Currently available antifungal drugs show a range of adverse effects, which may lead the patients to stop treatment. In this context, propolis extract (PE) proved to be effective in treating fungal infections preventing microbiological resistance to commercial antifungals.[2],[3] Despite several advances in research on in vitro PE, there are few reports of cases proving its antifungal effectiveness in vivo.[4] Here, we report the effect of topical treatment with a commercially available PE solution in patients of onychomycosis. A commercially available PE solution was obtained from an apiary of hives of Apis mellifera L. bees from a farm of Cianorte City, Brazil.[5] The inclusion of elderly volunteers followed the standards imposed by the internal committee for ethics in research involving human subjects, registered under number 615643/2014.


   Case Reports Top


Case 1

A female patient, 68 year old, retired, diagnosed with diabetes, dyslipidemia, and hypertension, had long periods of contact with farm animals and worked as a maid for a long time. She had mycoses in the toe and fingernails. It began in her hand 15 years earlier, with the appearance of white spots, which turned black over time, without itchy lesions, though she felt pain during local compression [Figure 1]a and [Figure 1]c. She had undertaken treatment with antifungals in the past, but that failed to cure the condition. After being isolated from the nails, the pathogenic agents were cultured and identified as Candida tropicalis (fingernails) and Candida parapsilosis (toenails). In vitro tests resulted in minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values for PE of 273.43 mg/mL and 546.87 mg/mL, respectively. The PE application was done twice a day on the infected nails, after the usual cleaning of the affected areas. The patient was monitored monthly during the treatment period. After 1 year of treatment, a considerable decrease of the lesions was observed [Figure 1]b and [Figure 1]d, even though the fungi could still be found in the lesions.
Figure 1: Case 1, onychomycosis by Candida parapsilosis (a) and by Candida tropicalis (c). After treatment with propolis extract (b and d)

Click here to view


Case 2

A female patient, 69 year old, had onychomycosis on a toenail [Figure 2]a. It had yellowish color and hollow appearance with the absence of itching and presence of local pain. She had never confirmed the diagnosis with laboratory tests. The only treatment she had tried was with fluconazole, prescribed by a dermatologist for a year without clinical improvement. Subsequently, the collection and identification of the microorganism detected the presence of C. parapsilosis. In vitro, the fungus was subjected to MIC and MFC tests with PE and both showed the same value of 546.87 mg/mL. The patient was treated with PE (as in case 1) for 1 year. After this period, it was possible to observe the regression of white lesions in the nail [Figure 2]b, negative KOH examination and there was an absence of fungal growth in the culture of collected samples.
Figure 2: Case 2, onychomycosis by Candida parapsilosis (a). After treatment with application of propolis extract (b)

Click here to view


Case 3

A female patient, 65 year old, developed toenail mycosis. It had whitish color and hollow appearance [Figure 3]a, an absence of itching and the presence of local pain. With laboratory tests indicating the presence of fungi, treatment with terbinafine was initiated and carried out for four months without any improvement. Later, fungal culture was done and identified as Fusarium solani. The patient was treated with PE (as in case 1 and 2) for 1 year. After this period, complete regression of onychomycosis was observed [Figure 3]b. No fungal elements were microscopically visualized and culture was negative.
Figure 3: Case 3, onychomycosis by Fusarium solani (a). After treatment with propolis extract (b)

Click here to view



   Discussion Top


The incidence of onychomycosis has risen in recent years in Maringá, following the global trend, coupled with the modernization of health services, including confirmatory laboratory tests, training of laboratory resources associated with the search for solutions to health problems.[6],[7] In the present study, four nail samples were analyzed from three patients with clinical suspicion of onychomycosis of the toenails and the fingernails. They were evaluated with PE as a possible antifungal agent for onychomycosis treatment.

According to our results, only nondermatophyte fungi were isolated from patients with onychomycosis (one C. tropicalis, two C. parapsilosis, and one F. solani). Although the dermatophytes are the best-known cause of onychomycosis, studies show that infections caused by Candida spp.[1] and Fusarium spp.[7],[8] have been increasing, mainly associated with paronychia.

Due to the fact that these agents are usually part of the skin microbiota (such as Candida spp.) or environmental contaminants (such as Fusarium spp.), they are commonly and unduly present in laboratory cultures. Thus, for greater reliability of these results, we followed rigorous laboratory criteria described by Guilhermetti et al., 2007, such as positive direct mycological examination, repetitive cultures, and absence of a truly pathogenic fungus in the sample.[8]

PE has been described as a promising alternative in the treatment against fungi. The chemical composition of PE is very complex; however, the researcher's attention is being drawn toward flavonoids.[9] This group of chemicals has already demonstrated antifungal potential,[10],[11] however, its specific action against the fungal cells has not been well elucidated so far. Several studies have shown that PE has medicinal properties such as anti-inflammatory,[12] antibacterial,[13] and antifungal, showing activity in vitro against different species of fungi such as Candida spp., Fusarium spp., and Trichophyton spp.[2],[3],[7],[9] Although, it is not well established how this compound promotes cell death, in vitro studies have shown that PE has an important role in the host-fungus relationship, since it is able to increase significantly reactive oxygen species production, oxygen consumption, microbicidal activity, and myeloperoxidase activity of human neutrophils against different isolates of C. albicans.[14] However, little has been published in relation to in vivo activity of PE. Most of the in vivo studies suggested the beneficial roles of PE on experimental wound healing, and this has also been approved in the clinical trial studies.[15]

In our in vitro experiments, PE was able to inhibit Candida spp. like other cases in the literature.[2],[4]In vivo, four nails were treated with PE of which two of them showed complete resolution. Culture was negative. The other two nails showed a reduction of over 50% of the lesion; however, fungi were still isolated. Based on the results obtained during in vitro studies as well as results obtained from tests performed after topical treatment, it can be concluded that propolis possesses antifungal potential and is a promising therapeutic option in cases of onychomycosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

We would like to thank Professor Marco Antonio Costa for following the patients and providing the PE.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Silva-Rocha WP, de Azevedo MF, Chaves GM. Epidemiology and fungal species distribution of superficial mycoses in Northeast Brazil. J Mycol Med 2017;27:57-64.  Back to cited text no. 1
    
2.
Tobaldini-Valerio FK, Bonfim-Mendonça PS, Rosseto HC, Bruschi ML, Henriques M, Negri M, et al. Propolis: A potential natural product to fight Candida species infections. Future Microbiol 2016;11:1035-46.  Back to cited text no. 2
    
3.
Veiga FF, Gadelha MC, da Silva MR, Costa MI, de Castro-Hoshino LV, Sato F, et al. Propolis extract for onychomycosis topical treatment: From bench to clinic. Front Microbiol 2018;9:779.  Back to cited text no. 3
    
4.
Capoci IR, Bonfim-Mendonça PD, Arita GS, Pereira RR, Consolaro ME, Bruschi ML, et al. Propolis is an efficient fungicide and inhibitor of biofilm production by vaginal Candida albicans. Evid Based Complement Altern Med 2015;2015:28769.  Back to cited text no. 4
    
5.
Marcucci MC. Propolis: Chemical composition, biological properties and therapeutic activity. Apidologie 1995;26:83-99.  Back to cited text no. 5
    
6.
Martelozo IC, Guilhermetti E, Svidzinski TI. Ocorrência de onicomicose em Maringá, Estado do Paraná, Brasil. Acta Sci Health Sci 2005;27:177-182.  Back to cited text no. 6
    
7.
Galletti J, Tobaldini-Valerio FK, Silva S, Kioshima ÉS, Trierveiler-Pereira L, Bruschi M, et al. Antibiofilm activity of propolis extract on Fusarium species from onychomycosis. Future Microbiol 2017;12:1311-21.  Back to cited text no. 7
    
8.
Guilhermetti E, Takahachi G, Shinobu CS, Svidzinski TI. Fusarium spp. As agents of onychomycosis in immunocompetent hosts. Int J Dermatol 2007;46:822-6.  Back to cited text no. 8
    
9.
Siqueira AB, Gomes BS, Cambuim I, Maia R, Abreu S, Souza-Motta CM, et al. Trichophyton species susceptibility to green and red propolis from brazil. Lett Appl Microbiol 2009;48:90-6.  Back to cited text no. 9
    
10.
Firdaus S, Ali F, Sultana N. Dermatophytosis (Qooba) a misnomer infection and its management in modern and unani perspective - A comparative review. J Med Plants 2016;4:109-14.  Back to cited text no. 10
    
11.
Agüero MB, Svetaz L, Baroni V, Lima B, Luna L, Zacchino S, et al. Urban propolis from San Juan province (Argentina): Ethnopharmacological uses and antifungal activity against Candida and dermatophytes. Ind Crops Prod 2014;57:166-73.  Back to cited text no. 11
    
12.
Lima Cavendish R, de Souza Santos J, Belo Neto R, Oliveira Paixão A, Valéria Oliveira J, Divino de Araujo E, et al. Antinociceptive and anti-inflammatory effects of brazilian red propolis extract and formononetin in rodents. J Ethnopharmacol 2015;173:127-33.  Back to cited text no. 12
    
13.
Mohdaly AA, Mahmoud AA, Roby MH, Smetanska I, Ramadan MF. Phenolic extract from propolis and bee pollen: Composition, antioxidant and antibacterial activities. J Food Biochem 2015;39:538-47.  Back to cited text no. 13
    
14.
Alves de Lima NC, Ratti BA, Souza Bonfim Mendonça P, Murata G, Araujo Pereira RR, Nakamura CV, et al. Propolis increases neutrophils response against Candida albicans through the increase of reactive oxygen species. Future Microbiol 2018;13:221-30.  Back to cited text no. 14
    
15.
Oryan A, Alemzadeh E, Moshiri A. Potential role of propolis in wound healing: Biological properties and therapeutic activities. Biomed Pharmacother 2018;98:469-83.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (698 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Reports
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed251    
    Printed5    
    Emailed0    
    PDF Downloaded34    
    Comments [Add]    

Recommend this journal