title: Ultraviolet C inactivation of dermatophytes: implications for treatment of onychomycosis.
abstract: BACKGROUND
  Onychomycosis responds to systemic antifungals and sometimes to topical lacquers, but alternative treatments are desirable. Topical application of germicidal ultraviolet (UV) C radiation may be an acceptable and effective therapy for infected nails.
  
  
  OBJECTIVE
  To test the ability of UVC to inactivate dermatophyte suspensions in vitro and to sterilize a novel ex vivo model of nail infection.
  
  
  METHODS
  Trichophyton rubrum, T. mentagrophytes, Epidermophyton floccosum and Microsporum canis suspensions were irradiated with UVC (254 nm) at a radiant exposure of 120 mJ cm(-2) and surviving colony-forming units quantified. T. rubrum infecting porcine hoof slices and human toenail clippings was irradiated with UVC at radiant exposures of 36-864 J cm(-2).
  
  
  RESULTS
  In vitro studies showed that 3-5 logs of cell inactivation in dermatophyte suspensions were produced with 120 mJ cm(-2) UVC irradiation. Depending on factors such as the thickness and infectious burden of the ex vivo cultures, the radiant exposure of UVC needed for complete sterilization was usually in the order of tens to hundreds of J cm(-2). Resistance of T. rubrum to UVC irradiation did not increase after five cycles of subtotal inactivation in vitro.
  
  
  CONCLUSIONS
  UVC irradiation may be a less invasive treatment option for onychomycosis, when the appropriate consideration is given to safety.
authors.affiliation: Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: T
authors.initials: T
authors.lastname: Dai
authors.forename: G P
authors.initials: GP
authors.lastname: Tegos
authors.forename: G
authors.initials: G
authors.lastname: Rolz-Cruz
authors.forename: W E
authors.initials: WE
authors.lastname: Cumbie
authors.forename: M R
authors.initials: MR
authors.lastname: Hamblin
mesh_terms: D000287:Administration, Topical; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003883:Arthrodermataceae / Q000528:radiation effects*; D003881:Dermatomycoses / Q000532:radiotherapy*; D006724:Hoof and Claw / Q000382:microbiology; D006801:Humans; D009262:Nails / Q000382:microbiology; D014009:Onychomycosis / Q000382:microbiology / Q000532:radiotherapy*; D034421:Sus scrofa; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*
chemical_list: D000935:Antifungal Agents