Gupta A K, Gregurek-Novak T
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site), and University of Toronto, Ont., Canada.
Dermatology. 2001;202(3):235-8. doi: 10.1159/000051643.
Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis.
To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis.
In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks.
There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25-53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment.
Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.
短帚霉是一种常见的非皮肤癣菌霉菌，可引起甲真菌病。
评估口服抗真菌药物灰黄霉素、酮康唑、伊曲康唑、氟康唑和特比萘芬治疗短帚霉感染的疗效和安全性。
在一项前瞻性、比较性、平行组、单盲、随机、非行业资助的研究中，将由短帚霉引起的趾甲真菌病患者随机分组，并用5种口服抗真菌药物之一进行治疗，即灰黄霉素、酮康唑、伊曲康唑（冲击疗法）、氟康唑或特比萘芬。治疗方案为：灰黄霉素600mg，每日2次，共12个月；酮康唑200mg，每日1次，共4个月；伊曲康唑冲击疗法，共3个疗程，每个疗程200mg，每日2次，连用1周，相邻疗程间隔3周；特比萘芬250mg，每日1次，共12周；氟康唑150mg，每日1次，共12周。
共有59例患者（48例男性，11例女性，平均年龄35.6岁，范围25 - 53岁）。所有患者均有远端和侧方甲真菌病的临床证据，目标趾甲有中度至重度病变。治疗组间患者的平均年龄及基线时甲真菌病的平均受累面积无显著差异。疗效参数为临床治愈（CC）和真菌学治愈（MC）。治疗开始后12个月时，结果如下：灰黄霉素组，CC 3/11，MC 0/11，CC + MC 0/11；酮康唑组，CC 10/12，MC 8/12，CC + MC 8/12；伊曲康唑组，CC 12/12，MC 12/12，CC + MC 12/12；特比萘芬组，CC 12/12，MC 11/12，CC + MC 11/12；氟康唑组，CC 8/12，MC 8/12，CC + MC 8/12。不良反应包括：灰黄霉素组，出现胃肠道症状、过敏反应、光性皮炎、肝肾功能障碍，11例患者中有3例停药；酮康唑组，2例出现肝功能障碍但无症状改变；伊曲康唑组，2例出现恶心和呕吐；特比萘芬组，2例出现味觉障碍，3例出现恶心；氟康唑组，5例出现严重胃肠道事件。接受酮康唑、伊曲康唑、特比萘芬或氟康唑治疗的患者均未停药。
伊曲康唑和特比萘芬对部分短帚霉引起的趾甲真菌病有效。这些药物在趾甲真菌病治疗过程中似乎也是安全的。灰黄霉素对短帚霉引起的趾甲真菌病无效。鉴于酮康唑有潜在不良反应，尤其是有更新的抗真菌药物可供选择，不推荐用于趾甲真菌病的治疗。
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