Robbins Jeffrey M
Podiatry Services, VA Central Office, Louis Stokes Cleveland DVAMC, 10701 East Boulevard, Cleveland, OH 44106, USA.
J Diabetes Complications. 2003 Mar-Apr;17(2):98-104. doi: 10.1016/s1056-8727(02)00199-x.
Onychomycosis is a common medical condition in patients with diabetes. Conflicting data exist as to whether diabetes predisposes patients to the disease. Controversy notwithstanding, patients with diabetes have several medical conditions (obesity, peripheral neuropathy, and retinopathy) that can inhibit the identification or mask the progression of fungal nail infections. In addition, vascular insufficiency, impaired wound healing, and compromised immunologic status associated with diabetic foot increase the risk of secondary infections in diabetic patients with onychomycosis. Such factors contribute to an increased morbidity and decreased quality of life in these patients and underscore the need for effective antifungal treatment. Oral antifungal agents are generally well tolerated, but serious adverse events independent of or associated with a number of significant drug interactions have been reported. The availability of a topical therapy, ciclopirox topical solution, 8% (Penlac Nail Lacquer), provides clinicians with an additional effective and well-tolerated treatment option. In order to further increase the efficacy of topical or oral treatment, mechanical intervention (e.g., debridement) may be combined with either of these options. Choice of appropriate treatment and careful monitoring of fungal nail infections can prevent significant morbidity in patients with diabetes.
甲癣是糖尿病患者的常见病症。关于糖尿病是否使患者易患该疾病，存在相互矛盾的数据。尽管存在争议，但糖尿病患者有多种病症（肥胖、周围神经病变和视网膜病变），这些病症可能会妨碍对甲真菌病的识别或掩盖其进展。此外，与糖尿病足相关的血管功能不全、伤口愈合受损和免疫状态受损，增加了患有甲癣的糖尿病患者继发感染的风险。这些因素导致这些患者的发病率增加和生活质量下降，并突出了有效抗真菌治疗的必要性。口服抗真菌药物一般耐受性良好，但已报告了与许多严重药物相互作用无关或相关的严重不良事件。一种局部治疗药物8%环吡酮外用溶液（Penlac Nail Lacquer）的出现，为临床医生提供了另一种有效且耐受性良好的治疗选择。为了进一步提高局部或口服治疗的疗效，可将机械干预（如清创术）与这些选择中的任何一种联合使用。选择合适的治疗方法并仔细监测甲真菌病，可预防糖尿病患者出现严重的发病情况。
