Brasch J
Klinik für Dermatologie, Venerologie und Allergologie, UKSH, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Deutschland.
Hautarzt. 2012 May;63(5):390-5. doi: 10.1007/s00105-011-2259-x.
Recent observations indicate that Arthroderma benhamiae can cause bullous tinea, that onychomycosis increasingly occurs in children and that molds can cause tinea-like lesions. If a mycotic infection is suspected, the pathogen needs to be identified. The first genetic assays for the detection of dermatophytes have successfully been tested under routine conditions. Using appropriate techniques, genetic diagnosis is faster and more sensitive than a culture. Laboratory standards that would facilitate widespread implementation of genetic identification of dermatophytes have not yet been established. For the identification of yeasts, MALDI-TOF has already been established in many laboratories. This method is being refined for the diagnosis of hyphomycetes too. Newer antimycotics that are approved for certain systemic mycoses such as the triazoles voriconazole and posaconazole and the echinocandines caspofungin, micafungin und anidulafungin may be considered for dermatomycoses that cannot be treated by other therapies. Thermotherapy and photodynamic therapy are additional options in particularly difficult cases.
近期观察表明，贝氏节皮菌可引起大疱性癣，甲癣在儿童中越来越常见，并且霉菌可引起癣样损害。如果怀疑有真菌感染，则需要鉴定病原体。用于检测皮肤癣菌的首批基因检测方法已在常规条件下成功进行了测试。使用适当的技术，基因诊断比培养更快且更灵敏。尚未建立有助于广泛实施皮肤癣菌基因鉴定的实验室标准。对于酵母菌的鉴定，基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）已在许多实验室中确立。该方法也正在针对丝状真菌的诊断进行改进。对于无法用其他疗法治疗的皮肤真菌病，可考虑使用已获批用于某些全身性真菌病的新型抗真菌药，如三唑类的伏立康唑和泊沙康唑以及棘白菌素类的卡泊芬净、米卡芬净和阿尼芬净。在特别困难的病例中，温热疗法和光动力疗法是额外的选择。
