Cooper Medical School of Rowan University, Camden, NJ, USA.
Am Fam Physician. 2013 Dec 1;88(11):762-70.
Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. It is caused by a variety of organisms, but most cases are caused by dermatophytes. Accurate diagnosis involves physical and microscopic examination and culture. Histologic evaluation using periodic acid-Schiff staining increases sensitivity for detecting infection. Treatment is aimed at eradication of the causative organism and return to a normal appearance of the nail. Systemic antifungals are the most effective treatment, with meta-analyses showing mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing, and 48% for fluconazole. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%. Several nonprescription treatments have also been evaluated. Laser and photodynamic therapies show promise based on in-vitro evaluation, but more clinical studies are needed. Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure.
甲真菌病是一种由真菌引起的指甲感染，会导致指甲变色、变厚和与甲床分离。甲真菌病在普通人群中的发病率为 10%，60 岁以上人群中的发病率为 20%，70 岁以上人群中的发病率为 50%。它由多种生物体引起，但大多数病例是由皮肤癣菌引起的。准确的诊断需要进行物理和显微镜检查以及培养。使用过碘酸-Schiff 染色进行组织学评估可提高检测感染的敏感性。治疗的目的是消灭致病生物体并使指甲恢复正常外观。系统抗真菌药是最有效的治疗方法，荟萃分析显示特比萘芬的真菌治愈率为 76%，脉冲剂量伊曲康唑为 63%，连续剂量伊曲康唑为 59%，氟康唑为 48%。同时进行指甲清创术可进一步提高治愈率。环吡酮甲涂剂等局部治疗效果较差；其失败率超过 60%。一些非处方治疗方法也已得到评估。基于体外评估，激光和光动力疗法显示出一定的前景，但仍需要更多的临床研究。尽管进行了治疗，由于再次感染或未治愈真菌感染，甲真菌病的复发率仍为 10%至 50%。
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