Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
J Eur Acad Dermatol Venereol. 2015 Jul;29(7):1275-9. doi: 10.1111/jdv.12950. Epub 2015 Jan 15.
Onychomycosis is a common fungal infection of the nails that is increasing in prevalence in the old, diabetics and immunocompromised. Onychomycosis presents a therapeutic challenge that can lead to significant reductions in quality of life leading to both physical and psychological consequences. Current treatment modalities are difficult to implement due to the poor penetration of topical treatments to the nail bed, the slow growing nature of nails and the need for prolonged use of topical and/or oral medications. Standard of care medications have cure rates of 63-76% that leads to a high propensity of treatment failures and recurrences. Photodynamic therapy (PDT) offers an alternative treatment for onychomycosis. Methylene blue dye, methyl-aminolevulinate (MAL) and aminolevulinic acid (ALA) have been used as photosensitizers with approximately 630 nm light. These modalities are combined with pre-treatment of urea and/or microabrasion for better penetration. PDT treatments are well tolerated with only mild transient pain, burning and erythema. In addition, significant cure rates for patients who have contraindications to oral medications or failed standard medications can be obtained. With further enhancements in photosensitizer permeability, decreased pre-treatment and photosensitizer incubation times, PDT can be a more efficient and cost-effective in office based treatment for onychomycosis. However, more large-scale randomized control clinical trials are needed to access the efficacy of PDT treatments.
甲真菌病是一种常见的指甲真菌感染，在老年人、糖尿病患者和免疫功能低下者中患病率不断上升。甲真菌病治疗具有挑战性，会导致生活质量显著下降，从而产生身体和心理两方面的后果。由于局部治疗药物难以渗透到甲床、指甲生长缓慢以及需要长期使用局部和/或口服药物，目前的治疗方法难以实施。标准治疗药物的治愈率为 63-76%，导致治疗失败和复发的可能性很高。光动力疗法（PDT）为甲真菌病提供了一种替代治疗方法。亚甲蓝染料、甲基氨基酮戊酸（MAL）和氨基酮戊酸（ALA）已被用作光敏剂，其波长约为 630nm。这些方法与尿素预处理和/或微磨蚀相结合，以提高渗透性。PDT 治疗耐受性良好，仅有轻度短暂疼痛、烧灼感和红斑。此外，对于那些对口服药物有禁忌症或标准药物治疗失败的患者，可以获得显著的治愈率。随着光敏剂渗透性的进一步提高，预处理和光敏剂孵育时间的缩短，PDT 可以成为一种更有效和更具成本效益的基于办公室的甲真菌病治疗方法。然而，还需要更多的大规模随机对照临床试验来评估 PDT 治疗的疗效。
