Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada.
Mediprobe Research Inc., 645 Windermere Road, London, ON, N5X2P1, Canada.
Am J Clin Dermatol. 2019 Feb;20(1):123-133. doi: 10.1007/s40257-018-0403-4.
Onychomycosis is a fungal nail infection caused by dermatophytes, non-dermatophyte molds, and yeasts. Treatment of this infection can be difficult, with relapse likely to occur within 2.5 years of cure. The objective of this article is to review factors that can impact cure and to suggest practical techniques that physicians can use to maximize cure rates. Co-morbidities, as well as disease severity and duration, are among the many patient factors that could influence the efficacy of antifungal therapies. Furthermore, organism, treatment, and environmental factors that may hinder cure include point mutations, biofilms, affinity for non-target enzymes, and exposure to fungal reservoirs. To address patient-related factors, physicians are encouraged to conduct confirmatory testing and treat co-morbidities such as tinea pedis early and completely. To combat organism-focused factors, it is recommended that disruption of biofilms is considered, and drugs with multiple routes of delivery and unique mechanisms of action are prescribed when traditional agents are not effective. Extending follow-up periods, using combination treatments, and considering pulse regimens may also be of benefit. Through these practical techniques, physicians can maximize cure and limit the risk of relapse and re-infection.
甲真菌病是一种由真菌引起的指甲感染，包括皮肤癣菌、非皮肤癣菌霉菌和酵母菌。这种感染的治疗可能很困难，治愈后 2.5 年内很可能复发。本文的目的是回顾可能影响治愈率的因素，并提出医生可以用来最大限度提高治愈率的实用技术。合并症以及疾病的严重程度和持续时间是许多可能影响抗真菌治疗效果的患者因素之一。此外，可能阻碍治愈的病原体、治疗和环境因素包括点突变、生物膜、非靶标酶亲和力和真菌库暴露。为了解决与患者相关的因素，鼓励医生进行确认性检测，并早期和彻底治疗合并的足癣。为了对抗以病原体为重点的因素，建议考虑破坏生物膜，并在传统药物无效时开具具有多种给药途径和独特作用机制的药物。延长随访期、使用联合治疗以及考虑脉冲疗法也可能有益。通过这些实用技术，医生可以最大限度地提高治愈率，并降低复发和再感染的风险。
