1Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, 5001 Australia.
2International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, City East, Adelaide, SA 5001 Australia.
J Foot Ankle Res. 2019 Apr 11;12:22. doi: 10.1186/s13047-019-0332-3. eCollection 2019.
Onychomycosis, a fungal infection affecting the nail plate, is a common condition often requiring prolonged treatment regimens, with low success rates. Urea is one treatment option, which is thought to improve the efficacy of topical and oral antifungal agents. Despite a theoretical basis for the use of urea for the treatment of onychomycosis, the evidence-base for this treatment has not been systematically reviewed.
The purpose of this study was to conduct a systematic literature review to determine the efficacy and safety of urea as a monotherapy and as adjunct therapy, compared to other treatment regimens for onychomycosis.
A systematic literature search of ten electronic databases was conducted. Only studies that used microscopy and culture or other validated laboratory-based testing method to confirm the presence of a fungal infection before treatment were included. The outcome measures assessed were efficacy (defined in terms of mycological, clinical and complete cure) and safety (defined as self-reported adverse events).
The systematic search yielded 560 unique studies for review. Of these, only six were eligible for inclusion. All studies were observed to have methodological concerns, most studies consisted of small sample sizes and were difficult to compare given heterogeneity in outcome measures and follow-up time. Despite this, a trend was observed to suggest that urea, when added to topical or oral antifungal treatment regimens, improved efficacy of the treatment.
This review suggests that topical urea, as an adjunct to topical and oral antifungal treatment regimens, may improve the efficacy of treatment. However, further research is needed.
甲真菌病是一种影响甲板的真菌感染，是一种常见的疾病，通常需要长期的治疗方案，但成功率较低。尿素是一种治疗选择，它被认为可以提高局部和口服抗真菌药物的疗效。尽管尿素治疗甲真菌病有理论依据，但这种治疗方法的证据基础尚未得到系统审查。
本研究旨在进行系统文献回顾，以确定尿素作为单一疗法和辅助疗法治疗甲真菌病的疗效和安全性，与其他治疗方案进行比较。
对十个电子数据库进行了系统文献检索。仅纳入在治疗前使用显微镜和培养或其他经证实的实验室检测方法来确认真菌感染存在的研究。评估的结局指标是疗效（定义为真菌学、临床和完全治愈）和安全性（定义为自我报告的不良事件）。
系统搜索产生了 560 项可供审查的独特研究。其中，只有 6 项符合纳入标准。所有研究都存在方法学问题，大多数研究样本量较小，由于结局指标和随访时间的异质性，难以进行比较。尽管如此，仍观察到一种趋势，表明尿素与局部或口服抗真菌治疗方案联合使用，可提高治疗效果。
本综述表明，局部应用尿素作为局部和口服抗真菌治疗方案的辅助治疗方法，可能会提高治疗效果。但是，还需要进一步的研究。
