University of Pittsburgh Medical Center, St. Margaret New Kensington Family Health Center and St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA.
University of Texas Medical Branch, Galveston, TX, USA.
Am Fam Physician. 2021 Oct 1;104(4):359-367.
Onychomycosis is a chronic fungal infection of the fingernail or toenail bed leading to brittle, discolored, and thickened nails. Onychomycosis is not just a cosmetic problem. Untreated onychomycosis can cause pain, discomfort, and physical impairment, negatively impacting quality of life. Onychomycosis should be suspected in patients with discolored nails, nail plate thickening, nail separation, and foul-smelling nails. Accurate diagnosis is important before initiating treatment because therapy is lengthy and can cause adverse effects. A potassium hydroxide preparation with confirmatory fungal culture, periodic acid-Schiff stain, or polymerase chain reaction is the preferred diagnostic approach if confirmative testing is cost prohibitive or not available. Treatment decisions should be based on severity, comorbidities, and patient preference. Oral terbinafine is preferred over topical therapy because of better effectiveness and shorter treatment duration. Patients taking terbinafine in combination with tricyclic antidepressants, selective serotonin reuptake inhibitors, atypical antipsychotics, beta blockers, or tamoxifen should be monitored for drug-drug interactions. Topical therapy, including ciclopirox 8%, efinaconazole 10%, and tavaborole 5%, is less effective than oral agents but can be used to treat mild to moderate onychomycosis, with fewer adverse effects and drug-drug interactions. Nail trimming and debridement used concurrently with pharmacologic therapy improve treatment response. Although photodynamic and plasma therapies are newer treatment options that have been explored for the treatment of onychomycosis, larger randomized trials are needed. Preventive measures such as avoiding walking barefoot in public places and disinfecting shoes and socks are thought to reduce the 25% relapse rate.
甲真菌病是一种慢性真菌感染，累及指甲或趾甲床，导致指甲变脆、变色和增厚。甲真菌病不仅是一个美容问题。未经治疗的甲真菌病可引起疼痛、不适和身体功能障碍，从而降低生活质量。如果指甲变色、甲板增厚、指甲分离和指甲发臭，应怀疑患有甲真菌病。在开始治疗之前，准确诊断很重要，因为治疗时间长且可能会引起不良反应。如果确诊试验费用过高或不可用，建议使用氢氧化钾制剂加真菌培养、过碘酸-Schiff 染色或聚合酶链反应进行确认性诊断。治疗决策应基于严重程度、合并症和患者偏好。口服特比萘芬优于局部治疗，因为前者的有效性更高且治疗时间更短。服用特比萘芬的患者如果同时服用三环类抗抑郁药、选择性 5-羟色胺再摄取抑制剂、非典型抗精神病药、β受体阻滞剂或他莫昔芬，应监测药物相互作用。包括环吡酮 8%、依氟康唑 10%和他泊沙罗 5%在内的局部治疗药物不如口服药物有效，但可用于治疗轻度至中度甲真菌病，不良反应和药物相互作用更少。指甲修剪和清创术与药物治疗同时使用可改善治疗反应。尽管光动力疗法和等离子体疗法是治疗甲真菌病的新治疗方法，但需要更大规模的随机试验。预防措施如避免在公共场所赤脚行走以及对鞋子和袜子进行消毒，被认为可以降低 25%的复发率。
