Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Mycoses. 2023 Jun;66(6):497-504. doi: 10.1111/myc.13575. Epub 2023 Feb 12.
The prognostic factors for cure have been derived from cases of dermatophyte onychomycosis. However, there are limited studies in non-dermatophyte onychomycosis. Neoscytalidium dimidiatum is the common causative agents of non-dermatophyte onychomycosis which has proven to be recalcitrant to treatment.
This retrospective cohort study investigated mycological cure and prognostic factors in Neoscytalidium onychomycosis patients.
Patients aged 18 or older with newly diagnosed Neoscytalidium onychomycosis were enrolled. All patients were treated and followed up for at least 1 year. Mycological cure was analysed with Cox proportional hazard regression. The hazard ratios (HRs) of previously reported potential prognostic factors were included in univariable and multivariable stratified Cox regression analyses.
From total 198 patients, mycological cure was achieved in 108 (54.6%) patients with a median of 490 (± SD 62.2) days. The poor prognostic factors for mycological cure were age ≥ 70 years (HR, 0.63; 95% CI, 0.41-0.97; p = .034); nail thickness ≥2 mm (HR, 0.20; 95% CI, 0.11-0.35; p < .001); and peripheral vascular disease (HR, 0.46; 95% CI, 0.28-0.77; p = .003). Combination therapy was associated with achieving a mycological cure (HR, 2.55; 95% CI, 1.49-4.38; p < .001).
Approximately half of the patients with onychomycosis caused by Neoscytalidium dimidiatum achieved a mycological cure, with a median time to cure exceeding 1 year. Combined topical and systemic antifungal treatments yield a higher chance of mycological cure than monotherapies. Advanced age, nail thickness and peripheral vascular disease are obstacle factors to cure.
治愈的预测因素来自于皮肤癣菌引起的甲真菌病病例。然而，非皮肤癣菌性甲真菌病的研究有限。半知菌属是常见的非皮肤癣菌性甲真菌病的病原体，已被证明对抗真菌治疗具有耐药性。
本回顾性队列研究调查了半知菌属甲真菌病患者的真菌学治愈和预测因素。
招募年龄在 18 岁或以上的新发半知菌属甲真菌病患者。所有患者均接受治疗并随访至少 1 年。采用 Cox 比例风险回归分析真菌学治愈情况。单变量和多变量分层 Cox 回归分析纳入了先前报道的潜在预测因素的风险比（HR）。
198 例患者中，108 例（54.6%）患者实现了真菌学治愈，中位治愈时间为 490（±SD 62.2）天。对真菌学治愈的不良预测因素包括年龄≥70 岁（HR，0.63；95%CI，0.41-0.97；p=0.034）；甲厚度≥2mm（HR，0.20；95%CI，0.11-0.35；p<0.001）；和外周血管疾病（HR，0.46；95%CI，0.28-0.77；p=0.003）。联合治疗与真菌学治愈相关（HR，2.55；95%CI，1.49-4.38；p<0.001）。
大约一半的由半知菌属引起的甲真菌病患者实现了真菌学治愈，中位治愈时间超过 1 年。与单一治疗相比，联合局部和全身抗真菌治疗更有可能实现真菌学治愈。高龄、甲厚度和外周血管疾病是治愈的障碍因素。
