Nenoff Pietro, Cleffmann Ulrike, Klonowski Esther, Uhrlaß Silke
Labor Leipzig-Mölbis, labopart - Medizinische Laboratorien, Partnerschaft Dr. Michael Gerber, Prof. Frank Bühling, Prof. Pietro Nenoff, Tobias Löwe, Erik von Rein, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
Dermatologie am Groner Tor, Groner-Tor-Str. 25, 37073, Göttingen, Deutschland.
Dermatologie (Heidelb). 2025 May;76(5):301-312. doi: 10.1007/s00105-025-05502-3. Epub 2025 Apr 9.
Fungal nail infections in children and adolescents are on the rise worldwide. Diagnosis and, above all, treatment is a challenge. A 15-year-old girl had been suffering from onychomycosis of the toenails for more than 6 years, and later also of a fingernail on her right hand. Trichophyton (T.) rubrum had already been identified by culture and polymerase chain reaction (PCR) as the pathogen years ago. However, treatment attempts with topical antimycotics and fluconazole did not lead to a cure. Mycological diagnostics using PCR and sequencing of the ITS (Internal Transcribed Spacer) region of the rDNA of the dermatophyte confirmed the diagnosis of tinea unguium caused by T. rubrum. Ciclopiroxolamine-containing water-soluble nail varnish and oral terbinafine were used for treatment, both in off-label use and with the consent of the girl's parents. Terbinafine was given continuously once daily and subsequently intermittently once weekly. After 7 months of combined antifungal therapy, the nail mycosis of the fingernails and toenails healed completely. The endpoint of the therapy was clinical healing and negative PCR for T. rubrum. There have been no recurrences over the past more than 3 years-first under prophylaxis with the antifungal nail varnish.
全球范围内，儿童和青少年的甲真菌病发病率呈上升趋势。诊断，尤其是治疗，是一项挑战。一名15岁女孩的 toenails 患甲癣已超过6年，后来右手的一个 fingernail 也患病。数年前，通过培养和聚合酶链反应（PCR）已鉴定红色毛癣菌（T. rubrum）为病原体。然而，局部抗真菌药和氟康唑的治疗尝试均未治愈。使用PCR和皮肤癣菌rDNA的ITS（内转录间隔区）区域测序进行的真菌学诊断证实了由红色毛癣菌引起的甲癣诊断。含环吡酮胺的水溶性指甲油和口服特比萘芬用于治疗，均为超说明书用药且经女孩父母同意。特比萘芬持续每日一次给药，随后改为每周一次间歇给药。联合抗真菌治疗7个月后，手指甲和 toenails 的甲真菌病完全治愈。治疗终点为临床治愈且红色毛癣菌PCR检测阴性。在过去3年多的时间里，在使用抗真菌指甲油进行预防的情况下，没有复发。
