Gupta Aditya K, Liddy Amanda, Magal Lee, Shemer Avner, Cooper Elizabeth A, Saunte Ditte Marie L, Wang Tong
Mediprobe Research Inc., London, ON N5X 2P1, Canada.
Division of Dermatology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada.
Life (Basel). 2025 Aug 13;15(8):1285. doi: 10.3390/life15081285.
Onychomycosis is a prevalent and clinically relevant complication among individuals with diabetes. It is associated with an elevated risk of secondary fungal and bacterial infections, foot ulceration, and, in advanced cases, amputation. Factors contributing to the increased prevalence of onychomycosis in this population include age, peripheral vascular disease, poor glycemic control, neuropathy, suboptimal foot hygiene, and nail trauma. While dermatophytes are the most common pathogens, diabetic patients are more prone to mixed infections involving species with varying antifungal susceptibility profiles, necessitating accurate identification to guide therapy. Prompt diagnosis and early intervention are important to prevent complications. Systemic antifungals such as terbinafine and itraconazole are considered first-line therapies, particularly for moderate to severe onychomycosis. However, drug interactions, renal, hepatic, and metabolic comorbidities may necessitate individualized treatment plans. For patients with mild to moderate disease, or contraindications to oral therapy, topical agents such as efinaconazole or tavaborole offer viable alternatives. Adjunctive measures, including education on foot hygiene, prompt treatment of tinea pedis, and environmental sanitization, are important in preventing recurrence and reinfection. This review summarizes the epidemiology, diagnosis, and treatment considerations for onychomycosis in diabetic patients, emphasizing the need for individualized care to improve outcomes in this high-risk population.
甲癣是糖尿病患者中一种常见且具有临床相关性的并发症。它与继发真菌和细菌感染、足部溃疡的风险增加相关，在晚期病例中还与截肢相关。导致该人群中甲癣患病率增加的因素包括年龄、外周血管疾病、血糖控制不佳、神经病变、足部卫生欠佳以及指甲外伤。虽然皮肤癣菌是最常见的病原体，但糖尿病患者更容易发生涉及具有不同抗真菌药敏谱的菌种的混合感染，因此需要准确鉴定以指导治疗。及时诊断和早期干预对于预防并发症很重要。特比萘芬和伊曲康唑等全身性抗真菌药被视为一线治疗药物，特别是对于中重度甲癣。然而，药物相互作用、肾脏、肝脏和代谢合并症可能需要个体化的治疗方案。对于轻度至中度疾病患者或口服治疗有禁忌证的患者，艾氟康唑或他瓦罗芬等局部用药提供了可行的替代方案。辅助措施，包括足部卫生教育、及时治疗足癣以及环境卫生，对于预防复发和再感染很重要。本综述总结了糖尿病患者甲癣的流行病学、诊断和治疗注意事项，强调需要个体化护理以改善这一高危人群的治疗效果。
