一项关于甲癣治疗管理的问卷调查研究：加拿大视角

A questionnaire study on the management of onychomycosis: a Canadian perspective.

作者信息

Gupta A K, Shear N H

机构信息

Department of Medicine, Sunnybrook Health Science Center, Toronto, Canada.

出版信息

Int J Dermatol. 1998 Jun;37(6):457-60. doi: 10.1046/j.1365-4362.1998.00409.x.

DOI:10.1046/j.1365-4362.1998.00409.x

PMID:9646138

Abstract

BACKGROUND

Onychomycosis of the toenails is a condition that responds poorly to griseofulvin. The introduction of terbinafine in Canada in May 1993 resulted in a marked shift in the choice of treatment for pedal onychomycosis.

METHODS

A questionnaire survey was carried out in 1996 among Canadian dermatologists regarding the management of onychomycosis.

RESULTS

There were 160 respondents from the roughly 350 practicing dermatologists. The dermatologists saw 8 +/- 0.6 patients per week (average +/- standard error (SE) with suspected or diagnosed onychomycosis, with 5 +/- 0.5 patients per week consulting the dermatologists for the first time. Most dermatologists performed mycological testing prior to starting treatment for onychomycosis. The management options for onychomycosis (mean +/- SE) were oral systemic antifungal therapy 51 +/- 3%, no therapy 31 +/- 3%, and nondrug therapy 9 +/- 2%. The majority of dermatologists (83%) used terbinafine as first-line therapy if, indeed, they used oral antifungal agents. In contrast, griseofulvin and ketoconazole were used as first-line therapy in 5% and 1% of cases, respectively. In Canada, there are no monitoring requirements when using oral terbinafine for onychomycosis. Therefore, it is not surprising that only 30% of dermatologists performed monitoring with terbinafine. In contrast, the frequency of monitoring with griseofulvin and ketoconazole was 40% and 80%, respectively. The subset of dermatologists who reported monitoring carried it out in only a fraction of their patients: 47%, 53% and 83% for terbinafine, griseofulvin, and ketoconazole, respectively. Therefore, the overall number of patients in whom regular monitoring was performed was 14.1% 21.2%, and 71.4% for terbinafine, griseofulvin, and ketoconazole, respectively. The perceived cure rates with terbinafine and griseofulvin (mean +/- SE) were 83.7 +/- 1% and 41 +/- 3.1%, respectively.

CONCLUSIONS

In May 1996, within three years of the introduction of terbinafine to Canada, this agent has become the drug of choice for the treatment of pedal onychomycosis (at the time of the survey neither itraconazole or fluconazole were approved for onychomycosis). Terbinafine has been found to be very effective and safe, and only a minority of dermatologists perform regular monitoring with this drug.

摘要

背景

趾甲甲癣对灰黄霉素反应不佳。1993年5月特比萘芬在加拿大上市，导致足部甲癣治疗选择发生显著转变。

方法

1996年对加拿大皮肤科医生进行了一项关于甲癣治疗管理的问卷调查。

结果

约350名执业皮肤科医生中有160名回复。皮肤科医生每周诊治8±0.6例疑似或确诊甲癣患者，其中每周有5±0.5例患者首次咨询皮肤科医生。大多数皮肤科医生在开始治疗甲癣前进行真菌学检测。甲癣的治疗选择（均值±标准误）为口服全身抗真菌治疗51±3%，不治疗31±3%，非药物治疗9±2%。如果确实使用口服抗真菌药物，大多数皮肤科医生（83%）将特比萘芬作为一线治疗药物。相比之下，灰黄霉素和酮康唑分别仅在5%和1%的病例中用作一线治疗药物。在加拿大，使用口服特比萘芬治疗甲癣没有监测要求。因此，不足为奇的是，只有30%的皮肤科医生对特比萘芬进行监测。相比之下，灰黄霉素和酮康唑的监测频率分别为40%和80%。报告进行监测的皮肤科医生亚组仅对部分患者进行监测：特比萘芬、灰黄霉素和酮康唑分别为47%、53%和83%。因此，定期接受监测的患者总数分别占使用特比萘芬、灰黄霉素和酮康唑患者的14.1%、21.2%和71.4%。特比萘芬和灰黄霉素的预期治愈率（均值±标准误）分别为83.7±1%和41±3.1%。