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首页> 外文期刊>Prescrire international >Fungal nail infections: diagnosis and management.
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Fungal nail infections: diagnosis and management.

机译：指甲真菌感染：诊断和处理。

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1) Fungal nail infection, or onychomycosis, mainly affects toenails. Infections are generally asymptomatic. Spontaneous regressions, but also complications, appear to be rare. Discomfort and cosmetic complaint are occasionally reported; 2) After a review of the literature based on the standard Prescrire procedure, we examined the diagnosis and management of fungal nail infections; 3) Clinical signs of fungal nail infections are non-specific. Alternative diagnoses include psoriasis and nail microtrauma. Nail hyperkeratosis and leukonychia are useful diagnostic pointers. Matrix involvement has important implications in the choice of treatment; 4) Detection of fungal structures by direct examination of a nail sample is strongly suggestive of fungal nail infection. In contrast, cases of negative direct examination with positive culture must be interpreted with caution, as contamination is frequent; 5) Antifungal lacquers (5% amorolfine and 8% ciclopirox) applied to the nails cure about 30% of fungal infections and sometimes cause mild irritation. There is no firm evidence that these solutions are any more effective than other topical antifungals applied daily to the affected nail. Trimming, filing or grinding the nail, in addition to these drug treatments, is likely to be beneficial, but these measures have not been evaluated; 6) Chemical nail destruction with a combination of urea and bifonazole, followed by treatment with an antifungal ointment, can be used when the nail is markedly thickened. Non-comparative trials have shown cure rates close to 70% at three months when the matrix is not involved, and 40% with matrix involvement. Drug application is inconvenient and local reactions are frequent. Surgical nail avulsion carries a risk of local infection and permanent nail dystrophy; 7) Oral terbinafine is effective in more than 50% of cases but its cutaneous, hepatic and haematological adverse effects are severe in about 1 in 2000 patients and can be life-threatening; 8) It is better to treat Candida nail infections with oral azoles (ketonazole, itraconazole) than with terbinafine. These treatments carry a risk of serious adverse effects and numerous drug interactions; 9) Fungal nail infections are usually mild. Treatments with potentially severe adverse effects must therefore be used with caution. It is better not to treat fungal nail infections if the risks outweigh the expected benefits.
机译：1）指甲真菌感染或甲癣主要影响脚趾甲。感染通常是无症状的。自发的消退以及并发症似乎很少见。偶尔会出现不适和美容投诉; 2）在根据标准的Prescrire程序对文献进行回顾之后，我们检查了真菌性指甲感染的诊断和处理; 3）指甲真菌感染的临床体征是非特异性的。替代诊断包括牛皮癣和指甲微伤。指甲过度角化和白细胞增多症是有用的诊断指标。基质的参与对治疗的选择具有重要的意义。 4）通过直接检查指甲样品来检测真菌结构强烈提示真菌指甲感染。相比之下，培养阳性的阴性直接检查阴性病例必须谨慎处理，因为污染很频繁。 5）涂在指甲上的抗真菌清漆（5％阿莫罗芬和8％环吡酮）可治愈约30％的真菌感染，有时会引起轻度刺激。没有确凿的证据表明这些解决方案比每天应用于患处指甲的其他局部抗真菌药更有效。除这些药物治疗外，修指甲，锉指甲或打磨指甲可能是有益的，但尚未评估这些措施。 6）当指甲明显增厚时，可以使用尿素和联苯苄唑的组合化学破坏指甲，然后用抗真菌药膏治疗。非对比试验显示，不使用基质时三个月的治愈率接近70％，不涉及基质时治愈率为40％。药物应用不便，局部反应频繁。手术性指甲撕脱有局部感染和永久性营养不良的风险; 7）口服特比萘芬在50％以上的病例中有效，但其皮肤，肝和血液学不良反应在2000名患者中约有1人是严重的，可能危及生命; 8）与特比萘芬相比，口服唑类药物（酮康唑，伊曲康唑）治疗念珠菌指甲感染更好。这些治疗方法存在严重不良反应和大量药物相互作用的风险。 9）指甲真菌感染通常是轻度的。因此，必须谨慎使用具有潜在严重不良影响的治疗方法。如果风险超过预期收益，最好不要治疗指甲真菌感染。

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    《Prescrire international》 |2009年第99期|共5页
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  • 正文语种 eng
  • 中图分类 药学;
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