Abstract
Onychomycosis is a fungal infection of nails of fingers of the hands or feet, resulting in thinning, and the subsequent destruction, discoloration and desquamation of the nail plate from the nail bed. The etiology of onychomycosis in most cases are dermatomycetes, Candida species and non-dermatomycetes filamentous fungi. The prevalence of onychomycosis in the general population is high and varies in different countries. Current approaches to the therapy include the use of systemic therapy, which is the main therapeutic approach, topical (local) therapy, administered to a specific group of patients and a number of non-drug treatments. When using any of the therapy the achieving of high clinical efficacy is a difficult task. The main problem is the inability to create sufficient concentrations of the active substance in the structure of the nail unit. At present, there is research data regarding a new drug compounds and the novel representatives of existing classes of antimycotics. One of the potential approaches to the treatment of onychomycosis may be the use of drugs, leading to a decrease in pH in the nail tissue and inhibition of the growth of fungi. This article provides general information about the epidemiology, etiology and pathogenesis of onychomycosis, and also a data on pharmacology and clinical studies of the new combined preparation for the therapy of onychomycosis will be presented for the first time.
-
1.
Burzykowski T., Molenberghs G., Abeck D., et al. High prevalence of foot disease in Europe; results of the Achilles Project. Mycoses 2003; 46:496-505.
-
2.
Clinical Mycology. Elias J. Anaissie, Michael R. McGinnis, and Michael A. Pfaller Philadelphia: Churchill Livingstone, 2003. 608 pp.
-
3.
Drakensjö I.T., Chryssanthou E. Epidemiology of dermatophyte infections in Stockholm, Sweden: a retrospective study from 2005-2009. Med Mycol 2011; 49:484-8.
-
4.
Ghannoum M.A., Hajjeh R.A., Scher R., et al. A large scale North American study of fungal isolated from nails; the frequency of onychomycosis, fungal distribution, and antifungal susceptibility patterns. J Am Acad Dermatol 2000; 43:641-8.
-
5.
Gupta A.K., Jain H.C., Lynde C.W. Prevalence and epidemiology of onychomycosis in patients visiting physicians’ offices: a multicenter Canadian survey of 15,000 patients. J Am Acad Dermatol 2000; 43:244-8.
-
6.
Gulcan A., Gulcan E., Oksuz S., Sahin I., Kaya D. Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors. J Am Podiatr Med Assoc 2011; 101:49-54.
-
7.
Narotham Reddy K., Akshaya Srikanth B., Ram Sharan T., Biradar P. Epidemiological, clinical and cultural study of onychomycosis. Amer J Dermatol Venereol 2012; 1:35-40.
-
8.
Ahmed M., Gupta S., Gupta S. A Clinico-mycological study of onychomycosis. Egyptian Dermtol Online J 2010; 6:4.
-
9.
Rodríguez-Pazos L., Pereiro-Ferreirós M.M., Pereiro M. Jr., Toribio J. Onychomycosis observed in children over a 20-year period. Mycoses 2011; 54:450-3.
-
10.
Lehenkari E., Silvennoinen-Kassinen S. Dermatophytes in northern Finland in 1982-90. Mycoses 1995; 38:411-4.
-
11.
Burri C.H., Hany M. Zur Epidemiologie der Dermatphytosen in der Region Zurich. Akt Dermatol 1986; 12:128-32.
-
12.
Kostanje M.J., Staats C. Fungal infections in the Netherlands. Dermatology 1995; 190:39-42.
-
13.
Miklić P., Skerlev M., Budimcić D., Lipozencić J. The frequency of superficial mycoses according to agents isolated during a ten-year period (1999-2008) in Zagreb area, Croatia. Acta Dermatovenerol Croat 2010; 18:92-8.
-
14.
Budak A., Bogusz B., Tokarczyk M., Trojanowska D. Dermatophytes isolated from superficial fungal infections in Krakow, Poland, between 1995 and 2010. Mycoses 2013. Неопубликованные (предварительные данные).
-
15.
Dhib I., Fathallah A., Yaacoub A., et al. Clinical and mycological features of onychomycosis in central Tunisia: a 22-years retrospective study (1986-2007). Mycoses 2012. Неопубликованные (предварительные данные).
-
16.
Greer D.L. Evolving role of nondermatophytes in onychomycosis. Int J Dermatol 1995; 34:521-4.
-
17.
Monod M., Capoccia S., Lechenne B., et al. Secreted proteases from pathogenic fungi. Int J Med Microbiol 2002; 292:405-19.
-
18.
Ito T., Meyer K.C., Ito N., Paus R. Immune privilege and the skin. Curr Dir Autoimmun 2008; 10:27-52.
-
19.
Martinez-Rossi N.M., Persinoti G.F., Peres N.T., Rossi A. Role of pH in the pathogenesis of dermatophytoses. Mycoses 2012; 55:381-7.
-
20.
Seebacher C., Brasch J., Abeck D., et al. Onychomycosis. Mycoses 2007; 50:321-7.
-
21.
Van Minnebruggen G., François I., Cammue B., et al. A General overview on past, present and future antimycotics. The Open Mycology Journal 2010; 4:22-32.
-
22.
Roberts D.T., Taylor W.D., Boyle J.; British Association of Dermatologists. Guidelines for treatment of onychomycosis. Br J Dermatol 2003; 148:402-10.
-
23.
Ryder N.S., Favre B. Antifungal activity and mechanism of action of terbinafine. Rev Contemp Pharmacother 1997; 8:275-87.
-
24.
Zapata B., Sanclemente G., Gallego M., et al. In vitro activity of fluconazole, itraconazole, voriconazole and terbinafine against fungi causing onychomycosis. Clin Exp Dermatol 2010; 35:658-63.
-
25.
Piraccini B.M., Sisti A., Tosti A. Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents. J Am Acad Dermatol 2010; 62:411-4.
-
26.
Bellmann R. Clinical pharmacokinetics of systemically administered antimycitocs. Curr Clin Pharmacol 2008; 2:37-58.
-
27.
Lecha M. Effendy I., Feuilhade de Chauvin M., Di Chiacchio N., Baran R. Taskforce on onychomycosis education. Treatment options-development of consensus guidelines. J Eur Acad Dermatol Venereol 2005; 19(Suppl 1):25-33.
-
28.
Choi T.S., Solomon B., Nowakowski M., et al. Effect of naftifine on neutrophil adhesion. Skin Pharmacol 1996; 9:190-6.
-
29.
Subissi A., Monti D., Togni G., Mailland F. Ciclopirox: recent nonclinical and clinical data relevant to its use as a topical antimycotic agent. Drugs 2010; 70:2133-52.
-
30.
Lai W.Y., Tang W.Y., Loo S.K., Chan Y. Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrоphic nails. Hong Kong Med J 2011; 17:127-31.
-
31.
Hochman L.G. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmеt Las Ther 2011; 13:2-5.
-
32.
Aspiroz C., Fortuño Cebamanos B., Rezusta A., et al. Photodynamic therapy for onychomycosis. Case report and review of the literature. Rev Iberoam Micol 2011; 28:191-3.
-
33.
Jo Siu W.J., Tatsumi Y., Senda H., et al. Comparison of in vitro antifungal activities of efinaconazole and currently available antifungal agents against a variety of pathogenic fungi associated with onychomycosis. Antimicrob Agents Chemother 2013. [Epub ahead of print].
-
34.
Elewski B.E., Rich P., Pollak R., et al. Efinaconazole 10% solution in the treatment of toenail onychomycosis: Two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol 2012; (S0190-9622):1140-1.
-
35.
Emtestam L., Kaaman T., Rensfeldt K. Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study. Mycoses 2012; 55:532-40.
-
36.
Letscher-Bru V., Obszynski C.M., Samsoen M., et al. Antifungal activity of sodium bicarbonate against fungal agents causing superficial infections. Mycopathologia 2012. [Epub ahead of print].
-
37.
Matsuda T., Yano T., Maruyama A., Kumagai H. Antimicrobial activities of organic acids determined by minimum inhibitory concentrations at different pH ranged from 4.0 to 7.0. Nippon Shokuhin Kogyo Gakkaishi 1994; 41:687-702.
-
38.
Kunert et al. Physiology of keratinophilic fungi. In: Kushwaha RKS, Guarro J (Eds.). Biology of Dermatophytes and other Keratinophilic Fungi. Revista Iberoamericana de Micología, Bilbao, 2000.
-
39.
Paveia M. Culture media alkalinization by dermatophytes. Mycopathologia 1975; 55:35-40.
-
40.
Murdan S., Milcovich G., Goriparthi G.S. An assessment of the human nail plate pH. Skin Pharmacol Physiol 2011; 24:175-81.
-
41.
Honraet K., Rigole P., Matthijs N., Rossel B., Coenye T. Acidification as an approach to control dermatophytes. 20th EADV Congress, 20-24 October 2011, Lisbon, Portugal. Abstr. PO 480.