Modern view on the specifics of topical and combined therapy of onychomycosis patients
Journal Title: Український журнал дерматології, венерології, косметології - Year 2019, Vol 0, Issue 1
Abstract
Onychomycosis is a common disease of the nail apparatus, caused by dermatophytes, fungi- saprophytes and yeast, and makes up to 50 % of all nail diseases. Onychomycosis is difficult to treat, due to the compact structure of the nail plate, its slow growth, and the presence of biofilms, which act as a protective barrier for microorganisms, and help fungi to adapt to stressful situations and can be a constant source of infection. It is necessary to use an individual approach in the treatment of this disease, given the degree of damage to the nail plates using Onychomycosis Severity Index (OSI). Depending on the severity, either topical or systemic therapy, or a combination of them, is prescribed using the advantages of each treatment method. For effective penetration of the active substance into the nail plate, a balance between the physicochemical properties of the drug and the biophysical characteristics of the nail plate is needed. Due to the advantages of modern topical antifungal drugs in the form of varnish, which improve adhesion and penetration of the active substance through the nail plate, it is possible to improve drug access through the nail barrier, expand the spectrum of antifungal action, reduce the load of systemic antifungal drugs on the body, by using combination therapy, which, owing to different mechanisms of action, can reduce the duration of treatment and reduce the cumulative dose of oral antifungal drugs. Given the lack of resistance to ciclopirox, which has been proven in many studies, it is possible to use this drug for a long time in cases that are difficult to treat, as anti-recurrence therapy, and as a prophylactic agent for lesion of the nail plates with a fungal infection.
Authors and Affiliations
G. S. Stovbyr
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