การติดเชื้อราที่เล็บ
คำสำคัญ:
การรักษา, การวินิจฉัย, เชื้อราที่เล็บบทคัดย่อ
การติดเชื้อราที่เล็บเป็นการติดเชื้อราที่แผ่นเล็บ จัดเป็นการติดเชื้อราที่ผิวหนังชั้นตื้นที่พบได้บ่อย โดยทั่วไปนอกจากจะมีความผิดปกติของแผ่นเล็บ สีเล็บผิดปกติ มีขุยใต้เล็บ เล็บร่อนได้ เชื้อที่ก่อการติดเชื้อที่เล็บนั้น มีได้ทั้งกลุ่ม สายรา dermatophytoses, เชื้อกลุ่มยีสต์ และเชื้อรากลุ่ม mold การวินิฉัยอาศัยการตรวจพบสายราจากการตรวจด้วยกล้องจุลทรรศน์ และส่งตัวอย่างเพาะเชื้อเพื่อช่วยวางแผนการรักษา การรักษาด้วยยาทาเฉพาะที่มีประสิทธิภาพน้อยกว่าการรักษา ด้วยยารับประทานซึ่งจัดเป็นการรักษามาตรฐาน การรักษาใช้เวลานานหลายเดือน นอกจากนี้ การประเมินผลการรักษา และการหายนั้นยังมีความหลากหลายตามงานศึกษา แม้รักษาตามการรักษามาตรฐานด้วยยาชนิดรับประทานแล้ว บางครั้งก็ยังพบการดื้อต่อการรักษา ยังคงพบสายราจากรอยโรค หรือเพาะเชื้อขึ้น ทำให้ต้องพัฒนาวิธีการรักษาเพื่อกำจัดเชื้อราจากเล็บที่ติดเชื้อต่อไป
เอกสารอ้างอิง
1. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol 2010;28:197-201.
2. Cozzani E, Agnoletti AF, Speziari S, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy. Geriatr Gerontol Int 2016;16:486-91.
3. Papini M, Piraccini BM, Difonzo E, Brunoro A. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification. Mycoses 2015;58:659-64.
4. Dubljanin E, Dzamic A, Vujcic I, et al. Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification. Mycoses 2016. Jul 29. doi: 10.1111/myc.12537.
5. Gupta AK, Gupta G, Jain HC, et al. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol 2016;30:1567-72.
6. Nenoff P, Kruger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014;12:188-209; quiz 10, 188-211; quiz 2.
7. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000;42:217-24.
8. Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol 2012;66:830-41.
9. Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502.
10. Ungpakorn R, Lohaprathan S, Reangchainam S. Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand. Clin Exp Dermatol 2004;29:87-90.
11. Blake N, Zhu J, Hernandez G, Juliano PJ. A Retrospective Review of Diagnostic Testing for Onychomycosis of the Foot. J Am Podiatr Med Assoc 2015;105:503-8.
12. Bet DL, Reis AL, Di Chiacchio N, Belda Junior W. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples. An Bras Dermatol 2015;90:904-6.
13. Nenoff P, Kruger C, Schaller J, et al. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2014;12:749-77.
14. Petinataud D, Berger S, Contet-Audonneau N, Machouart M. Molecular diagnosis of onychomycosis. J Mycol Med 2014;24:287-95.
15. Bombace F, Iovene MR, Galdiero M, et al. Nondermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses 2016;59:558-65.
16. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56:939-44.
17. Chang A, Wharton J, Tam S, Kovich OI, Kamino H. A modified approach to the histologic diagnosis of onychomycosis. J Am Acad Dermatol 2007;57:849-53.
18. Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol 2004;140:696-701.
19. Allevato MA. Diseases mimicking onychomycosis. Clin Dermatol 2010;28:164-77.
20. Nenoff P, Kruger C, Paasch U, Ginter-Hanselmayer G. Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy. J Dtsch Dermatol Ges 2015;13:387-410; quiz 1.
21. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol 2014;7:10-8.
22. Kushwaha A, Murthy RN, Murthy SN, et al. Emerging therapies for the treatment of ungual onychomycosis. Drug Dev Ind Pharm 2015;41:1575-81.
23. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171:937-58.
24. Auvinen T, Tiihonen R, Soini M, et al. Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial. Br J Dermatol 2015;173:940-8.
25. Gupta AK, Studholme C. Novel investigational therapies for onychomycosis: an update. Expert Opin Investig Drugs 2016;25:297-305.
26. Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:489-502.
27. McAuley WJ, Jones SA, Traynor MJ, et al. An investigation of how fungal infection influences drug penetration through onychomycosis patient's nail plates. Eur J Pharm Biopharm 2016;102:178-84.
28. Vlahovic TC, Joseph WS. Efinaconazole topical, 10% for the treatment of toenail onychomycosis in patients with diabetes. J Drugs Dermatol 2014;13:1186-90.
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. Campione E, Paterno EJ, Costanza G, et al. Tazarotene as alternative topical treatment for onychomycosis. Drug Des Devel Ther 2015;9:879- 86.
31. Stensen W, Turner R, Brown M, et al. Short Cationic Antimicrobial Peptides Display Superior Antifungal Activities toward Candidiasis and Onychomycosis in Comparison with Terbinafine and Amorolfine. Mol Pharm 2016;13:3595-3600
32. Gupta AK, Simpson FC. Medical devices for the treatment of onychomycosis. Dermatol Ther 2012;25:574-81.
33. Bhatta AK, Keyal U, Huang X, Zhao JJ. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol 2016;74:916-23.
34. Zhang J, Lu S, Huang H, et al. Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer. Lasers Med Sci 2016;31:1391-6.
35. Bristow I, Baran R, Score M. Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution. J Drugs Dermatol 2016;15:974-8.
36. de Sa DC, Lamas AP, Tosti A. Oral therapy for onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:17-36.
37. Gupta AK, Simpson FC. New pharmacotherapy for the treatment of onychomycosis: an update. Expert Opin Pharmacother 2015;16:227-36.
38. Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013;69:416-25.
39. Dietz AJ, Barnard JC, van Rossem K. A randomized, double-blind, multiple-dose, placebo-controlled, dose escalation study with a 3-cohort parallel group design to investigate the tolerability and pharmacokinetics of albaconazole in healthy subjects. Clin Pharmacol Drug Dev 2014;3:25-33.
40. Bristow IR. The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res 2014;7:34.
41. Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJ, Landman GW. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015;16:108.
42. Karsai S, Jager M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nmNd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol 2016. Aug 13. doi: 10.1111/jdv.13798.
43. Gupta AK, Simpson FC, Heller DF. The future of lasers in onychomycosis. J Dermatolog Treat 2016;27:167-72.
44. Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis. Dermatol Surg 2016 Jul 25. doi : 10.1097/DSS.0000000000000841
45. Bhatta AK, Keyal U, Wang XL. Photodynamic therapy for onychomycosis: A systematic review. Photodiagnosis Photodyn Ther 2016;15:228-35.
46. Gilaberte Y, Robres MP, Frias MP, et al. Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2016 Aug 12. doi: 10.1111/jdv.13842.
47. Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-82.
48. Ghannoum M, Isham N, Catalano V. A second look at efficacy criteria for onychomycosis: clinical and mycological cure. Br J Dermatol 2014;170:182-7.
49. Yin Z, Xu J, Luo D. A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. J Dermatolog Treat 2012;23:449-52.
50. Feuilhade de Chauvin M. A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%. J Eur Acad Dermatol Venereol 2012;26:875-8.
51. Gupta AK, Brintnell WC. Sanitization of Contaminated Footwear from Onychomycosis Patients Using Ozone Gas: A Novel Adjunct Therapy for Treating Onychomycosis and Tinea Pedis? J Cutan Med Surg 2013;17:243-9.
52. Ghannoum MA, Isham N, Long L. Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 2012;102:309-13.
2. Cozzani E, Agnoletti AF, Speziari S, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy. Geriatr Gerontol Int 2016;16:486-91.
3. Papini M, Piraccini BM, Difonzo E, Brunoro A. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification. Mycoses 2015;58:659-64.
4. Dubljanin E, Dzamic A, Vujcic I, et al. Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification. Mycoses 2016. Jul 29. doi: 10.1111/myc.12537.
5. Gupta AK, Gupta G, Jain HC, et al. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol 2016;30:1567-72.
6. Nenoff P, Kruger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014;12:188-209; quiz 10, 188-211; quiz 2.
7. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000;42:217-24.
8. Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol 2012;66:830-41.
9. Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502.
10. Ungpakorn R, Lohaprathan S, Reangchainam S. Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand. Clin Exp Dermatol 2004;29:87-90.
11. Blake N, Zhu J, Hernandez G, Juliano PJ. A Retrospective Review of Diagnostic Testing for Onychomycosis of the Foot. J Am Podiatr Med Assoc 2015;105:503-8.
12. Bet DL, Reis AL, Di Chiacchio N, Belda Junior W. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples. An Bras Dermatol 2015;90:904-6.
13. Nenoff P, Kruger C, Schaller J, et al. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2014;12:749-77.
14. Petinataud D, Berger S, Contet-Audonneau N, Machouart M. Molecular diagnosis of onychomycosis. J Mycol Med 2014;24:287-95.
15. Bombace F, Iovene MR, Galdiero M, et al. Nondermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses 2016;59:558-65.
16. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56:939-44.
17. Chang A, Wharton J, Tam S, Kovich OI, Kamino H. A modified approach to the histologic diagnosis of onychomycosis. J Am Acad Dermatol 2007;57:849-53.
18. Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol 2004;140:696-701.
19. Allevato MA. Diseases mimicking onychomycosis. Clin Dermatol 2010;28:164-77.
20. Nenoff P, Kruger C, Paasch U, Ginter-Hanselmayer G. Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy. J Dtsch Dermatol Ges 2015;13:387-410; quiz 1.
21. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol 2014;7:10-8.
22. Kushwaha A, Murthy RN, Murthy SN, et al. Emerging therapies for the treatment of ungual onychomycosis. Drug Dev Ind Pharm 2015;41:1575-81.
23. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171:937-58.
24. Auvinen T, Tiihonen R, Soini M, et al. Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial. Br J Dermatol 2015;173:940-8.
25. Gupta AK, Studholme C. Novel investigational therapies for onychomycosis: an update. Expert Opin Investig Drugs 2016;25:297-305.
26. Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:489-502.
27. McAuley WJ, Jones SA, Traynor MJ, et al. An investigation of how fungal infection influences drug penetration through onychomycosis patient's nail plates. Eur J Pharm Biopharm 2016;102:178-84.
28. Vlahovic TC, Joseph WS. Efinaconazole topical, 10% for the treatment of toenail onychomycosis in patients with diabetes. J Drugs Dermatol 2014;13:1186-90.
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. Campione E, Paterno EJ, Costanza G, et al. Tazarotene as alternative topical treatment for onychomycosis. Drug Des Devel Ther 2015;9:879- 86.
31. Stensen W, Turner R, Brown M, et al. Short Cationic Antimicrobial Peptides Display Superior Antifungal Activities toward Candidiasis and Onychomycosis in Comparison with Terbinafine and Amorolfine. Mol Pharm 2016;13:3595-3600
32. Gupta AK, Simpson FC. Medical devices for the treatment of onychomycosis. Dermatol Ther 2012;25:574-81.
33. Bhatta AK, Keyal U, Huang X, Zhao JJ. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol 2016;74:916-23.
34. Zhang J, Lu S, Huang H, et al. Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer. Lasers Med Sci 2016;31:1391-6.
35. Bristow I, Baran R, Score M. Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution. J Drugs Dermatol 2016;15:974-8.
36. de Sa DC, Lamas AP, Tosti A. Oral therapy for onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:17-36.
37. Gupta AK, Simpson FC. New pharmacotherapy for the treatment of onychomycosis: an update. Expert Opin Pharmacother 2015;16:227-36.
38. Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013;69:416-25.
39. Dietz AJ, Barnard JC, van Rossem K. A randomized, double-blind, multiple-dose, placebo-controlled, dose escalation study with a 3-cohort parallel group design to investigate the tolerability and pharmacokinetics of albaconazole in healthy subjects. Clin Pharmacol Drug Dev 2014;3:25-33.
40. Bristow IR. The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res 2014;7:34.
41. Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJ, Landman GW. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015;16:108.
42. Karsai S, Jager M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nmNd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol 2016. Aug 13. doi: 10.1111/jdv.13798.
43. Gupta AK, Simpson FC, Heller DF. The future of lasers in onychomycosis. J Dermatolog Treat 2016;27:167-72.
44. Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis. Dermatol Surg 2016 Jul 25. doi : 10.1097/DSS.0000000000000841
45. Bhatta AK, Keyal U, Wang XL. Photodynamic therapy for onychomycosis: A systematic review. Photodiagnosis Photodyn Ther 2016;15:228-35.
46. Gilaberte Y, Robres MP, Frias MP, et al. Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2016 Aug 12. doi: 10.1111/jdv.13842.
47. Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-82.
48. Ghannoum M, Isham N, Catalano V. A second look at efficacy criteria for onychomycosis: clinical and mycological cure. Br J Dermatol 2014;170:182-7.
49. Yin Z, Xu J, Luo D. A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. J Dermatolog Treat 2012;23:449-52.
50. Feuilhade de Chauvin M. A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%. J Eur Acad Dermatol Venereol 2012;26:875-8.
51. Gupta AK, Brintnell WC. Sanitization of Contaminated Footwear from Onychomycosis Patients Using Ozone Gas: A Novel Adjunct Therapy for Treating Onychomycosis and Tinea Pedis? J Cutan Med Surg 2013;17:243-9.
52. Ghannoum MA, Isham N, Long L. Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 2012;102:309-13.
ดาวน์โหลด
เผยแพร่แล้ว
2016-09-01
รูปแบบการอ้างอิง
Smithrithee, R., & Limtanyakul, P. (2016). การติดเชื้อราที่เล็บ. วารสารโรคผิวหนัง, 32(3), 179–198. สืบค้น จาก https://he02.tci-thaijo.org/index.php/TJD/article/view/159313
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นิพนธ์ต้นฉบับ
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เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใดๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นลิขสิทธิ์ของวารสารฯ หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใดๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากบรรณาธิการวารสารโรคผิวหนังก่อนเท่านั้น
