萘替芬酮康唑乳膏治疗浅部真菌病128例

目的:观察萘替芬酮康唑乳膏治疗浅部真菌病的临床效果和安全性.方法:浅部真菌病人随机分成实验组(萘替芬酮康唑乳膏组)和对照组(环吡酮胺乳膏组),两组均每天用药2次,连用4周,于治疗2周和4周时随访观察.结果:治疗2周时实验组真菌清除率为92 17%,高于对照组82 76%(P<0 05),实验组的临床疗效也高于对照组(P<0 05).治疗4周时实验组的有效率为92 97%,真菌清除率为94 53%,但两组病人在治疗4周时的临床疗效、真菌病疗效的差异无统计学意义(P>0 05).实验组的不良反应发生率为1 56%,对照组为7 5%,两组比较差异有统计学意义(P<0 05).结论:萘替芬酮康唑乳膏治疗浅部真菌病疗效好,不良反应少.     

封包削甲联合萘替芬酮康唑乳膏及CO2激光治疗轻型甲真菌病的研究

目的:观察封包削甲后外用萘替芬酮康唑乳膏联合CO2点阵激光治疗轻型甲真菌病的疗效。方法:最终纳入55例符合轻型甲真菌病的患者,其中治疗组27例(病甲58个),对照组28例(病甲61个),治疗组封包削甲后,外用萘替芬酮康唑乳膏每天2次,同时每周照射1次CO2点阵激光,对照组封包削甲后仅外用萘替芬酮康唑乳膏,对比两组12周时的治疗效果。结果:治疗组病甲58个,痊愈55个,显效3个,有效率100%。对照组病甲61个,痊愈39个,显效11个,好转9个,无效2个,有效率81.97%。两组疗效差异有统计学意义(X^2=9.48,P<0.05)。结论:封包削甲后外用萘替芬酮康唑乳膏联合每周照射一次CO2点阵激光的方法治疗轻型甲真菌病疗效较好,无明显不良反应,值得临床推广。     

点阵二氧化碳激光联合5%盐酸阿莫罗芬擦剂治疗甲真菌病的疗效观察

目的 观察点阵二氧化碳(CO₂)激光联合5%盐酸阿莫罗芬擦剂治疗甲真菌病的疗效。方法 募集2018年1月—2020年3月于南京医科大学第二附属医院皮肤科门诊就诊的甲真菌病患者70例(总计252个病甲)。患者随机分为联合组和对照组各35例。联合组给予点阵CO₂激光(每2周1次)联合5%盐酸阿莫罗芬擦剂(每周1次)治疗,共6个月;对照组给予单纯外用5%盐酸阿莫罗芬擦剂(每周1次)治疗,共6个月,治疗结束后3个月对2组行临床疗效及真菌学疗效评价。结果 70例患者均完成治疗及随访,联合组患者35例共计130个病甲,临床有效率为70.8%,真菌清除率为73.1%;对照组患者35例共计122个病甲,临床有效率为52.5%,真菌清除率为57.4%。联合组临床有效率及真菌清除率均显著高于对照组,差异有统计学意义(P<0.05)。结论 点阵CO₂激光联合5%盐酸阿莫罗芬擦剂治疗甲真菌病是一种安全有效的方法,其疗效优于单纯外用5%盐酸阿莫罗芬擦剂。     

萘替芬酮康唑乳膏治疗浅部真菌病128例

目的:观察萘替芬酮康唑乳膏治疗浅部真菌病的临床效果和安全性.方法:浅部真菌病人随机分成实验组(萘替芬酮康唑乳膏组)和对照组(环吡酮胺乳膏组),两组均每天用药2次,连用4周,于治疗2周和4周时随访观察.结果:治疗2周时实验组真菌清除率为92 17%,高于对照组82 76%(P<0 05),实验组的临床疗效也高于对照组(P...     

窄谱中波紫外线联合萘替芬酮康唑乳膏治疗股癣49例

目的观察窄谱中波紫外线(NB-UVB)联合萘替芬酮康唑乳膏治疗股癣的临床疗效。方法将100患者随机分为两组,治疗组给予NB-UVB联合萘替芬酮康唑乳膏治疗,对照组单用萘替芬酮康唑乳膏,每周观测1次,治疗3周后判断疗效。结果两组真菌清除率各周比较均无统计学意义。治疗组有效率为91.8%,对照组有效率为85.1%,两组比较差异有统计学意义(P0.05)。两组均无明显不良反应。结论 NB-UVB联合萘替芬酮康唑乳膏治疗股癣疗效肯定,临床上值得应用。     

超脉冲CO2激光联合布替萘芬软膏治疗甲真菌病的自身对照研究

目的：评价超脉冲CO2激光联合布替萘芬软膏治疗甲真菌病的疗效和安全性。方法：从同一甲真菌病患者中随机挑选一个或多个病甲分别作为治疗组和对照组,治疗组采用超脉冲CO2激光联合布替萘芬软膏外用治疗,激光每周治疗一次,4次后,每4周一次,布替萘芬软膏每日2次,指甲治疗12～16周,趾甲治疗20～24周。对照组仅外用布替萘芬软膏。结果：共治疗19例甲真菌病患者131个病甲,其中治疗组为66个病甲,对照组为65个病甲。治疗组有效率为51.52%高于对照组的18.46%,两者差异有显著性(P＜0.05);治疗组真菌镜检阴性率为66.67%高于对照组的26.15%,差异有显著性(P＜0.05)。结论：超脉冲CO2激光联合布替萘芬软膏治疗甲真菌病优于单用布替萘芬软膏。     

1%盐酸布替萘芬乳膏治疗花斑癣疗效观察

目的观察1%盐酸布替萘芬乳膏对花斑癣的治疗效果。方法每日用1%盐酸布替萘芬乳膏均匀涂抹于皮损处1次进行治疗,观察治疗2周、3周、4周时的疗效。结果临床有效率及真菌清除率逐周均有明显提高。2周后有效率为35.29%,真菌清除率为8.82%,4周后有效率为98.53%,真菌清除率为95.59%。结论1%盐酸布替萘芬乳膏治疗花斑癣疗效肯定,安全性高。     

萘替芬酮康唑乳膏治疗花斑癣的疗效观察

目的观察萘替芬酮康唑乳膏治疗花斑癣的疗效。方法将63例患者随机分为治疗组和对照组,治疗组外用萘替芬酮康唑乳膏,对照组外用硝酸咪康唑乳膏,根据疗效指数和真菌镜检结果判定疗效。结果治疗组治疗2周及4周时的疗效(2周时为65.63%和4周时为96.88%)和治疗2周时真菌清除率(治疗组78.13%,对照组51.61%)均明显高于对照组(2周时为38.71%和4周时为80.65%),差异均有统计学意义(P0.05)。结论萘替芬酮康唑乳膏治疗花斑癣安全而有效。     

萘替芬酮康唑乳膏与两种中药制剂合用治疗角化过度型足癣临床观察

目的观察萘替芬酮康唑乳膏分别联合中药复方香莲外洗液、抗真菌颗粒剂治疗角化过度型足癣的临床疗效。方法将120例角化过度型足癣患者随机分为A组40例(萘替芬酮康唑乳膏外用联合温水外洗)、B组40例(萘替芬酮康唑乳膏外用联合中药抗真菌颗粒剂口服)和C组40例(萘替芬酮康唑乳膏联合中药复方香莲外洗液外用),观察3组患者的临床疗效和真菌学疗效。结果停药后2周时,A,B和C三组的痊愈率分别是34.21%,57.89%和82.50%,有效率分别是68.42%,89.47%和97.50%,真菌清除率分别是89.47%,92.11%和100.00%。C组和B组的痊愈率、有效率均明显高于A组(P均<0.05);C组的痊愈率明显高于B组(P<0.05),有效率则略高于B组,但两者相比无明显差异(P>0.05)。C组的真菌清除率明显高于A组(P<0.05);C组与B组、B组与A组的真菌清除率比较均无明显差异(P均>0.05)。结论萘替芬酮康唑乳膏分别与中药复方香莲外洗液、抗真菌颗粒剂联合治疗角化过度型足癣均取得较好的疗效和安全性。     

1%盐酸布替萘芬乳膏治疗浅部真菌病临床观察

目的：评价1％盐酸布替萘芬乳膏治疗浅部真菌病的临床疗效及安全性，并与1％联苯苄唑凝胶进行比较。方法：对83例浅部真菌病患者进行治疗，其中治疗组43例，外用1％盐酸布替萘芬乳膏，每日1次；对照组40例，外用1％联苯苄唑凝胶，每日1次，体股癣疗程2周，手足癣4周。分别于停药及停药2周时观察记录患者的临床表现及治疗效果。结果：1％盐酸布替萘芬乳膏和1％联苯苄唑凝胶临床疗效相似，停药时临床总有效率分别为90．7％和90．0％，真菌总清除率为93．0％和90．0％；停药2周时临床总有效率分别为97．7％和92．5％，真菌总清除率为100．0％和92．5％。不良反应少。结论：1％盐酸布替萘芬乳膏治疗浅部真菌病疗效显著且安全。     

The efficacy of fractional carbon dioxide (CO2) laser combined with terbinafine hydrochloride 1% cream for the treatment of onychomycosis

Background: Although systemic and topical antifungal agents are widely used to treat onychomycosis, oral medications can cause adverse effects and the efficacy of topical agents is not satisfying. Currently, laser treatment has been studied for its efficacy in the treatment of onychomycosis. Our study was aimed to evaluate the efficacy of fractional carbon dioxide (CO₂) laser treatment combined with terbinafine cream for 6 months in the treatment of onychomycosis and to analyze the influencing factors. Methods: A total of 30 participants (124 nails) with clinical and mycological diagnosis of onychomycosis received fractional CO₂ laser treatment at 2-week interval combined with terbinafine cream once daily for 6 months. The clinical efficacy rate (CER) was assessed from the percentage of fully normal-appearing nails or nails with ≤5% abnormal appearance, and the mycological clearance rate (MCR) was assessed from the percentage of nails with negative fungal microscopy. Results: The CER was evaluated at 3 time points: at the end of treatment (58.9%), at 1 month after the last treatment (63.5%), and at 3 months after the last treatment (68.5%). The MCRs at 1 month and 3 months after the last treatment were 77.4 and 74.2%, respectively. The evaluation of influencing factors showed significantly higher CER (p < 0.05) in nails of participants with age <50 years, distal lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), nail thickness <2 mm, affected first-to-fourth finger/toenails, Trichophyton rubrum, and Trichophyton mentagrophytes. All participants experienced tolerable mild burning sensation during laser treatment, but there were no other adverse reactions reported. Conclusions: Fractional CO₂ laser treatment combined with terbinafine cream for 6 months was an effective and safe method for the treatment of onychomycosis. There were 5 factors that positively influenced the treatment outcome: age, clinical type of onychomycosis, nail thickness, involved nail, and species of fungus.     

超脉冲CO2点阵激光治疗甲真菌病疗效观察

目的 评估超脉冲CO2点阵激光治疗甲真菌病的疗效及安全性。 方法 收集临床具有甲真菌病典型临床表现且真菌真接镜检阳性病例,给予超脉冲CO2点阵激光治疗8次,根据患者年龄、病甲感染类型、甲板厚度、感染面积、甲板感染长度等进行临床甲真菌病临床评分指数（SCIO）和甲真菌病严重度指数（OSI）评估,比较治疗前、治疗结束、疗后1个月和疗后3个月的临床评分变化,计算真菌学清除率,记录观察激光治疗的不良反应。 结果 共入组20例甲真菌病患者共75个病甲,完成治疗及随访18例71个病甲。治疗前、治疗结束、疗后1个月及3个月SCIO分别为13.07 ± 6.47、9.03 ± 6.14、8.51 ± 6.99、7.89 ± 7.26,OSI分别为21.11 ± 11.94、13.63 ± 12.10、14.18 ± 13.65、13.70 ± 13.93,疗后3个时间点真菌学清除率分别为57.75%（41/71）、59.15%（42/71）、61.97%（44/71）,SCIO、OSI与治疗前相比差异均有统计学意义（均P < 0.05）。其中远端侧位甲下型SCIO和OSI治疗前分别为12.48 ± 5.41和16.44 ± 9.89,疗后3个月降至5.01 ± 5.56和6.44 ± 8.26;而全甲营养不良型SCIO和OSI治疗前分别为17.86 ± 3.98和34.05 ± 2.56,疗后3个月分别为15.88 ± 4.10和31.00 ± 7.28。治疗过程中偶有一过性轻微疼痛,未发生甲下出血等其他不良反应。 结论 超脉冲CO2点阵激光治疗远端侧位甲下型等轻中度甲真菌病,尤其甲板侵入较浅且甲板生长速度较快时疗效可靠。超脉冲CO2激光对真菌仅表现为直接的抑制和杀伤作用,治疗时应根据病情适当延长疗程。     

长脉宽Nd:YAG激光治疗甲真菌病疗效观察

目的 探讨长脉宽Nd:YAG激光治疗甲真菌病的疗效及安全性。 方法 对35例甲真菌病患者使用长脉宽Nd:YAG激光进行治疗,治疗参数：波长1064 nm,能量30 ～ 40 J/cm2,脉宽35 ms,光斑4 mm。观察疗效及不良反应,并根据不同感染菌种、临床类型、病甲位置对病例进行分组,采用SPSS17.0统计软件进行卡方检验比较不同分组间疗效、复发情况的差异。结果 共治疗79甲,随访至初次治疗后9个月,临床有效率为67.1%,真菌学有效率为73.4%,复发或再感染率为19.0%。红色毛癣菌组的临床疗效（χ2 = 10.913,P < 0.05）及真菌学疗效（χ2 = 13.532,P < 0.05）均优于其他真菌组,复发或再感染率低于其他真菌组（χ2 = 10.980,P < 0.05）,但与白念珠菌组比较这三方面的差异均无统计学意义。白色浅表甲真菌病（WSO）组的临床疗效优于远侧甲下真菌病（DLSO）组（χ2 = 11.935,P < 0.05）,而DLSO组的临床疗效又优于近端甲下真菌病（PSO）及全甲营养不良甲真菌病（TDO）组（χ2 = 17.515,P < 0.05）。根据病甲位置不同分类,第2 ～ 5指甲组的临床疗效优于拇指甲/第2 ～ 5趾甲组（χ2 = 13.437,P < 0.05）及拇趾甲组（χ2 = 10.595,P < 0.05）,而拇指甲/第2 ～ 5趾甲组与拇趾甲组相比临床疗效差异无统计学意义（χ2 = 3.030,P > 0.05）,它们的真菌学疗效及治疗后的复发或再感染率差异无统计学意义。治疗过程中除疼痛外未发生其他不良反应。结论 长脉宽Nd:YAG激光是治疗甲真菌病的一种安全有效的方法,其疗效受到感染菌种、临床类型、病甲位置的影响。     

超脉冲CO_2点阵激光联合外用药治疗顽固性白癜风的疗效评价

目的:评价超脉冲CO_2点阵激光联合外用药膏治疗顽固性白癜风的临床疗效。方法:将56例顽固性白癜风患者随机分成治疗组29例(皮损52块)和对照组27例(皮损48块),均外用丙酸氟替卡松乳膏及卡泊三醇每日1次,疗程12周。治疗组另给予CO_2点阵激光治疗,1次/3周,共4次。12周后评价疗效。结果:治疗组中有效皮损36块,有效率76.6%;对照组有效皮损18块,有效率42.9%,差异有显著性(P0.01)。结论:点阵激光联合外用药物治疗白癜风比单用药物疗效明显。     

激光治疗甲病的临床应用

甲病,包括嵌甲、甲真菌病及甲营养不良,临床治疗困难,对患者及医生造成很大的困扰.激光的应用使得甲病的治疗有了新进展.CO2激光能够迅速破坏局部组织,切除肥厚甲襞,又能够瞬间凝固小血管,在治疗嵌甲中取得良好效果.Nd:YAG激光、CO2点阵激光以及二极管激光等,为甲真菌病提供治疗新选择.CO2点阵激光形成的微治疗区可以显著增强外用药物在甲中的渗透与吸收,使其甲营养不良的治疗中也展现了肯定的疗效.     

Fractional CO2 laser plus topical antifungal versus fractional CO2 laser versus topical antifungal in the treatment of onychomycosis

Onychomycosis is an important medical disorder affecting both health and quality of life of patients. This study was done to compare the efficacy of CO₂ laser in combination with topical tioconazole versus CO₂ laser only versus topical tioconazole alone in onychomycosis. A total of 120 patients with onychomycosis were randomly assigned to three groups. Group A patients were treated with fractional CO₂ laser followed by topical tioconazole 28% for five sessions with 3 weeks interval. Group B patients were treated with only fractional CO₂ laser for five sessions with 3 weeks interval. Group C patients were treated with only topical tioconazole 28% for 16 weeks. The clinical effect, KOH examination, and culture for the affected nails in the three groups were analyzed. One month after the last session, regarding clinical response, 55% showed complete clinical improvement in Group A versus 30% in Group B versus 25% in Group C with a significant difference in between. There was a significant difference between the three studied groups as regard KOH test and culture after treatment. Fractional CO₂ laser combined with topical antifungal is a safe and effective treatment for onychomycosis.     

Treatment of onychomycosis by partial nail avulsion and topical miconazole

13 patients with distal subungual onychomycosis in a total of 48 dermatophyte-infected nails were treated with chemomechanical, partial nail avulsion followed by topical miconazole for 8 weeks. On examination, 6 months after cessation of therapy, 42% of the nails were cured by clinical and mycological criteria. The therapeutic response was related to the pretreatment extension of subungual hyperkeratosis. Periungual skin irritation was common during the initial avulsion period. Miconazole solution was well tolerated and this treatment modality proved to be a valuable alternative to other remedies for the treatment of onychomycosis limited to a few number of nails.     

伊曲康唑间歇冲击治疗趾甲真菌病疗效和血清及甲中药物水平临床研究

目的:研究伊曲康唑间歇冲击疗法治疗趾甲真菌病(甲母质未受累)的疗效和在血清及甲中药物水平的变化。方法:41例趾甲真菌病患者应用伊曲康唑连续3个冲击治疗,第52周进行最终疗效评价;采用高压液相色谱仪(HPLC)法对其中15例趾甲真菌病患者进行了血清及甲中药物测定。结果:每次冲击后4周,血清中均未测得伊曲康唑;甲组织中伊曲康唑水平较高,在8或12周时达到高峰,停药后,伊曲康唑仍能以较高的水平在甲中储留36周;同一时间点,指甲和趾甲中的药物水平相似(P>0.05)。在第52周时,趾甲真菌病的临床治愈率为66.7％,临床有效率为79.5％,真菌学清除率为64.1％。结论:伊曲康唑口服吸收后从血液迅速向甲组织分布,停药后仍以较高水平储留在甲组织中并持续存在36周以上。     

Combination of surgical avulsion and topical therapy for single nail onychomycosis: a randomized controlled trial

BACKGROUND: Conventional therapy of onychomycosis is prolonged and often frustrating, which is why combination therapy involving topical, oral and surgical measures has been advocated as the treatment of choice. There are no controlled studies evaluating the efficacy of nail avulsion followed by topical antifungal therapy. OBJECTIVES: To evaluate the efficacy of combined surgical and topical therapy for onychomycosis. METHODS: Forty patients with single nail onychomycosis [28 with distal and lateral subungual onychomycosis, seven with total dystrophic onychomycosis (TDO) and five with proximal subungual onychomycosis] were randomly assigned to four treatment groups. Each group received avulsion of the involved nail, followed by ketoconazole 2% cream without (group I) or with occlusion (group II), or oxiconazole 1% cream without (group III) or with occlusion (group IV). Topical therapies were applied twice daily. The patients were reviewed monthly and treatment was continued until the regrowth of completely normal nail (mycologically negative). In cured cases, further monthly review was carried out for at least 6 months, without any form of therapy. At each visit direct microscopic examination was repeated. RESULTS: There was a high dropout rate, with seven patients (group I), six patients (group II), six patients (group III) and eight patients (group IV) completing the treatment protocol. Out of these, mycological cure was achieved in three (43%) patients in group I, four (67%) in group II, two (33%) in group III and six (75%) in group IV. All the cases of TDO failed to respond to this therapy. Overall, 15 of 27 (56%) patients were cured with this approach. On further follow up, recurrence of onychomycosis was recorded in two patients in group I. No side-effects or long-term complications of the nail avulsion were encountered. Important limitations encountered in the present study included a small sample size, a high dropout rate (32%) and poor patient compliance. CONCLUSIONS: Contrary to earlier reports, surgical nail avulsion with topical antifungal agents was not found to be a very encouraging modality for the treatment of onychomycosis. Both oxiconazole and ketoconazole delivered comparable results. Occlusion improved the treatment outcome, although the difference was not statistically significant. As a subtype, TDO showed poorest response. Surgical nail avulsion followed by topical antifungal therapy cannot be generally recommended for the treatment of onychomycosis.