影响甲真菌病预后因素的研究进展

甲真菌病顽固难治,目前采用的治疗方法包括局部治疗、口服抗真菌药物治疗以及口服药物和局部治疗等综合疗法,但这些方法的疗效常受多种因素的影响.影响甲真菌病预后的因素主要有甲的局部因素,包括甲真菌病的临床类型、甲板生长速度、甲板厚度、甲母质受累、甲下癣菌瘤或甲下条索状损害的影响,另外还有甲的既往感染史,遗传因素,药物的选择以及糖尿病、银屑病的影响等.其中甲的局部改变是影响预后的最主要因素.充分了解影响甲真菌病的预后因素有助于临床医生确定治疗方案以及随访时间的长度,从而有助于提高甲真菌病的治愈率,改善患者生活质量.     

易被忽视的非皮肤癣菌性甲真菌病51例分析

甲真菌病是最常见的甲病之一。近几年来 ,一度被认为甲板中不存在或罕见的非皮肤癣菌性丝状真菌引起的甲真菌病在迅速增多。该文报告了非皮肤癣菌性甲真菌病的发生率 ,临床特点 ,抗真菌治疗的疗效及不良反应等。病例收集自 1994年 1月至 1997年 1月意大利米兰的圣保罗医院。其间因甲病就诊患者共 10 12例 ,均做真菌学检查 ,包括镜检和培养。若首次培养示霉菌生长则重复两次取材培养以证实非皮肤癣菌性甲真菌病的诊断 ,否则视为污染苗。结果显示共有 589例经真菌学检查确诊为甲真菌病 ,其中皮肤癣菌引起者 4 0 3例 ,占 6 8% ,酵母菌135例 ,占…     

美国甲真菌病继续教育课程解读

甲真菌病是真菌感染指(趾)甲形成的甲病,是皮肤科临床工作中最常见的甲病.该文对比《中国甲真菌病诊疗指南(2015年版)》,对美国继续医学教育系列文章《甲真菌病临床概述与诊断》和《甲真菌病治疗与预防复发》进行解读:病史、查体、皮肤镜等临床表现为诊断甲真菌病提供了重要线索,确诊依赖于实验室真菌学检查.治疗方案包括口服和局部...     

5%阿莫罗芬甲擦剂治疗甲真菌病的临床疗效观察

目的 评价5%阿莫罗芬甲擦剂与内服特比萘芬片治疗未累及甲母质的浅表型或远端侧位型甲真菌病的临床疗效.方法 将入选的324例患者随机分成A,B两组,A组给予5%阿莫罗芬甲擦剂外涂,1次/周,治疗6个月.B组给予特比萘芬片(兰美抒)0.25g/d口服,指甲真菌病患者服药12周,趾甲真菌病患者服药16周.分别于治疗后第10周及24周进行疗效评价.结果 治疗24周后,A组痊愈率 87.7%,有效率92.6%;B组分别为88.9%,95.1%.两组痊愈率、有效率差异均无显著性(P>0.05).结论 5%阿莫罗芬甲擦剂治疗未累及甲母质的浅表型或远端侧位型甲真菌病疗效好.     

影响甲真菌病疗效的因素

我科甲真菌病门诊1994年7月至1999年6月用伊曲康唑治疗该病共545例,均完成疗程和随访,且资料完整,指甲真菌病痊愈率达83.14%,趾甲真菌病达79.23%.同时我们也发现了以下现象:①治疗后长出的新甲,有的长到某一长度后就停止了,即使继续服药也不再延长;②治疗后病甲范围缩小或已痊愈,但一停药又渐渐扩大或重新出现病甲;③治疗前病甲色深而厚者治疗后真菌培养转阴,但有的新甲仍稍厚或有纵嵴或有纵条状色素沉着或甲脆无光泽,需再经6～9个月后才完全正常;④在追踪随访中发现复发或再感染等.为了探讨产生这些现象的原因,以提高甲真菌病的疗效,现就伊曲康唑口服治疗545例的结果,对影响甲真菌病疗效的因素初步分析如下.     

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.     

0.3 ms脉宽的1064 nm Nd:YAG激光治疗甲真菌病的临床疗效观察

目的:评估0.3 ms脉宽1064 nm Nd:YAG激光对甲真菌病的治疗疗效及安全性。方法:收集36例受试者共103个指甲,采用随机对照方式分为两组,一组采用激光治疗4次,另一组治疗6次,每组均根据甲真菌病临床评分分为A、B、C 3个亚组。激光治疗每周1次。在开始治疗前、治疗后的第3个月、第6个月照相并给予评分。结果:根据甲真菌病临床评分分组进行亚组分析,发现分级在轻、中、重度组激光治疗的治愈率不同,较轻组的患病指甲治愈率高于中、重度患病指甲。同时甲真菌病白色表浅型、近端甲下型及远端侧位甲下型疗效均优于全甲损毁型,治疗次数在采用4次和6次之间疗效差异无统计学意义。结论:Nd:YAG对各型甲真菌病均有良好的治疗效果,该方法安全性及有效性均较好。     

伊曲康唑联合拔甲及外用药物治疗甲真菌病55例疗效观察

目的探讨伊曲康唑联合拔甲及外用抗真菌药物治疗甲真菌病的疗效及安全性。方法将110例患者随机分为治疗组和对照组,各55例,两组均采用化学拔甲法拔甲,治疗组在此基础上加服伊曲康唑治疗。结果两组有效率按病例计算分别为67.27%和41.82%,按病甲计算分别为75.26%和62.05%。两组比较差异有统计学意义(P均<0.01)。结论伊曲康唑联合化学拔甲及外用抗真菌药物治疗甲真菌病安全有效。     

原发性病原真菌和条件性真菌所致的甲真菌病

近40年间在易感或免疫受损个体中原发性和条件性真菌感染显著增多。其发病率的增加与艾滋病的流行和医疗技术的重大发展,尤其是器官移植、肿瘤及免疫性疾病新的治疗方法相关。在真菌性疾病中,尽管某些人群更易患甲真菌病,但每一个体均可能患该病。虽然甲真菌病呈慢性经过且并不威胁生命,但可严重影响患者的身心健康。甲真菌病的患病率在许多国家似乎呈上升趋势,范围在3%～15%。尽管临床表现可提示有真菌感染,但保证诊断正确和治疗合理仍依赖实验室检查。尽管酵母和霉菌也可成为单独或混合感染的病原菌,但大多数甲真菌病是由皮肤癣菌引起的。…     

甲真菌病的治疗方法

甲真菌病是一种皮肤科常见疾病,治疗存在很大的挑战。治疗方法主要有局部用药、系统用药、仪器治疗及联合治疗。目前局部治疗新技术的发展和联合疗法取得的成功经验也进一步提高了甲真菌病的治疗水平。本文总结近年来甲真菌病的治疗方法。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.