Onychomysosis - 爪白癬（そうはくせん）
爪白癬（そうはくせん） (Onychomysosis) の影響を受けた足の爪
テルビナフィン経口薬の投与を開始して 10 週間が経過した爪真菌感染症のある人の足。残っている感染した爪の後ろに健康な爪が生えている帯に注目してください。
References
抗真菌薬の全身投与が最も効果的な治療法です。メタ分析では、真菌の治癒率は次のように示されます: terbinafine = 76%, itraconazole with pulse dosing = 63%, itraconazole with continuous dosing = 59%, fluconazole =48% 。爪のデブリードマンを併用すると、治癒率がさらに高まります。 ciclopirox による局所療法はあまり効果がありません。故障率は60%を超えています。
Systemic antifungals are the most effective treatment. Meta-analyses shows mycotic cure rates as follows: terbinafine = 76%, itraconazole with pulse dosing = 63%, itraconazole with continuous dosing = 59%, fluconazole =48%. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%.
Systemic antifungals are the most effective treatment. Meta-analyses shows mycotic cure rates as follows: terbinafine = 76%, itraconazole with pulse dosing = 63%, itraconazole with continuous dosing = 59%, fluconazole =48%. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%.
爪真菌症は、爪に影響を及ぼす真菌感染症です。皮膚糸状菌によって引き起こされる場合は爪白癬と呼ばれます。爪真菌症には、皮膚糸状菌、酵母菌、カビによって引き起こされる感染症が含まれます。真菌感染症が原因ではない爪の問題は nail dystrophy と呼ばれます。手の爪と足の爪の両方に影響を与える可能性がありますが、足の爪爪真菌症の方が一般的です。この記事では、足の爪爪真菌症の影響、臨床タイプ、段階、診断、治療など、さまざまな側面について説明します。爪真菌症は生命を脅かすものではありませんが、蜂窩織炎、敗血症、骨感染症、組織損傷、爪の喪失などの重篤な合併症を引き起こす可能性があります。
Onychomycosis is a fungal infection of the nail unit. When dermatophytes cause onychomycosis, this condition is called tinea unguium. The term onychomycosis encompasses the dermatophytes, yeasts, and saprophytic mold infections. An abnormal nail not caused by a fungal infection is a dystrophic nail. Onychomycosis can infect both fingernails and toenails, but onychomycosis of the toenail is much more prevalent. Discussed in detail in this activity are all evolving facets of the topic, including disease burden, clinical types, staging, diagnosis, and management of toenail onychomycosis. While non-life-threatening, onychomycosis can lead to severe complications such as cellulitis, sepsis, osteomyelitis, tissue damage, and nail loss.
Onychomycosis is a fungal infection of the nail unit. When dermatophytes cause onychomycosis, this condition is called tinea unguium. The term onychomycosis encompasses the dermatophytes, yeasts, and saprophytic mold infections. An abnormal nail not caused by a fungal infection is a dystrophic nail. Onychomycosis can infect both fingernails and toenails, but onychomycosis of the toenail is much more prevalent. Discussed in detail in this activity are all evolving facets of the topic, including disease burden, clinical types, staging, diagnosis, and management of toenail onychomycosis. While non-life-threatening, onychomycosis can lead to severe complications such as cellulitis, sepsis, osteomyelitis, tissue damage, and nail loss.
Terbinafine は、スクアレン エポキシダーゼをブロックすることで真菌感染症と戦う薬です。多くの種類の皮膚真菌に対して効果があり、経口摂取による爪真菌の治療が承認されています。頭痛や胃の問題などのほとんどの副作用は軽度で自然に治りますが、味覚の変化（味覚障害）は軽度から重度までさまざまで、場合によっては体重減少につながることもあります。永続的な味覚の変化はまれですが、報告されています。
Terbinafine is an antifungal medication that works through the inhibition of squalene epoxidase. It has activity against most dermatophytes, and it has approval for use as an oral therapy for the treatment of onychomycosis. Although most side effects are mild and self-limited, such as headache and gastrointestinal symptoms, taste disturbances (dysgeusia) can range from mild to severe, resulting in weight loss, and have rarely been reported permanent.
Terbinafine is an antifungal medication that works through the inhibition of squalene epoxidase. It has activity against most dermatophytes, and it has approval for use as an oral therapy for the treatment of onychomycosis. Although most side effects are mild and self-limited, such as headache and gastrointestinal symptoms, taste disturbances (dysgeusia) can range from mild to severe, resulting in weight loss, and have rarely been reported permanent.
爪真菌症は、爪に影響を及ぼす真菌感染症です。足の爪の感染症の約 90%、指の爪の感染症の 75% は真菌 (Trichophyton mentagrophytes, Trichophyton rubrum) によって引き起こされます。症状には、爪の変色、肥厚、爪床からの剥離、過成長などがあります。治療には通常、テルビナフィンやイトラコナゾールなどの経口薬が使用されますが、軽度から中等度の場合には局所治療も選択肢となります。
Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis.
Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis.
経口投与される抗真菌薬テルビナフィンが最も効果的であると思われますが、テルビナフィンには肝臓への副作用が伴います。
爪白癬（そうはくせん） (onychomysosis) は成人人口の約 10% に発生しており、高齢者がより頻繁に罹患します。男性は女性よりも頻繁に影響を受けます。 爪白癬（そうはくせん） (onychomysosis) は爪の病気の約半分を占めます。これは、足の爪の変形が爪真菌症以外の原因からも発生する可能性があることを意味します。
○ 治療 ― OTC医薬品
爪真菌症は、厚くなった爪には薬が浸透しにくいため、外用薬で治療するのは困難です。
#Ketoconazole
#Clotrimazole
#Miconazole
#Terbinafine
#Butenafine [Lotrimin]
#Tolnaftate
○ 処理
通常、感染した足の爪が完全に除去されるまで、長期間の治療が必要です。
#Terbinafine (oral)
#Itraconazole
#Efinaconazole lacquer [Jublia]
#Ciclopirox lacquer