A method of treating onychomycosis

 

(57) Abstract:

The invention relates to medicine, Mycology and dermatology, to methods of treatment of onychomycosis. As antimycotic tools use solution for preparation of which is ground to a powder, 14 tablets lamizila, pour 100 ml of 1% solution Dimexidum, the resulting mixture is soaked day in a sealed container made of dark glass, and then there was added 100 ml of 70% acetic acid and 100 ml of a 5% solution of iodine, after which the resulting solution was applied to the nail plate and nail rollers 1 times a day, and on the skin of the feet 2 times a week for 6 months. This method increases the effectiveness of treatment by increasing the percentage of clinical and laboratory cure of onychomycosis and prevents the development of recurrent disease.

The invention relates to medicine, namely to dermatology, and relates to one of the most urgent problems is the treatment of fungal infections of the nail plate.

Onychomycosis is a very common disease, occurring in 40% of the population [1] . Onychomycosis is almost never affect children [4]. The incidence increases with age and is highest among pool pathology, which is contraindicated for use highly effective systemic antimycotic funds, but often do not have the ability to use these tools because of their high cost. Therefore, this category of patients forced to receive only local treatment, which is less efficient than the system, and cannot provide a cure for the common and long-existing fungal nail infections [4].

Local antifungal drugs (bifonazole - cream, solution; isoconazole - cream; ketoconazole - cream; clotrimazole ointment, cream, solution; miconazole - cream; econazole cream, solution; naftifine - cream, solution; terbinafine cream; natamycin - cream; chlornitrofen - solution) contain very high concentrations of active compounds that are active against fungi - causative agents of onychomycosis. However, these high concentrations are only on the surface of the nail plate, and deep to the nail bed, where the most viable fungi, antimycotics not always penetrate into effective concentrations [4]. Traditionally, this problem was solved so: before you assign a local antimycotics performed surgical removal of the affected nail plate. However, firstly, this operation PTS the second bed, that sometimes leads to regrowth of deformed nails [4]. It should be noted that surgical removal of the nail acceptable for younger patients who do not have common diseases and diseases of the blood vessels of the extremities [4]. In this regard, for the treatment of onychomycosis have been proposed lipsticks, their main advantage is that they can be applied to the nail plate without removing it. Other drugs cannot penetrate the nail plate that requires its prior removal [4].

Closest to the proposed method is a method of treatment of onychomycosis using local antifungals in the form of nail Polish (loceryl, batrafen).

Nail batrafen (8% ciclopirox) applied every other day for the first month of treatment, two times per week during the second month, and then once a week. Lacquer loceryl (5% amorolfine) is applied once per week.

Before beginning treatment with any paint should be removed as much of the affected nail plate (mechanically or with keratolytic patches). The remaining nail plate, which will be applied lacquer, we saw the attached file to create an uneven surface. Lacquer NAS is whether an alcohol swab and nail plate sawing process. The varnish layer can also be removed by placing a nail in warm water, scraping the varnish of the branches of scissors. Duration of treatment depends on the rate of regrowth of healthy nail plate. For the treatment of onychomycosis on hand is enough 6 months, legs - 9-12 months [4].

Significant disadvantages of this method are:

1) lack of efficacy: clinical cure is achieved in 46% of patients [5];

2) a high percentage of relapses;

3) high cost of treatment.

The purpose of this invention is to improve the effectiveness of treatment by increasing the percentage of clinical and laboratory cure of onychomycosis and prevent the recurrence of the disease, a significant increase accessibility method (lower cost).

This goal is achieved using the original penetrant solution with the preliminary cleanup of the affected parts of the nail (mechanically or with keratolytic patches).

Penetrating solution consists of:

1) tablets lamizila 250 mg - antifungal antifungal drug with a wide spectrum of class allylamino, effective, is tawlae enzyme - Schwalenberg epoxidase fungi [5] . He has the highest among the systemic antimycotics activity against dermatophytes that cause most (94%) cases of ringworm [4];

2) a solution of 5% iodine and 70% acetic acid having fungistatic properties;

3) 1% solution of Dimexidum - inflammatory drug with an antiseptic effect, having the ability to enhance skin penetration of some drugs [2], in particular lamizila, iodine and acetic acid.

The ingredients used in the present antimycotic solution, this combination enhances the action of each other and give way to a new property, providing sverhsummarny therapeutic effect.

Penetrating solution is prepared as follows. 14 tablets lamizila grind to powder mass and pour 100 ml of a 1 % solution of Dimexidum. This mixture is soaked in a sealed container in dark glasses during the day. Then there was added 100 ml of 70% acetic acid and 100 ml of 5% solution of iodine. This solution was applied to the nail plate and nail rollers for 6 months (1 per day). On the skin of the feet the same solution should be applied 2 times per week during the IN conjunction with the Department dermatoveneroligii St. Petersburg medical Academy of postgraduate education.

Examples of the application method.

Example 1. Patient C. 42 years of onychomycosis of the hands and feet for 15 years. Before contacting the clinic research Institute of Medical Mycology, St. Petersburg maps used loceryl nail Polish on the affected nail plate within 6 months without any significant effect. On examination, all of the nail plate to the toes first and third fingers of the right hand normal configuration, dull, yellow hue from the free edge to the middle of the nail plate, with thickening in the corners of the nail plate due to the accumulation of Horny masses, on the skin of the hands and feet - lamellar peeling. In a laboratory study: microscopically in skin scrapings and nail found scales fungal mycelium, culture - the growth of Trichophyton rubrum.

Diagnosis: rubrofitiya hands and feet dry squamous type of onychomycosis is distal-lateral subungual form (normotrophic type of lesion of the nail plate toes, the first and third fingers of the right hand).

After preliminary cleanup of affected parts of the nail plate ill for 6 months was applied to the nail plate daily on the skin of the feet two times a week original penetrant solution, Kotor ml of 1% solution of Dimexidum, this mixture was drawn the day in a sealed container made of dark glass, and then thereto was added 100 ml of 70% acetic acid and 100 ml of 5% solution of iodine.

After treatment of the nail plate were clinically healthy. One month after completion of treatment in the microscopic study of the mycelium of the fungus was not detected, culturally - Trichophyton rubrum was not detected.

Example 2. Patient M 84 years onychomycosis stop for 20 years. Before contacting the clinic research Institute of Medical Mycology, St. Petersburg maps use of various external antifungal agents without effect. On examination, all of the nail plate toes yellow, thickened throughout by the Horny masses (mild subungual hyperkeratosis), at the free edge of the nail plate dirty-gray color, loosened on the skin of the feet - lamellar peeling. In a laboratory study microscopically in skin scrapings and nail found scales fungal mycelium, culture - the growth of Trichophyton rubrum.

Diagnosis: rubrovaria feet dry squamous type apicoectomy total dystrophic forms (hypertrophic type of lesion of the nail plate to the toes).

After previtellogenic, on the skin of the feet two times a week original penetrant solution, which was prepared as follows: 14 tablets lamizila were pulverized to powder mass was poured 100 ml of 1% solution of Dimexidum, this mixture was drawn the day in a sealed container made of dark glass, and then thereto was added 100 ml of 70% acetic acid and 100 ml of 5% solution of iodine.

After the treatment, apparently unaltered nail plate had grown to half the nail bed. One month after completion of treatment in the microscopic study of the mycelium of the fungus was not detected, culturally - Trichophyton rubrum was not detected.

In this way were treated 95 patients with onychomycosis in age from 18 to 84 years, including onychomycosis brushes - 4 onychomycosis - 91. T. rubrum was sown in 82, C. albicans - 8 persons, fungi - 5 people.

Relapses were observed within two years after the end of treatment. Side effects and complications were not observed.

Comparison of results of proposed method of treatment with the prototype showed:

1) the percentage of clinical and laboratory cure of onychomycosis in patients treated with the original penetrant solution was due to recurrence of the disease;

3) the average cost of treating an original penetrant solution 3.5 times cheaper than lacquer (loceryl, batrafen).

Literature

1. Terbinafine in the treatment of patients with onychomycosis. Manual for doctors. M., 1999. - 3 C.

2. Mashkovsky M. D. Medicines. M.: Medicine, 1993, 1 ton 222 S.

3. Rukavishnikova M Century Modern methods of treatment of patients with mycosis of the feet. The magazine "the doctor" 10.

4. Sergeev, Y. C., A. Sergeev Y. Onychomycosis. Fungal nail infections. M : GEOTAR medicine, 1998. - 33 S., 100-108 C.

5. Stepanova J. C. Fungal diseases. M: crown press, 1996. - 48 S.

6. Stepanova J. C. Onychomycosis. Russian medical journal 14, 1999.

The method of treatment of onychomycosis by the local action of antimycotic means, characterized in that used as antimycotic funds solution for preparation of which pound 14 tablets lamizila to powder mass, pour 100 ml of 1% solution Dimexidum, this mixture is soaked day in a sealed container made of dark glass, and then there was added 100 ml of 70% acetic acid and 100 ml of a 5% solution of iodine, after which the solution within 6 months 1 per day applied to the nail plate and the nail is

 

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