A modern view on diagnostics and treatment of onychomycoses (literature review)

Abstract

This article provides an overview of current data on the diagnosis and treatment of onychomycosis. Fungal infection is the cause of 50 % to 60 % of all nail diseases. In other cases, nail diseases are non-fungal in nature and are caused by various pathological processes, including chronic and infectious skin diseases, chronic somatic lesions, endocrine and psychological disorders caused by hereditary, occupational and traumatic factors. Onychomycosis constitutes a significant part of the pathology of nails, according to numerous researchers, onychomycosis accounts for about 20 % of all diseases of the nails. Known pathogens of onychomycosis are usually divided into three groups: dermatophytes, yeast-like fungi of the Candida species, and mold fungi. According to preliminary studies, dermatophytic onychomycosis accounts for up to 83 % of all infectious lesions of the feet nails and more than 50 % of the nails of the hands. Mixed infections are becoming increasingly important in the etiology of onychomycosis. Data has appeared on mixed dermatophytic-bacterial and dermatophytic-viral onychomycoses. Laboratory diagnostics are based on traditional methods: microscopic examination of pathological material and cultural studies, as well as modern methods (PCR diagnostics). Molecular genetic research showed the high sensitivity of this PCR method, which allows researchers to confirm the diagnosis of onychomycosis in just a day and reveals a larger percentage of patients with onychomycosis compared to traditional methods were able to, thus this indicates the need to revise existing approaches to laboratory diagnosis. Currently, there are a large number of methods for treating onychomycosis. Etiotropic therapy is the only effective approach in the onychomycosis treatment. The main types of therapy are local therapy, systemic and combined. Higher therapeutic efficacy of combination therapy is associated with different routes of antifungal drugs, their synergistic action, the possibility of using drugs with various differing mechanisms of action and, consequently, the expansion of the spectrum of action, the creation of a high concentration of antifungal drugs in the nail plate and surrounding tissues, and the removal of a significant mass of the spreading infectious agent. In addition, the advantage of combination therapy in the treatment of onychomycosis is shorter therapy duration, and therefore a reduction in the likelihood of side effects, as well as epidemiological and economic efficiency, and a high cosmetic effect. Key words: onychomycosis, polymerase chain reaction, systemic and topical antimycotics, combination therapy. For citation: Kutasevych YF, Oliinyk IO, Ishcheikin KY, Bilozorov OP, Mashtakova IO, Zimina TV, Suprun KH, Chekhovska HS. A modern view on diagnostics and treatment of onychomycoses (literature review). Journal of the National Academy of Medical Sciences of Ukraine. 2019;25(3):313–20