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甲癬 Onychomycosis,tinea unguium,或是你要說他是灰指甲。

另外補充一下

 

tinea ungium 通常指有沒培養出dermatophyte 的灰指甲
onychomycosis 是指和tinea ungium 相似的症狀,但培養不出dermatophyte的灰指甲

 

目前簡單分成以下幾種:


螢幕快照 2012-07-22 上午1.19.04  

distal lateral subungual onychomycosis (DLSO),遠端側緣甲下型

DLSO

Lateral fungal nail involvement in onychomycosis

LSO  

superficial white onychomycosis (SWO或WSO),白色淺表型

onychomycosis_white.jpg  

proximal subungual onychomycosis (PSO),近端甲下型

或是 proximal subungual white onychomycosis

proximal-subungual-onychomycosis.jpg  

endonyx onychomycosis (EO),甲板侵入型

fungal-nail.png  

candidal onychomycosis念珠菌感染型

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Total dystrophic type全損壞型

螢幕快照 2012-07-22 上午1.22.56  

在這邊要先跟各位強調,指甲變形有很多種可能,但是真正檢查發現式灰指甲的,大約只有60-70%左右。

所以,要真的判斷是不是灰指甲,式要找醫師的,不是自己用肉眼判斷。

一般說來,醫師會用一個很簡單的試劑,來看看你的指甲是不是有菌絲感染,那就是氫氧化鉀(KOH)

螢幕快照 2011-04-04 上午8.42.20.png  

當然,也是可以直接用染色法鏡檢

這個是各種鏡檢的圖片:

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實驗室鏡檢法:In the laboratory, the sample may be treated with a solution made from 20%potassium hydroxide (KOH) in dimethyl sulfoxide (DMSO) to rule out the presence of fungi. The specimen may also be treated with dyes (a process called staining) to make it easier to see the fungi through the microscope.

念珠菌主要在手部指甲,由其是60歲以上女性,而腐生性黴菌則與潮濕工作有關,如農夫及魚夫,以鐮刀黴菌(Fusarium solani)為主,其次為黑麴黴菌(Aspergillus niger)。 

 

以病原體來說,甲癬的病原體涵蓋:

螢幕快照 2011-03-31 上午12.39.57.png  

對比一下之前提過的足癬(足癬 Tinea Pedis),妳就可以發現到,得香港腳跟得灰指甲並沒有絕對關係,但是甲癬常伴隨香港腳而來,但有時候足底僅僅是帶菌,在外觀上並無明顯的脫皮現象。甲癬病原,除一般導致香港腳的皮癬菌外,念珠菌也很常見,尤其在糖尿病患者。更麻煩的是甲癬也可以由一些腐生性黴菌所引起,而這類的甲癬,傳統的藥物治療幾乎完全無效。

Treatment of Onychomycosis 甲癬治療

你可以參考機轉圖:

圖解藥理學-21 抗真菌藥的機轉 03

 

Medications

In the past, medicines used to treat onychomycosis (OM) were not very effective. OM is difficult to treat because nails grow slowly and receive very little blood supply. However, recent advances in treatment options, including oral (taken by mouth) andtopical (applied on the skin or nail surface) medications, have been made. Newer oral medicines have revolutionized treatment of onychomycosis. However, the rate ofrecurrence is high, even with newer medicines. Treatment is expensive, has certain risks, and recurrence is possible.

  • Topical antifungals are medicines applied to the skin and nail area that kill fungus.

      • These topical agents should only be used if less than half the nail is involved or if the person with onychomycosis cannot take the oral medicines. Medicines include amorolfine (approved for use outside the United States), ciclopiroxolamine (Penlac, which is applied like nail polish), sodium pyrithione, bifonazole/urea (available outside the United States), propylene glycol-urea-lactic acid, imidazoles, such as ketoconazole (Nizoral Cream), and allylamines, such as terbinafine (Lamisil Cream).
      • 傳統治療是將抗黴菌藥物直接塗在指甲上,例如Ciclopirox、sodium pyrithione、ketoconazole、bifonazole/urea、terbinafine

    • Topical treatments are limited because they cannot penetrate the nail deeply enough, so they are generally unable to cure onychomycosis. Topical medicines may be useful as additional therapy in combination with oral medicines.不過因為這些外用藥劑的穿透力有限,所以多半治癒率都不高。
  • Newer oral medicines are available. These antifungal medicines are more effective because they go through the body to penetrate the nail plate within days of starting therapy.

      • Newer oral antifungal drugs terbinafine (Lamisil Tablets) and itraconazole(Sporanox Capsules) have replaced older therapies, such as griseofulvin, in the treatment of onychomycosis. They offer shorter treatment periods (oral antifungal medications usually are administered over a 3-month period), higher cure rates, and fewer side effects. These medications are fairly safe, with few contraindications (conditions that make taking the medicine inadvisable), but they should not be taken by patients with liver disease or heart failure. Before prescribing one of these medications, doctors often order a blood test to make sure the liver is functioning properly. Common side effects include nausea and stomach pain.


  • To decrease the side effects and duration of oral therapy, topical and surgical treatments may be combined with oral antifungal management.

Surgery 外科處置(妳也可以參考這篇:Technique - Partial or Full Nail Removal 全甲拔除或部分指甲移除)

螢幕快照 2012-07-22 上午1.17.11  

Surgical approaches to onychomycosis treatment include surgically or chemically removing the nail (nail avulsion or matrixectomy).

    • Removing the nail plate (fingernail or toenail) is not effective treatment on its own. This procedure should be considered an adjunctive (additional) treatment combined with oral therapy.



  • A combination of oral, topical, and surgical therapy can increase the effectiveness of treatment and reduce the cost of ongoing treatments.

 

 

Summary of Common Types of Onychomycosis

Characteristics of Common Types of Onychomycosis (OM)

Characteristic DLSO PSO WSO
Frequency Most common Generally uncommon but frequent in AIDS patients Makes up 10% of cases of OM
Progress of infection Infection begins with invasion of the space under the nail edge where the nail separates from the nail bed (called the hyponychium) Infection begins at the nail fold (where the nail meets the finger or toe) and affects newly forming nail Infection begins at the surface of the nail (nail plate) and progresses to deeper layers
Clinical appearance Separation of the nail from the nail bed (onycholysis), thickening of the area under the nail (subungual hyperkeratosis) Subungual hyperkeratosis, white discoloration (leukonychia), separation of the nail from the nail bed (onycholysis), and destruction of the nail unit White areas on the nail surface, eventually involving the entire nail surface
Most common causative organism Trichophyton rubrum Trichophyton rubrum Trichophyton mentagrophytes, Aspergillus terreus, Acremonium roseogriseum, Fusarium oxysporum
Affected nails Toenails most commonly affected but may affect fingernails as well Much more common on the toenails, rarely affects fingernails Mainly affect toenails

The term total dystrophic onychomycosis is not a subtype, but is, instead, the final stage of any of the previously described forms of onychomycosis, candidal onychomycosis, or both

順便提供一些市面上買的到的抗甲癬藥物:

1.Funginix
螢幕快照 2011-04-06 上午12.04.42.png螢幕快照 2011-04-06 上午12.04.50.png  

介紹:It combines the anti-fungal agent undecylenic acid with herbal remedies such as camphor and essential oils like tea tree, lavender and jasmine. It is a sophisticated and complete treatment that has been thoroughly tested to guarantee that it kills fungus.

2.ZetaClear Nail Fungus Treatment

螢幕快照 2011-04-06 上午12.07.55.png螢幕快照 2011-04-06 上午12.07.46.png  

介紹:The product contains a combination of Tea tree oil, Jojoba oil, Lavender oil, Clove oil, and Undecylenic acid which are known anti-fungal agents. ZetaClear also soothes the nail area, can reduce the discoloration that is associated with nail fungus infections and helps encourage healthy nail growth.

3.Tineacide Antifungal Cream

螢幕快照 2011-04-06 上午12.09.40.png  

The active ingredient is a powerful antifungal agent called undecylenic acid.  The formulation has an emollient base that includes tea tree oil, lavender oil, urea (to help penetration) and clotrimazole.

 

4.FungiCure Antifungal Liquid Extra Strength

螢幕快照 2011-04-06 上午12.11.00.png  

FungiCure Antifungal Liquid is a powerful, extra strength treatment for fungal infections of the finger and toe areas. Finger and toenail fungal infections require a strong medicine that can destroy the fungus on contact. The active ingredient in FungiCure is Undecylenic acid (25%) which has been proven to inhibit the growth and reproduction of fungal cells.

 

5.Mycocide NS

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The active ingredient in Mycocide NS is Benzalkonium Chloride, a broad spectrum antimicrobial that is effective at killing fungi, yeasts, molds, bacteria and virus.  Mycocide also contains an emollient called Allantoin to help stimulate healing.  The journal of the American Podiatric Medical Association reported that 90% of patients in a 10 month clinical study conducted on the effectiveness of Benzalkonium Chloride and Allantoin for pedal onychomycosis rated their results as good or excellent.

5.Nail-Rx natural remedy for toenail fungus

螢幕快照 2011-04-06 上午12.15.19.png  

Nail-Rx contains the following carefully selected undiluted essential aromatherapy oils in therapeutic dosage:

  • Tea Tree Oil (Melaleuca laterifolia) and is used externally for the skin. This oil has excellent supportive properties for the skin and helps to maintain nail health and integrity. Constituents of tea tree oil include 1,8-cineole, terpinen-4-ol, alpha-terpineol, and gamma-terpinen and Tea Tree Oil has been studied for its ability to support skin health and skin flora. (Satchell, A. C., Saurajen, A., Bell, C., and Barnetson, R. S. “Treatment of interdigital tinea pedis with 25% and 50% tea tree oil solution: A randomized, placebo-controlled, blinded study”. Australas.J Dermatol 2002;43(3):175-178).     
  • Lavender (Lavendula officinalis) is a sweet-smelling essential oil frequently used for its beneficial effects on the skin and nails. (Gabbrielli G, Loggini F, Cioni PL, et al. “Activity of lavandino essential oil against non-tubercular opportunistic rapid grown mycobacteria”. Pharmacol Res Commun 1988;20 Suppl 5:37-40.)
  • Lemon Grass (Cymbopogon citrates) is known for its supportive properties for nail and skin health and also helps to maintain the normal process of skin and nail-bed cell regeneration. (Abe, S., Sato, Y., Inoue, S., Ishibashi, H., Maruyama, N., Takizawa, T., Oshima, H., and Yamaguchi, H. “Anti-Candida albicans activity of essential oils including Lemongrass (Cymbopogon citratus) oil and its component, citral”. Nippon Ishinkin.Gakkai Zasshi 2003;44(4):285-291.)
  • Clove Oil (Syzygium aromaticum) and is considered an excellent tonic for the skin and nails.(Chami N, Bennis S, Chami F, et al. “Study of anticandidal activity of carvacrol and eugenol in vitro and in vivo.” Oral Microbiol.Immunol 2005; 20(2):106-111.)

6.Loceryl (Amorolfine) Nail Fungus Treatment

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快樂小藥師 Im pharmacist nichts glücklich

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  • medical student
  • 謝謝您的分享:)
    小補充:
    tinea ungium 通常指有沒培養出dermatophyte 的 灰指甲
    onychomycosis 是指和tinea ungium 相似的症狀,但培養不出dermatophyte的灰指甲稱之
  • 謝謝你

    快樂小藥師 於 2013/04/11 13:06 回覆

  • vivian
  • 甲床分離也是甲癬嗎?有時候全部好了有時又來了,我發現我的指甲往下生長但是不痛也沒有甲溝發炎的現象

    謝謝

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