Arenas R, Ruiz-Esmenjaud J

Language: Spanish
References: 28
Page: 178-181
PDF size: 101.69 Kb.

ABSTRACT

Background: in onychomycosis, surgical excision of the nail might increase the index of therapeutic success.
Methods: a critical review of surgical or chemical removal of the nail was done. It is a logical approach to eradicate the pathogen from lateral nail disease and from the underlying debris from the onycholysis. Treatment with bifonazole-urea ointment is a non-surgical procedure. Cure rates ranged from 46% to 75%. Carbon dioxide laser has also been used in the treatment of onychomycosis.
Results: removal of diseased nail is helpful if associated to antifungal treatment. Chemical avulsion is a therapeutic alternative in patients which do not have more than four affected nails, in onycholysis due to Candida, in children and patients which can not be submitted to systemic treatment. It is optimal for patients with diabetes mellitus, vascular insufficiency, digital neuropathy or immunosupression and also in those receiving anticoagulants. Topical alternatives are amorolfine and ciclopirox.
Conclusions: surgery is not recommended as first-line therapy. Complete or partial removal of the nail plate has not been shown to shorten the period of treatment. Chemical avulsion of the involved nail plate may be a useful adjuvant to the topical or systemic management of onychomycosis.

REFERENCES

1. Co hen PR, Scher RK. To pi cal and sur gi cal treat ment of ony chomy co sis. J Am Acad Der ma tol 1994; 31: 574-577

2. Ba ran R, Daw ber RPR. Di sea ses of the nails and their ma na ge ment. Ox ford. Black well Scien Pub. 2nd ed. 1994: 116-118

3. Ba ran R, Hay R, Ha ne ke E, Tos ti A, Pi rac ci ni BM. Ony chomy co sis. The cu rrent ap proach to diag no sis and the rapy. Lon don. Mar tin Du nitz Pub. 1999: 47-49

4. Mach ler BC, Kirs ner RS, El gart GW. Rou ti ne his to lo gic exa mi na tion for the diag no sis of ony chomy co sis: an eva lua tion of sen si ti vity and spe ci fi city. Cu tis 1998; 61 (4): 217-219

5. Sáez de Oca riz MM, Are nas R, Ra ne ro-Juá rez GA et al. Fre quency of toe - nail ony chomy co sis in pa tients with cu ta neous ma ni fes ta tions of ch ro nic ve nous in suf fi ciency. Int J Der ma tol 2001; 40 (1): 18-25

6. Ba ran R, De Donc ker P. La te ral ed ge nail in vol ve ment in di ca tion poor prog - no sis for trea ting ony chomy co sis with the new sys te mic an ti fun gals. Ac ta Derm Ve ne reol 1996; 76: 82-83

7. Ro berts DT. Su bun gual der ma tophy to ma com pli ca ting der ma tophy te ony chomy - co sis. Br J Der ma tol 1998; 138: 189-1908. Kor ting HC, Scha fer-Kor - ting M. Is ti nea un guium still wi dely in cu ra ble? Arch Der ma tol 1992; 128: 243-248

8. Ba ran R, Tos ti A, Pi rac ci ni BM, Un com mon cli ni cal pat terns of Fu sa rium nail in fec tion: re port of th ree ca ses. Br J Der ma tol 1997; 67: 424-427

9. Ba ran R, Hay R. Par tial sur gi cal avul sión of the nail in ony chomy co sis. Clin Exp Der ma tol 1985; 10: 413-418

10. Da niel III CR. Ba sic nail pla te avul sion. J Der ma tol Surg On col. 1992; 18: 685-688

11. Tom CM; Ka ne MP. Ma na ge ment of toe nail ony chomy co sis. Am J Health Syst Pharm 1999; 56 (9): 865-871

12. Ba den HP. Treat ment of dis tal ony chomy co sis with avul sion and to pi cal an ti - fun gal agents un der oc clu sion. Arch Der ma tol 1991; 130: 558-559

13. Hard jo ko FS, Wid yan to S, Sing gih I et al. Treat ment of ony chomy co sis with a bi fo na zo le urea com bi na tion. My co ses 1990; 33: 167-171

14. Hay RJ, Ro berts DT, Do herty VR et al. The to pi cal treat ment of ony chomy - co sis using a new com bi na tion urea/i mi da zo le pre pa ra tion. Clin Exp Der - ma tol 1988

15. Are nas R, Ocam po J, So sa JL et al. Po ma da de bi fo na zol-urea co mo tra tamien - to to pi co de la oni co mi co sis. Der ma to lo gía Rev Mex 1995; 39 (2): 85-88

16. Aris ti mu ño M, Are nas R, Ru bal ca ba-Prie go J et al. Oni co mi co sis en pa - cien tes dia bé ti cos ti po 2, am bu la to rios. Da tos clí ni co-epi de mio ló gi cos y tra ta - mien to con bi fo na zol-urea. Der ma to lo gía Rev Mex 2000; 44 (2): 60-68

17. Bo ni faz A, Iba rra G. Ony chomy co sis in chil dren :treat ment with bi fo na zo leurea. Pe dia tric Der ma tol 2000; 17 (4): 310-314

18. Fried man-Birn baum R, Co hen A, She mer A et al. Treat ment of ony - chomy co sis: a ran do mi zed, dou ble-blind com pa ri son study with to pi cal bi fo na - zo le-urea oint ment alo ne and in com bi na tion with short-du ra tion oral gri seo - ful vin. Int J Der ma tol 1997; 36: 67-69

19. Con ne lley LK Jr; Di ne hart SM; Mc Do nald R. Ony chocryp to sis as so cia - ted with the treat ment of ony chomy co sis. J Am Po diatr Med As soc 1999; 89 (8): 424-426

20. Cei lley RI; Co lli son DW. Ma tri cec tomy. J Der ma tol Surg On col 1992; 18 (8): 728-734

21. Gem MA, Sy kes PA. In gro wing toe nails: stu dies of seg men tal che mi cal abla - tion.Br J Clin Pract 1990; 44 (12): 562-563

22. Are nas R, Ar ce M, Ley va J. Oni co mi co sis der ma to fí ti ca. Es tu dio abier to, com pa ra ti vo y alea to rio en tre po ma da de bi fo na zol-urea com bi na da con un mo no pul so de itra co na zol o ter bi na fi na. Der ma to lo gía Rev Mex 1999; 43 (4): 149-156

23. Do mín guez-Che rit J, Tei xei ra F, Are nas R. Com bi ned sur gi cal and sys te - mic treat ment of ony chomy co sis. Br J Der ma tol 1999; 140 (4): 778-780

24. Ge ro ne mus RG. La ser sur gery of the nail unit. J Der ma tol Surg On col 1992; 18: 735-743

25. Rot her mel E, Ap fel berg DB. Car bon dio xi de la ser use for cer tain di sea ses of the toe nails. Clin Po diatr Med Surg 1987; 2: 809-821

26. Ap fel berg DB, Rot her mel RG. Widt feldt A et al. Pre li mi nary re port on use of car bon dio xi de la ser in po diatry. J Am Po diatr Med As soc 1984; 74: 509-513

27. Tom CM, Ka ne MP. Ma na ge ment of toe nail ony chomy co sis. Am J Health Syst Pharm 1999; 56 (9): 865-871

28. Alam M, Scher RK. Cu rrent to pics in nail sur gery. J Cu tan Med Surg 1999; 3 (6): 324-333