Onikomikoz ve Tedavi Yaklaşımları

Onikomikoz, tırnak hastalıklarının yaklaşık %50'sini oluşturan başlıca tırnak enfeksiyonlarından biridir. Hastaların tedavi uyumsuzluğu, yüksek maliyet, uzun tedavi süreleri ve hastalığın tekrarlama olasılığının yüksek olması gibi pek çok faktör onikomikoz tedavisinde zorluk yaratır. Doğru ve uygun maliyetli onikomikoz tedavisi için tanıyı doğru koymak da önemlidir. Farklı tanı yöntemleri kullanılsa da, en sık tercih edilen yöntem fungal kültürdür. Onikomikozun tedavisinde oral ve topikal tedavi yöntemleri ayrı ayrı veya kombine olarak uygulanabilir. Oral tedavide allilaminler ve azoller kullanılmakta olup, etkinlik yüksektir. Ancak hepatotoksik etki ve ilaç-ilaç etkileşimleri oral tedavi için büyük problemler yaratabilir. Topikal tedavide ise en sık siklopiroks, amorolfin, efinaconazole ve tavaborole kullanılır. Topikal tedavi yöntemi olarak farklı antifungaller çözeltiler veya bitkisel ekstratlar da kullanılmaktadır. Topikal ilaçların uygulanması daha kolaydır ve çok daha az yan etki gösterir, ancak tırnakların keratin açısından zengin yapısı yetersiz penetrasyona neden olur. Bu derlemede, onikomikoz, tanı yöntemleri ve tedavideki yeni yaklaşımların neler olduğu gözden geçirilmiştir.

Anahtar Kelimeler:

Onikomikoz, Tırnak, Tedavi, Tinea unguium

Onıcomycosıs and Treatment Approaches

Onychomycosis is one of the main nail infections, accounting for approximately 50% of nail diseases. Many factors create difficulties in the treatment of onychomycosis, such as treatment non-compliance, high cost, long treatment period, and the high probability of recurrence of the disease. It is also important to make an accurate diagnosis for the treatment of onychomycosis accurately and cost-effectively. Although different diagnostic methods are used, the most preferred method is fungal culture. In the treatment of onychomycosis, oral and topical treatment methods can be applied separately or in combination. Allylamines and azoles are used in the oral treatment and the efficiency is high. However, hepatotoxic effects and drug-drug interactions can create major problems for oral therapy. In topical treatment, ciclopirox, amorolfine, efinaconazole, and tavborole are most commonly used. Different antifungals solutions or herbal extracts are also used as topical treatment method. Topical medications are easier to apply and have far fewer side effects, but the keratin-rich structure of the nails causes poor penetration. In this review, the diagnostic methods and new approaches in the treatment of onychomycosis are reviewed.

Keywords:

Onychomycosis, Diagnosis, Nail, Tinea unguium,

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