Methyl 5-aminolevulinic Acid를 이용한 발톱진균증의 광역동치료: 효과와 안전성
Photodynamic Therapy with Methyl 5-aminolevulinic Acid for Treatment of Toenail Onychomycosis: the Efficacy and Safety
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: The major limitations of the current therapeutic treatments for onychomycosis are the recurrence of the infection and the duration of the treatment. Recently, photodynamic therapy (PDT) is thought to be a novel alternative method for treatment of onychomycosis. Objective: The aim of this study is to investigate the efficacy and safety of PDT with methyl 5-aminolevulinic acid (MAL) for the treatment of onychomycosis. Methods: We performed MAL-PDT in eight patients with distal subungual onychomycosis on at least one great toenail. After the total three treatments, we observed the clinical and mycological courses for twelve months. Results: For the twelve months of follow-up period, three patients (37.5%) showed continuous clinical improvement, two patients (25%) aggravation after transient improvement, and the rest, three patients (37.5%) resistance to treatment. All subjects complained of quite severe burning pain during irradiation of light source. Conclusion: In this study, we observed the highly variable clinical and mycological results of PDT in onychomycosis. We concluded that it is too difficult to consistently achieve the best fungicidal effect by PDT without strictly selected conditions.
Abstract
Background: The major limitations of the current therapeutic treatments for onychomycosis are the recurrence of the infection and the duration of the treatment. Recently, photodynamic therapy (PDT) is thought to be a novel alternative method for treatment of onychomycosis. Objective: The aim of this study is to investigate the efficacy and safety of PDT with methyl 5-aminolevulinic acid (MAL) for the treatment of onychomycosis. Methods: We performed MAL-PDT in eight patients with distal subungual onychomycosis on at least one great toenail. After the total three treatments, we observed the clinical and mycological courses for twelve months. Results: For the twelve months of follow-up period, three patients (37.5%) showed continuous clinical improvement, two patients (25%) aggravation after transient improvement, and the rest, three patients (37.5%) resistance to treatment. All subjects complained of quite severe burning pain during irradiation of light source. Conclusion: In this study, we observed the highly variable clinical and mycological results of PDT in onychomycosis. We concluded that it is too difficult to consistently achieve the best fungicidal effect by PDT without strictly selected conditions.
참고문헌 (19)
- Lim SW, "Clinical features and identification of etiologic agents in onychomycosis", Korean J Dermatol, 42, pp.53~60 (2004)
- Kumar S, "New antifungal therapies for the treatment of onychomycosis", Expert Opin Investig Drugs, 18, pp.727~734 (2009)
- Elewski B, "Safety and tolerability of oral antifungal agents in the treatment of fungal nail disease: a proven reality", Ther Clin Risk Manag, 1, pp.299~306 (2005)
- 박현선, "Methyl 5-aminolaevulinic Acid 국소 광역동 요법을 이용한 광선각화증의 치료", 대한피부과학회지, 48(10), pp.837~843 (2010), 대한피부과학회
- Smijs TG, "Morphological changes of the dermatophyte Trichophyton rubrum after photodynamic treatment: a scanning electron microscopy study", Med Mycol, 46, pp.315~325 (2008)
- Donelly RF, "Bioadhesive patch-based delivery of 5-aminolevulinic acid to the nail for photodynamic therapy of onychomycosis", J Control Release, 103, pp.381~392 (2005)
- Zaias N., "Onychomycosis", Arch Dermatol, 105, pp.263~274 (1972)
- Han MH, "Onychomycosis and Trichosporon beigelii", Korean J Dermatol, 37, pp.1709~1714 (1999)
- Kim JA, "Clinical features and classification of nail diseases", Korean J Dermatol, 37, pp.1733~1742 (1999)
- Sotiriou E, "Photodynamic therapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: preliminary results of a single-centre open trial", Acta Derm Venereol, 90, pp.216~217 (2010)
- Piraccini BM, "Photodynamic therapy of onychomycosis caused by Trichophyton rubrum", J Am Acad Dermatol, 59, pp.75~76 (2008)
- Watanabe D, "Successful treatment of toenail onychomycsis with photodynamic therapy", Arch Dermatol, 144, pp.19~21 (2008)
- Smijs TG, "Investigation of conditions involved in the susceptibility of the dermatophyte Trichophyton rubrum to photodynamic treatment", J Antimicrob Chemother, 60, pp.750~759 (2007)
- Smijs TG, "A novel ex vivo skin model to study the susceptibility of the dermatophyte Trichophyton rubrum to photodynamic treatment in different growth phases", J Antimicrob Chemother, 59, pp.433~440 (2007)
- Kamp H, "Antifungal effect of 5- aminolevulinic acid PDT in Trichophyton rubrum", Mycoses, 48, pp.101~107 (2005)
- Zane C, "Photodynamic therapy with methylaminolevulinate as a valuable treatment option for unilesional cutaneous T-cell lymphoma", Photodermatol Photoimmunol Photomed, 22, pp.254~258 (2006)
- Murdan S, "Drug delivery to the nail following topical application", Int J Pharm, 236, pp.1~26 (2002)
- Walters KA, "Permeability characteristics of the human nail plate", Int J Cosmet Sci, pp.231~246 (1983)
- Walters KA, "Physicochemical characterisation of the human nail: permeation pattern for water and the homologous alcohols and differences with respect to the stratum corneum", J Pharm Pharmacol, 35, pp.28~33 (1983)