한국인 손발톱진균증의 임상적 분류
Classification of Onychomycosis in Korea
4
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Background: Clinical classification of onychomycosis is commonly divided into 4 clinical types but some authors suggest 5 clinical types. Pathogenic fungi, treatment response and prognosis of onychomycosis are different dependent upon the clinical type. Therefore, suitable clinical classification is necessary before treatment. Objective: The primary aim of this study was to investigate the incidence and distribution of 4 clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), total dystrophic onychomycosis (TDO). The secondary aim of this study was to clarify the DLSO, the most common type of the onychomycosis, by dividing it into 4 subtypes. Methods: The diagnosis of the patients were confirmed by more than 1 positive test among KOH smear, fungus culture, histopathologic test and KONCPA test. Total 817 onychomycotic nails of 589 patients (331 males, 258 females) who visited Department of dermatology, Catholic University, St. Mary hospital between January, 1999 and December, 2006 were included. Clinical photographs and charts of the patients were thoroughly reviewed and divided into 4 clinical types and 4 clinical subtypes in case of DLSO. Results: 1. Out of 817 nails, 623 (76.3%) fell into DLSO and 82 (10.0%) TDO, 65 (7.9%) SWO, 47 (5.8%) PSO, respectively. 2. 623 nails diagnosed to be DLSO were further divided into 4 clinical subtypes: 243 (39.0%) edge types, 211 (33.9%) distal types, 104 (16.7%) linear types and 65 (10.4%) lateral types. 3. 315 males with DLSO were further divided into 4 clinical subtypes: 130 (41.3%) edge types, 96 (30.5%) distal types, 54 (17.1%) linear types and 35 (10.6%) lateral types. Females in the same group also exhibited same ranks in terms of prevalence. 4. Out of 457 big toenails, there were 193 edge types (42.2%), 141 distal types (30.9%), 77 linear types (16.8%) and 46 lateral types (10.1%). Out of 105 other toenails, there were 42 distal types (40.0%), 28 edge types (26.7%), 19 linear types (18.1%) and 16 lateral types (15.2%). Conclusion: DLSO composed of 76.3% of onychomycosis were further classified into 4 clinical subtypes. Further clinical studies will be necessary to evaluate the value and efficacy of this subclassification in deciding the treatment methods and presumption of prognosis.
Abstract
Background: Clinical classification of onychomycosis is commonly divided into 4 clinical types but some authors suggest 5 clinical types. Pathogenic fungi, treatment response and prognosis of onychomycosis are different dependent upon the clinical type. Therefore, suitable clinical classification is necessary before treatment. Objective: The primary aim of this study was to investigate the incidence and distribution of 4 clinical types of onychomycosis: distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), total dystrophic onychomycosis (TDO). The secondary aim of this study was to clarify the DLSO, the most common type of the onychomycosis, by dividing it into 4 subtypes. Methods: The diagnosis of the patients were confirmed by more than 1 positive test among KOH smear, fungus culture, histopathologic test and KONCPA test. Total 817 onychomycotic nails of 589 patients (331 males, 258 females) who visited Department of dermatology, Catholic University, St. Mary hospital between January, 1999 and December, 2006 were included. Clinical photographs and charts of the patients were thoroughly reviewed and divided into 4 clinical types and 4 clinical subtypes in case of DLSO. Results: 1. Out of 817 nails, 623 (76.3%) fell into DLSO and 82 (10.0%) TDO, 65 (7.9%) SWO, 47 (5.8%) PSO, respectively. 2. 623 nails diagnosed to be DLSO were further divided into 4 clinical subtypes: 243 (39.0%) edge types, 211 (33.9%) distal types, 104 (16.7%) linear types and 65 (10.4%) lateral types. 3. 315 males with DLSO were further divided into 4 clinical subtypes: 130 (41.3%) edge types, 96 (30.5%) distal types, 54 (17.1%) linear types and 35 (10.6%) lateral types. Females in the same group also exhibited same ranks in terms of prevalence. 4. Out of 457 big toenails, there were 193 edge types (42.2%), 141 distal types (30.9%), 77 linear types (16.8%) and 46 lateral types (10.1%). Out of 105 other toenails, there were 42 distal types (40.0%), 28 edge types (26.7%), 19 linear types (18.1%) and 16 lateral types (15.2%). Conclusion: DLSO composed of 76.3% of onychomycosis were further classified into 4 clinical subtypes. Further clinical studies will be necessary to evaluate the value and efficacy of this subclassification in deciding the treatment methods and presumption of prognosis.
참고문헌 (20)
- Nelson MM, "Superficial fungal infections: Dermatophytosis, onychomycosis,tinea nigra, piedra. Dermatology in general medicine,6thed", pp.1989~2005 (2003), McGraw-Hill
- Zaias N., "Onychomycosis", Arch Dermatol, 105, pp.263~274 (1972)
- Baran R, "A new classification of onychomycosis", Br J Dermatol, 139, pp.567~571 (1998)
- Drake LA, "Guidelines of care for superficial mycotic infections of the skin: onychomycosis", J Am Acad Dermatol, 34, pp.116~121 (1996)
- Elewski BE, "Onychomycosis: pathogenesis, diagnosis, and management", Clin Microbiol Rev, 11, pp.415~429 (1998)
- Robert DT, "Guidelines for treatment of onychomycosis", Br J Dermatol, 148, pp.402~410 (2003)
- 오대헌, "선형 조갑진균증의 발생 요인과 치료 반응에 대한 연구", 대한의진균학회지, 10(1), pp.21~29 (2005), 대한의진균학회1
- 김덕한, "조갑진균증의 임상적 고찰 : 조갑진균증의 치료에 영향을 주는 인자와 그에 따른 치유율 비교", 대한의진균학회지, 10(2), pp.55~69 (2005), 대한의진균학회1
- Dawber RP, "Science of the nail apparatus,Diseases of the nails and their management, 3rded", pp.1~47 (2001), Blackwell Science
- 박장규, "조갑진균증의 임상적 고찰", 대한의진균학회지, 10(2), pp.46~54 (2005), 대한의진균학회1
- Baran R, "Lateral edge nail involvement indicates poor prognosis for treating onychomycosis with the new systemic antifungals", Acta Derm Venereol, 76, pp.82~83 (1996)
- Hay RJ., "Chronic dermatophyte infections,Superficial fungal infections", pp.23~24 (1998), MTP Press Ltd
- Roberts DT, "Subungual dermatophytoma complicating dermatophyte onychomycosis", Br J Dermatol, 138, pp.189~190 (1998)
- Burkhart CN, "Dermatophytoma:recalcitrance to treatment because of existence of fungal biofilm", J Am Acad Dermatol, 47, pp.629~631 (2002)
- Scher RK, "Onychomycosis in clinical practice: factors contributing to recurrence", Br J Dermatol, 149, pp.S5~S9 (2003)
- Gupta AK, "Ciclopirox nail lacquer solution 8% in the 21st century", J Am Acad Dermatol, 43, pp.96~102 (2001)
- Gupta AK, "Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: a multicentre survey", Br J Dermatol, 139, pp.665~671 (1998)
- 임성욱, "조갑진균증의 임상 양상 및 원인균 동정 (1999~2002)", 대피지, 42, pp.53~60 (2004)
- Sergeev AY, "The scoring clinical index for onychomycosis (SCIO index)", Skin Therapy Lett, 7, pp.S6~S7 (2002)
- Scher RK, "Onychomycosis: diagnosis and definition of cure", J Am Acad Dermatol, 56, pp.939~944 (2007)