CONCEPTUAL AND THEORETICAL EXPLORATION OF TREATMENT OF PATIENTS WITH ONYCHOMYCOSIS.

Abstract

The last decades regarding diseases of fungal etiology are characterized by a tendency towards changes in the understanding of the etiology and clinical picture of such lesions, and accordingly, the development of new treatment methods is necessary. The goal of our work was to optimize medical care for patients with onychomycosis through the use of therapeutic agents that improve the structure of the nail plates.

Materials and methods: The study involved 147 patients with various forms of onychomycosis of the hands and feet aged 23 to 79 years. Patients in the main group were offered to use a systemic antifungal drug with a drug that contains biotin and improves the structure and speed of nail plate growth. Patients in the control group used only a systemic antifungal drug. Examination of patients was performed with microscopic examination of pathological material (pieces of nail fragments), cultural study, PCR, epiluminescence surface microscopy of affected nail plates, dermatoscopy, determination of nail plate damage index.

Results: At the beginning of treatment, the most common clinical manifestations of onychomycosis were as follows: hyperkeratotic changes were observed in 44 patients (47.3%) of the main group and in 30 patients (55.6%) of the control group; onycholysis in the form of partial or complete detachment of the nail plates from the nail bed was observed in 26 patients (28.0%) with combined therapy and in 38 patients (70.4%) of the control group; destruction of the nail plates to their complete absence was observed in 4 patients of the main group and in 3 patients of the control group; color change was observed in almost all patients of both groups - 96.8% of the main group and in 96.3% of the control group; Surface deformation is also a characteristic sign of onychomycosis and at the beginning of treatment it was observed in a weak degree of severity in 41 patients (44.1%), in a moderate degree - in 26 (27.9%), in a significant degree - in 19 patients (20.4%). As for the patients of the control group, the largest number of them had moderate surface deformation in 25 patients (46.3%), then 14 patients (25.9%) with significant changes in the form of transverse and longitudinal striations, there were no surface changes at all in 11 patients. Such a symptom as a change in the free edge was completely absent in 10 patients (18.5%) of the control group and in 24 patients (25.8%) of the main group. The highest percentage of changes among the main group - 29.0% was observed in patients with moderate degree of delamination in 27 patients, absence - in 19 patients (20.0%), and insignificant in the form of slight partial delamination in 23 patients (24.7%). As a result of the treatment, it was found that the growth rate of nail plates in patients receiving complex therapy was 1.4 times (0.77±0.02 cm) higher than in patients in the control group, whose average growth rate was 0.53±0.03 cm.

Conclusions: A comprehensive method of treating patients with onychomycosis involving both antifungal agents and agents that improve the structure of the nail plates and accelerate their regrowth provides mycological elimination and a positive clinical outcome in patients: achieving mycological remission at 10-12 weeks in 89.1% of patients with comprehensive treatment, which is 19.5% more than in patients with traditional treatment. The developed method ensures the restoration of the normal structure of the nail plate in 96.8% of patients (respectively, in 81.5% of patients using traditional treatment).