ririРаны и раневые инфекции. Журнал имени проф. Б.М. КостючёнкаWounds and wound infections. The prof. B.M. Kostyuchenok journal2408-96132500-0594Regional non-governmental organization “Surgical society - Wounds and wound infections”10.17650/2408-9613-2015-2-2-17-23riri-3Research ArticleОБЗОРЫ, ЛЕКЦИИ, ИСТОРИЯ РАН И РАНЕВЫХ ИНФЕКЦИЙREVIEWS, LECTURES, HISTORY OF WOUNDS AND WOUND INFECTIONSОНИХОМИКОЗЫ: ВЗГЛЯД ДЕРМАТОЛОГА И ХИРУРГАONYCHOMYCOSES: THE VIEWS OF A DERMATOLOGIST AND A SURGEONБуроваС. А.BurovaS. A.doctorburova@mail.ruПривольневВ. В.PrivolnevV. V.

кафедра общей хирургии с курсом хирургии факультета повышения квалификации и профессиональной переподготовки специалистов

Department of General Surgery with Course of Surgery, Faculty for Advanced Training and Professional Retraining of Specialists

ГБУЗ г. Москвы «Московский научно-практический центр дерматовенерологии и косметологии Департамента здравоохранения г. Москвы»РоссияMoscow Research-and-Practical Center for Dermatovenereology and Cosmetology, Moscow Healthcare Department;Russian FederationГБОУ ВПО «Смоленский государственный медицинский университет» Минздрава РоссииРоссияSmolensk State Medical University, Ministry of Health of RussiaRussian Federation201516122015221723Copyright © Бурова С.А., Привольнев В.В., 20152015Бурова С.А., Привольнев В.В.Burova S.A., Privolnev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.riri.su/jour/article/view/3

В статье обобщены данные литературы и собственного клинического опыта по распространенности онихомикозов в мире, их этиологии, клинике и лечению. Описаны критерии для системной и местной терапии онихомикозов, методы удаления ногтевых пластин (показания, противопоказания и осложнения) с точки зрения дерматолога и хирурга. Приведена современная концепция лечения онихомикозов с использованием местного антимикотика нафтифина и аппаратного удаления ногтя.

The paper summarizes the data available in the literature on the prevalence of onychomycoses worldwide, their etiology, clinical presentation, and treatment and the authors’ clinical experience. It presents criteria for the systemic and local therapy of onychomycoses and describes nail plate removal methods (indications, contraindications, and complications) in the view of a dermatologist and a surgeon. The current concept of onychomycosis treatment with the local antimycotic naftifine and nail apparatus removal is given.

онихомикозысистемное лечениеместное лечениенафтифинметоды удаления ногтевых пластинсовременная концепция лечения онихомикозовonychomycosessystemic treatmentlocal treatmentnaftifinenail plate removal methodscurrent concept of onychomycosis treatmentReferencesСергеев А.Ю., Сергеев Ю.В. Онихомикозы и современная дерматология: медико-социальные аспекты. В кн.: Успехи медицинской микологии. Т. 10. М., 2007. С. 15–6. [Sergeev А.Yu., Sergeev Yu.V. Оnychomycosis and modern dermatology: medical and social aspects. In: Successes of medical micology. Vol. 10. Мoscow, 2007. Pp. 15–6. (In Russ.)].Сергеев А.Ю., Сергеев Ю.В. Онихомикозы и современная дерматология: медико-социальные аспекты. В кн.: Успехи медицинской микологии. Т. 10. М., 2007. С. 15–6. [Sergeev А.Yu., Sergeev Yu.V. Оnychomycosis and modern dermatology: medical and social aspects. In: Successes of medical micology. Vol. 10. Мoscow, 2007. Pp. 15–6. (In Russ.)].Thomas J., Jacobson G.A., Narkowicz C.K. et al. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 2010;35(5):497–519.Thomas J., Jacobson G.A., Narkowicz C.K. et al. Toenail onychomycosis: an important global disease burden. J Clin Pharm Ther 2010;35(5):497–519.Бурова С.А. Особенности лечения грибковых инфекций кожи и ее придатков в группах риска. Клиническая дерматология и венерология 2014;1:42–6. [Burovа S.А. Peculiarities of treatment of mycotic infections of the skin and cutaneous appendages in high-risk groups. Klinicheskaya dermatologiyaБурова С.А. Особенности лечения грибковых инфекций кожи и ее придатков в группах риска. Клиническая дерматология и венерология 2014;1:42–6. [Burovа S.А. Peculiarities of treatment of mycotic infections of the skin and cutaneous appendages in high-risk groups. Klinicheskaya dermatologiyai venerologiya = Clinical Dermatology and Venerology 2014;1:42–6. (In Russ.)].i venerologiya = Clinical Dermatology and Venerology 2014;1:42–6. (In Russ.)].Szepietowski J. et al. 6th Congress of ECMM 2000; Abstr. P7-005.Szepietowski J. et al. 6th Congress of ECMM 2000; Abstr. P7-005.Anaissie E., McGinnis M., Pfaller M. Clinical mycology. Churchill Livingstone, 2003.Anaissie E., McGinnis M., Pfaller M. Clinical mycology. Churchill Livingstone, 2003.Tchernev G., Penev P.K., Nenoff P. et al. Onychomycosis: modern diagnostic and treatment approaches. Wien Med Wochenschr 2013;163(1–2):1–12.Tchernev G., Penev P.K., Nenoff P. et al. Onychomycosis: modern diagnostic and treatment approaches. Wien Med Wochenschr 2013;163(1–2):1–12.Сергеев А.Ю., Сергеев Ю.В. Новые концепции патогенеза диагностики и терапии онихомикозов. Иммунология. Аллергология. Инфектология 2007;3:8–10. [Sergeev А.Yu., Sergeev Yu.V. New conceptsСергеев А.Ю., Сергеев Ю.В. Новые концепции патогенеза диагностики и терапии онихомикозов. Иммунология. Аллергология. Инфектология 2007;3:8–10. [Sergeev А.Yu., Sergeev Yu.V. New conceptsof diagnostics pathogenesis and onychomycosis therapy. Immunologiya. Аllergologiya. Infectologiya = Immunology. Аllergology. Infectology 2007;3:8–10. (In Russ.)].of diagnostics pathogenesis and onychomycosis therapy. Immunologiya. Аllergologiya. Infectologiya = Immunology. Аllergology. Infectology 2007;3:8–10. (In Russ.)].Жукова О.В. Современные методы наружной терапии онихомикозов. Клиническая дерматология и венерология 2012;5(1):1–3. [Zhukova О.V. Modern methods of the external therapy of onychomycosis. Klinicheskaya dermatologiya i venerologiya = Clinical Dermatology and Venerology 2012;5(1): 1–3. (In Russ.)].Жукова О.В. Современные методы наружной терапии онихомикозов. Клиническая дерматология и венерология 2012;5(1):1–3. [Zhukova О.V. Modern methods of the external therapy of onychomycosis. Klinicheskaya dermatologiya i venerologiya = Clinical Dermatology and Venerology 2012;5(1): 1–3. (In Russ.)].Ameen M., Lear J.T., Madan V. et al. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171(5):937–58.Ameen M., Lear J.T., Madan V. et al. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171(5):937–58.Lai W.Y., Tang W.Y., Loo S.K., Chan Y. Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails. Hong Kong Med J 2011;17(2):127–31.Lai W.Y., Tang W.Y., Loo S.K., Chan Y. Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails. Hong Kong Med J 2011;17(2):127–31.Song M., Ko H.C., Kwon K.S., Kim M.B. Surgical treatment of subungual glomus tumor: а unique and simple method. Dermatol Surg 2009;35(5):786–91.Song M., Ko H.C., Kwon K.S., Kim M.B. Surgical treatment of subungual glomus tumor: а unique and simple method. Dermatol Surg 2009;35(5):786–91.Ghaffarpour G., Tabaie S.M., Ghaffarpour G. A new surgical technique for the correction of pincer-nail deformity: сombination of splint and nail bed cutting. Dermatol Surg 2010;36(12):2037–41.Ghaffarpour G., Tabaie S.M., Ghaffarpour G. A new surgical technique for the correction of pincer-nail deformity: сombination of splint and nail bed cutting. Dermatol Surg 2010;36(12):2037–41.Гаин Ю.М., Богдан В.Г., Попков О.В., Алексеев С.А. Хирургия вросшего ногтя. Минск, 2007. 224 с. [Gain Yu.М., Bogdan V.G., Popkov О.V., Аlexeev S.А. Ingrown nail surgery. Мinsk, 2007. 224 p. (In Russ.)].Гаин Ю.М., Богдан В.Г., Попков О.В., Алексеев С.А. Хирургия вросшего ногтя. Минск, 2007. 224 с. [Gain Yu.М., Bogdan V.G., Popkov О.V., Аlexeev S.А. Ingrown nail surgery. Мinsk, 2007. 224 p. (In Russ.)].Shaikh F.M., Jafri M., Giri S.K., Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. J Am Podiatr Med Assoc 2008;98(2):118–22.Shaikh F.M., Jafri M., Giri S.K., Keane R. Efficacy of wedge resection with phenolization in the treatment of ingrowing toenails. J Am Podiatr Med Assoc 2008;98(2):118–22.Сергеев Ю.В., Сергеев А.Ю. Онихомикозы. Грибковые инфекции ногтей. М.: ГЭОТАР медицина, 1988. 126 с. [Sergeev Yu.V., Sergeev А.Yu. Оnychomycosis. Mycotic infections of nails. Мoscow: GEOTAR Medicine, 1988. 126 p. (In Russ.)].Сергеев Ю.В., Сергеев А.Ю. Онихомикозы. Грибковые инфекции ногтей. М.: ГЭОТАР медицина, 1988. 126 с. [Sergeev Yu.V., Sergeev А.Yu. Оnychomycosis. Mycotic infections of nails. Мoscow: GEOTAR Medicine, 1988. 126 p. (In Russ.)].Collins S.C., Cordova K., Jellinek N.J. Alternatives to complete nail plate avulsion. J Am Acad Dermatol 2008;59(4):619–26.Collins S.C., Cordova K., Jellinek N.J. Alternatives to complete nail plate avulsion. J Am Acad Dermatol 2008;59(4):619–26.Tatlican S., Eren C., Yamangokturk B. et al. Chemical matricectomy with 10 % sodium hydroxide for the treatment of ingrown toenails in people with diabetes. Dermatol Surg 2010;36(2):219–22.Tatlican S., Eren C., Yamangokturk B. et al. Chemical matricectomy with 10 % sodium hydroxide for the treatment of ingrown toenails in people with diabetes. Dermatol Surg 2010;36(2):219–22.Tatlican S., Yamangöktürk B., Eren C. et al. Comparison of phenol applications of different durations for the cauterization of the germinal matrix: аn efficacy and safety study. Acta Orthop Traumatol Turc 2009;43(4): 298–302.Tatlican S., Yamangöktürk B., Eren C. et al. Comparison of phenol applications of different durations for the cauterization of the germinal matrix: аn efficacy and safety study. Acta Orthop Traumatol Turc 2009;43(4): 298–302.Grover C., Bansal S., Nanda S. et al. Combination of surgical avulsion and topical therapy for single nail onychomycosis: а randomized controlled trial. Br J Dermatol 2007;157(2):364–68.Grover C., Bansal S., Nanda S. et al. Combination of surgical avulsion and topical therapy for single nail onychomycosis: а randomized controlled trial. Br J Dermatol 2007;157(2):364–68.Malay D.S., Yi S., Borowsky P. et al. Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial. J Foot Ankle Surg 2009;48(3):294–308.Malay D.S., Yi S., Borowsky P. et al. Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial. J Foot Ankle Surg 2009;48(3):294–308.Becerro de Bengoa Vallejo R., Losa Iglesias M.E., Cervera L.A. et al. EfficacyBecerro de Bengoa Vallejo R., Losa Iglesias M.E., Cervera L.A. et al. Efficacyof intraoperative surgical irrigation with polihexanide and nitrofurazone in reducing bacterial load after nail removal surgery. J Am Acad Dermatol 2011;64(2):328–35.of intraoperative surgical irrigation with polihexanide and nitrofurazone in reducing bacterial load after nail removal surgery. J Am Acad Dermatol 2011;64(2):328–35.Sotiriou E., Koussidou-Eremonti T., Chaidemenos G. et al. PhotodynamicSotiriou E., Koussidou-Eremonti T., Chaidemenos G. et al. Photodynamictherapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: preliminary results of a single-centre open trial. Acta Derm Venereol 2010;90(2):216–7.therapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: preliminary results of a single-centre open trial. Acta Derm Venereol 2010;90(2):216–7.Hochman L.G. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther 2011;13(1):2–5.Hochman L.G. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther 2011;13(1):2–5.Moossavi M., Scher R.K. Complications of nail surgery: а review of the literature. Dermatol Surg 2001;27(3):225–8.Moossavi M., Scher R.K. Complications of nail surgery: а review of the literature. Dermatol Surg 2001;27(3):225–8.Привольнев В.В., Решедько Г.К., Савкин В.А., Кречикова О.И. Структура возбудителей и их антибиотикорезистентность при инфекциях нижних конечностей у больных сахарным диабетом. Клиническая микробиология и антимикробная химиотерапия 2009;11(1):86–9. [Privolnev V.V., Reshedko G.K., Savkin V.А., Krechikova О.I. Structure of infectious organisms and their resistance to antibiotics at infections of lower extremities at patients with diabetes mellitus. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy 2009;11(1):86–9. (In Russ.)].Привольнев В.В., Решедько Г.К., Савкин В.А., Кречикова О.И. Структура возбудителей и их антибиотикорезистентность при инфекциях нижних конечностей у больных сахарным диабетом. Клиническая микробиология и антимикробная химиотерапия 2009;11(1):86–9. [Privolnev V.V., Reshedko G.K., Savkin V.А., Krechikova О.I. Structure of infectious organisms and their resistance to antibiotics at infections of lower extremities at patients with diabetes mellitus. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya = Clinical Microbiology and Antimicrobial Chemotherapy 2009;11(1):86–9. (In Russ.)].Häfner H.M., Schmid U., Moehrle M. et al. Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: а double-blind, randomized, placebo-controlled study. Clin Hemorheol Microcirc 2008;38(4):279–88.Häfner H.M., Schmid U., Moehrle M. et al. Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: а double-blind, randomized, placebo-controlled study. Clin Hemorheol Microcirc 2008;38(4):279–88.Monk J.P., Brogden R.N. Naftifine. A review of it santimicrobial activity and therapeutic use in superficial dermatomycoses. Drugs 1991;42(4):659–72.Monk J.P., Brogden R.N. Naftifine. A review of it santimicrobial activity and therapeutic use in superficial dermatomycoses. Drugs 1991;42(4):659–72.Verma A. Naftifine demonstrates potent fungicidal activity against the most common dermatophyte species with no evidenceVerma A. Naftifine demonstrates potent fungicidal activity against the most common dermatophyte species with no evidenceof resistance. J Am Acad Dermatol 2012; 66(4 Suppl 1):AB119.of resistance. J Am Acad Dermatol 2012; 66(4 Suppl 1):AB119.Сергеев Ю.В., Мокина Е.В., Чернявская М.Г. и др. ПроблемыСергеев Ю.В., Мокина Е.В., Чернявская М.Г. и др. Проблемыи перспективы терапии и профилактики микозов стоп и онихомикозов. Русский медицинский журнал 2004;12(18):3–9. [Sergeev Yu.V., Моkina Е.V., Chernyavskaya М.G. et al. Problems and prospects of therapy and prophylacticsи перспективы терапии и профилактики микозов стоп и онихомикозов. Русский медицинский журнал 2004;12(18):3–9. [Sergeev Yu.V., Моkina Е.V., Chernyavskaya М.G. et al. Problems and prospects of therapy and prophylacticsof feet mycosis and onychomycosis. Rossiyskiy meditsinskiy zhurnal = Russian Medical Journal 2004;12(18):3–9.of feet mycosis and onychomycosis. Rossiyskiy meditsinskiy zhurnal = Russian Medical Journal 2004;12(18):3–9.(In Russ.)].(In Russ.)].Бурова С.А. Опыт лечения онихомикозов кистей и стоп местными антимикотиками. Consilium medicum. Дерматология 2015;(1 Прил):12–5. [Burova S.А. Experience of treatment of onychomycosis of hands and feet with antimycotic agents. Consilium Medicum. Dermatologiya = Dermatology 2015;(1 Suppl):12–5. (In Russ.)].Бурова С.А. Опыт лечения онихомикозов кистей и стоп местными антимикотиками. Consilium medicum. Дерматология 2015;(1 Прил):12–5. [Burova S.А. Experience of treatment of onychomycosis of hands and feet with antimycotic agents. Consilium Medicum. Dermatologiya = Dermatology 2015;(1 Suppl):12–5. (In Russ.)].

The authors declare that there are no conflicts of interest present.