Abstract
Background
Antifungal agents are beneficial in the treatment of onychomycosis in the general population, as well as in children, the elderly, and immunocompromised individuals. Special patient populations can be more difficult to treat due to such factors as drug interactions with concomitant medications, adverse events, and poor compliance. In addition, there is limited information about the use of antifungal agents in special populations, e.g., children.
Objective
The pros and cons of oral and topical antifungal agents are discussed, with focus on special patient populations.
Methods
We searched MedLine (1966 to April 2003) for clinical studies evaluating the efficacy of oral and topical antifungal agents to treat onychomycosis. The key words used in conjunction with “onychomycosis” include: “terbinafine,” “itraconazole,” “fluconazole,” “amorolfine nail lacquer,” “ciclopirox nail lacquer,” “HIV,” “transplant patients,” “diabetes,” “children,” and “elderly.” Studies were excluded if published in a language other than English.
Results
Studies have shown that antifungal agents can be of benefit in treating the elderly, children, and immunocompromised individuals (e.g., transplant patients, Down’s patients, HIV patients, and diabetics) with onychomycosis.
Conclusion
The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.
Sommaire
Antécédents
Les avantages des antifongiques dans le traitement de l’onychomycose sont prouvés chez la population en général, mais surtout dans le cas des enfants, des aînés et des personnes immunocompromises. Le traitement des groupes de patients présentant des cas particuliers peut s’avérer plus difficile en raison de facteurs tels que l’interaction des médicaments, les événements indésirables et le manque de conformité au traitement. De plus, les données sur l’utilisation des antifongiques par des groupes particuliers, tels que les enfants, sont limitées.
Objectif
Les avantages et les inconvénients des antifongiques topiques et oraux seront discutés. Une attention particulière sera prêtée à leur usage par les groupes particuliers.
Méthode
Nous avons effectué des recherches dans MedLine (de 1966 jusqu’en avril 2003) sur les études cliniques qui évaluent l’efficacité des antifongiques oraux et topiques dans le traitement des onychomycoses. Les termes clés utilisés en cooccurrence avec «onychomycosis» étaient:«terbinafine», «itraconazole», «fluconazole», «amorolfine nail lacquer», «ciclopirox nail lacquer», «HIV», «transplant patients», «diabetes», «children» et «elderly». Les études publiées dans une langue autre que l’anglais étaient exclues.
Résultats
Les études ont montré l’avantage des antifongiques dans le traitement des aînés, des enfants et des personnes immunocompromises (p. ex., les patients ayant reçu une transplantation, les patients atteints de trisomie 21, les patients atteint du VIH et les diabétiques) présentant des onychomycoses.
Conclusion
Avant d’entamer un traitement antifongique des onychomycoses chez les groupes de patients particuliers, il faut tenir compte de la présentation clinique de l’onychomycose, de l’organisme causal, de la préférence du patient et du médecin traitant, des médicaments pris en même temps et de la possibilité d’événements indésirables.
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Gupta, A.K., Ryder, J.E. & Skinner, A.R. Treatment of Onychomycosis: Pros and Cons of Antifungal Agents. JCMS 8, 25–30 (2004). https://doi.org/10.1007/s10227-003-0109-x
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DOI: https://doi.org/10.1007/s10227-003-0109-x