第二代三唑类药物
第二代三唑类药物,例如伏立康唑,具有广谱抗真菌活性,但未获批准用于该适应证,并具有潜在的严重副作用(包括光毒性和皮肤癌)。只有在特比萘芬无效时才应考虑使用泊沙康唑。[36]Zhang AY, Camp WL, Elewski BE. Advances in topical and systemic antifungals. Dermatol Clin. 2007;25:165-183.http://www.ncbi.nlm.nih.gov/pubmed/17430754?tool=bestpractice.com[37]Elewski B, Pollak R, Ashton S, et al. A randomized, placebo- and active-controlled, parallel-group, multicentre, investigator-blinded study of four treatment regimens of posaconazole in adults with toenail onychomycosis. Br J Dermatol. 2012;166:389-398.http://www.ncbi.nlm.nih.gov/pubmed/21967490?tool=bestpractice.com[38]Elewski B, Pariser D, Rich P, et al. Current and emerging options in the treatment of onychomycosis. Semin Cutan Med Surg. 2013;32(suppl 1):S9-S12.http://www.ncbi.nlm.nih.gov/pubmed/24156162?tool=bestpractice.com
药物新剂型和给药方式
有研究显示新的给药方式或可增加甲癣治愈率。例如环吡趾甲油的水溶性生物聚合物较8%环吡趾甲油更亲和角蛋白,可渗透指甲,更好用。[26]Baran R, Tosti A, Hartmane I, et al. An innovative water-soluble biopolymer improves efficacy of ciclopirox nail lacquer in the management of onychomycosis. J Eur Acad Dermatol Venereol. 2009;23:773-781.http://www.ncbi.nlm.nih.gov/pubmed/19453778?tool=bestpractice.com
臭氧化油
已有研究证明葵花臭氧化油(用臭氧处理的过氧化向日葵油混合物)局部应用对甲癣有效。[39]Menéndez S, Falcón L, Maqueira Y. Therapeutic efficacy of topical OLEOZON® in patients suffering from onychomycosis. Mycoses. 2011;54:e272-e277.http://www.ncbi.nlm.nih.gov/pubmed/20492527?tool=bestpractice.com
新的治疗模式
其他治疗方法正在研究当中,包括激光疗法(870 nm 和 930 nm 激光)、热激光疗法和光动力疗法,[40]Mordon SR, Betrouni N, Trelles MA, et al. New treatment options for onychomycosis. J Cosmet Laser Ther. 2014;16:306-310.http://www.ncbi.nlm.nih.gov/pubmed/25148411?tool=bestpractice.com以及新型复方局部用治疗方案(丙二醇、尿素和乳酸)。这些新的治疗方法有望成为未来的替代疗法和/或辅助疗法。[41]Landsman AS, Robbins AH. Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure: some follow-up observations at 270 days. J Am Podiatr Med Assoc. 2012;102:169-171.http://www.ncbi.nlm.nih.gov/pubmed/22461276?tool=bestpractice.com[42]Emtestam L, Kaaman T, Rensfeldt K. Treatment of distal subungual onychomycosis with a topical preparation of urea, propylene glycol and lactic acid: results of a 24-week, double-blind, placebo-controlled study. Mycoses. 2012;55:532-540.http://www.ncbi.nlm.nih.gov/pubmed/22681227?tool=bestpractice.com
新的局部给药方式
新的给药方式包括:脂质体、囊泡、固体脂质纳米粒、纳米结构脂质体、银纳米粒子、微乳液和液晶。但需要更多研究以评价其有效性。[43]Ribeiro de Souza AL, Kiill CP, Kolenyak dos Santos FK, et al. Nanotechnology-based Drug Delivery Systems for Dermatomycosis Treatment. Curr Nanosci. 2012;8:512-519.