| Background:Onychomycosis is one chronic infectious disease of finger/toe nails that caused by dermatophytes,non-dermatophyte and yeasts.It involves nail bed,deck and tissues around nail,which is high incidence and difficult to cure,easy to recure.The Pathogenic dermatophytes are the most commonly,such as:the Trichophyton rubrum and the Trichophyton mentagrophytes(90%[1]),and the next are the Candida and non-dermatophyte filamentous fungi.Its asymptomatic on its earlier stage and mainly influence is on the appearance.The nail bed will deform along with the processing,in the case of severe infection,it will affect the patient's daily activities[2],at the same time,it will have a negative impact on the patient's mental and emotional state,social activities and family activities[3-6].There are certain estimation standards and treatments in medical community for many dermatological diseases such as the Atopic dermatitis and the Psoriasis etc.However onychomycosis yet has no any standards to estimate effectively,provide a reasonable treatment choice,evaluate the course of treatment,and judge the prognosis in the world.The OSI system is very convenient for clinical doctors in daily treatment,but its lack on prescription advise.The Itraconazole intermittent shock therapy has decreased the rate of adverse drug reactions than the Continuous treatment with Terbinafine[7],also increased the rate of patients'compliance.Therefore,in order to clarify the clinical efficacy and mycological efficacy of the OSI scoring system in guiding itraconazole in the treatment of onychomycosis,we conducted a clinical study.Objective:To explore the applicability of the OSI scoring system to guide the treatment of different courses of itraconazole in the treatment of distal lateral subgrade onychomycosis of different severity.Methods:Patients with a diagnosis of Distal and Lateral subungual onychomycosis?DLSO?from April 2018 to January 2019 were selected.They were 18 to 60 years old,regardless of gender.The positive direct microscopy and/or fungal culture,who are willing to participate and can be followed up on time;also have no history of allergy to azoles,no external using antifungal drugs within 1 month and no oral antifungal drugs within 6 months.The clinical score index?SCIO?and severity index of onychomycosis?OSI?were performed on the collected patients,grade the most serious nail according to the severity of OSI scoring system.Patients in the treatment group were given Itraconazole?SPORANOX??intermittent impact therapy in mild,moderate and severe cases:2 courses,3 courses,and 4 courses,control group intermittent impact therapy for4 courses.All the data before and after the treatment?especially 24&48 weeks after the treatment?were recorded for clinical score changes and mycological clearance rate?including adverse reaction?.Results:A total of 136 patients with Distal and Lateral subungual onychomycosis were collected and 114 patients completed treatment and follow-up,the patients'age between21 to 60,54 cases of male and 60 female.In 114 patients,97 cases?85.09%?were positive for direct fungal microscopy before treatment,and 86 cases?75.44%?were positive for fungal culture,including 74 cases of Trichophyton rubrum?86.05%?,7cases of Trichophyton violaceum?8.14%?,4 cases of Trichophyton mentagrophytes?4.65%?,and 1 case of yeast?1.16%?.The nails were classified according to the OSI scoring system:mild 40 cases?35.09%?,moderate 42 cases?36.84%?,severe 32 cases?28.07%?.The treatment group 74 cases?64.91%?,of which mild 20 Cases?27.03%?,moderate 22?29.73%?,severe 32?43.24%?;the control group 40?35.09%?,of which mild 20?50.00%?,moderate 20?50.00%?.There was no significant statistical difference in OSI score and SCIO score between the treatment group and the control group before treatment?P>0.05?.At the end of treatment,the clinical effective rate of the treatment group mild/moderate/severe patients were 6 cases?30.00%?/8 cases?36.36%?/12 cases?37.50%?in the treatment group,and the mild and moderate in the control group were 10 cases?50.00%?/9 cases?45.00%?.24 weeks after the treatment,the clinical effective rate of the treatment group mild/moderate/severe patients were 15 cases?75.00%?/15 cases?68.18%?/20 cases?62.50%?,while the clinical effective rate of the control group mild/moderate patients were 17 cases?85.00%?/15 cases?75.00%?.48 weeks after the treatment,the clinical effective rate of the treatment group mild/moderate/severe patients were 18 cases?90.00%?/18 cases?81.82%?/24 cases?75.00%?,and the clinical effective rate of the control group mild/moderate patients were 19 cases?95.00%?/18 cases?90.00%?,at the same time,the clinical effective rate of severe patients was lower than that of mild and moderate patients.24 weeks after the treatment,the mycological clearance effect of the treatment group mild/moderate/severe patients were 13 cases?65.00%?/16 cases?72.73%?/23 cases?71.87%?,the mycological clearance effect of the control group mild/moderate patients were 16 cases?80.00%?/15 cases?75.00%?.48 weeks after the treatment,the mycological clearance effect of the treatment group mild/moderate/severe patients were 15 cases?75.00%?/15 cases?68.18%?/20 cases?62.50%?,the mycological clearance effect of the control group mild/moderate patients were 17 cases?85.00%?/16 cases?80.00%?,recurrence in patients with dermatophytoma or hyperkeratosis.There were no statistical differences in clinical effect and mycological clearance between the treatment group and the control group at different time periods?P>0.05?,and there was no statistical difference between the severe and the treatment groups in light and moderate?P>0.05?.The clinical effectiveness of patients in the light,moderate,and severe groups in the treatment group was statistically different at the end of treatment,at 24 weeks after the treatment,and at 48 weeks after the treatment?P<0.05?.There were no statistical differences in clinical effect between 24 weeks after the treatment with 48 weeks after the treatment?P>0.05?.The patients with dermatophytoma or hyperkeratosis mainly focus on severe group about 24 cases?92.31%?,the clinical effective rate of the treatment group at the end of treatment,24 weeks after treatment,and 48 weeks after treatment were 6 cases?18.75%?/12 cases?46.15%?/16 cases?61.54%?.The mycological clearance effect of the treatment group at 24 weeks after treatment,48 weeks after treatment were 18 cases?69.23%?/14 cases?53.85%?.The clinical effect was not statistically different between the end of treatment with 24 weeks after treatment?P>0.05?,statistically different at the end of treatment and 48 weeks after treatment?P<0.05?.The clinical effect and the mycological clearance effect were not statistically different at the end of 24 weeks and48 weeks of treatment?P>0.05?.Also during the treatment there was 1 case of liver enzyme abnormality appeared,1 case of thirst and constipation,2 cases of mild gastrointestinal discomfort,and all returned to normal after drug withdrawal.Conclusion:The OSI scoring system guides itraconazole intermittent shock therapy for 2,3,and 4 courses of treatment for mild,moderate,and severe distal lateral subgrade onychomycosis,which is instructive and worthy of clinical promotion. |
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