RU2266743C2 - Method for treating onychomycosis cases with combined preparation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering combined medical preparation composed of 0.2 g of nisoral and 0.5 g of aspirin. Finger- or toe-nails are heat treated in hot water containing sodium chloride solved in 10:1 proportion during 20-30 min. Injured nail surface is erased and the preparation is applied. The mixture is covered with gauze napkin matching nail bed in size. Air-tight bandage with adhesive plaster is applied covering also 0.5-1 cm large healthy tissue zone above eponychium. The bandage is taken off 4-5 days later. The procedure is repeated 4 times or less, depending on injury depth.

EFFECT: enhanced effectiveness of treatment; reduced risk of complications and disease recurrence.

2 cl, 2 dwg

Description

The invention relates to medicine, namely to infectious and skin diseases, pharmacology.

Fungal diseases of the nails (onychomycosis) until recently remain one of the most difficult, complex problems of dermatovenereology, not only in the therapeutic, but also in the diagnostic and epidemiological aspects. The active use of antibiotics, a decrease in immunity in immunodeficiency diseases such as AIDS, trypanosomiasis, leishmaniasis, hemorrhagic fevers and other diseases, contribute to the defeat of the nails of the feet and hands of various kinds of fungi, which are highly contagious, virulence, and the ability to cause multiple nail lesions in a relatively short time as hands and feet. Fungal nail lesions are caused, as a rule, by the dermatophytes of the genera: Trichophyron, Microsporum, Epidermophyron floccosum, yeast and yeast-like fungi Candida, Pityrosporum.

The variety of factors that play a role in the pathogenesis of onychomycosis greatly complicates the already great difficulties of their treatment, contribute to the onset, progression and chronic, persistent course of these diseases.

The cost of drugs, contraindications for their use, duration of treatment, treatment inefficiency contribute to the search for both new methods and new combinations for the treatment of onychomycosis.

Treatment of onychomycosis involves the use of antifungal agents of general action, removal of nail plates and local fungicidal therapy.

The prototype of the proposed method, the author considers a method of removing affected nails using keratolytic plasters. // A.N.Rodionov “Handbook of skin and sexually transmitted diseases”, St. Petersburg, 2000, p. 58-59 //.

When removing nails with keratolytic patches, 20% urea (ureaplast) or 10% trichloroacetic patch is used. For the manufacture of patches, 2 g of urea (technical urea can be used) or 10 g of trichloroacetic acid are dissolved in 10 or 15 ml of hot water, respectively, and the resulting solution is poured with continuous stirring into a plaster mass consisting of 45 g of lead patch, 20 g of lanolin and 5 g of beeswax. Before applying the keratolytic patch, a hot soapy soda bath is prescribed and the upper shiny layer of the nail is scraped off with a scalpel or razor blade. A plaster mass is applied to the nail with a thick layer (3-5 mm) and sealed with a sticky adhesive. The patch mass is changed after 4 days 3-4 times, after removing the patch, the nail is removed with nippers or scissors, then local fungicidal therapy is prescribed.

In the final stage, before the nail regrowth, the hyperkeratotic masses appearing on the nail bed should be removed by lubrication with resorptive (5%) - milk-salicy (10%) varnish. The film formed after 4 days of lubrication is removed using a dressing with 20% salicylic ointment. The nail bed is lubricated with fungicidal solutions for 3-4 months until the nails regrowth.

However, surgical treatment, especially with the defeat of several nails in a patient, is reluctantly used by practical doctors. The operation is painful, as a result of this, patients often refuse treatment, in addition, with this method, a significant percentage of relapses is observed. The skin of the nail rollers and the nail skin are not treated, while the fungi present here can also cause the disease.

Currently, the most effective general-acting antimycotic drugs include lamisil, orungal, and nizoral.

As a prototype of a combined drug, the author proposes the treatment of onychomycosis with nizoral (ketoconazole). // M.D. Mashkovsky. "Medicines", fourteenth edition, M.: "New Wave", 2000, S. 359-360 //.

The drug has a fungicidal and fungistatic effect. Active against dermatophytes: Trichophyron, Microsporum, Epidermophyron floccosum, yeast and yeast-like fungi Candida, Pityrosporum.

An important feature of nizoral is its effectiveness when taken orally, because the drug is well absorbed, as well as its effect on both superficial and systemic mycoses. Take orally, 1 time per day with meals. Dose for adults - 0.2 g (1 tablet) until complete recovery (6-12 months), and if, against the background of taking the drug in the specified dose, no significant improvements were noted, then the daily dose is increased to 0.4 g.

However, the drug has only fungicidal and fungistatic action and, in addition, a number of side effects:

- from the central nervous system and peripheral nervous system: headache, dizziness, reversible damage to intracranial pressure;

- from the digestive system - nausea, vomiting, diarrhea;

- from the hemopoietic system - thrombocytopenia;

and contraindications

- pregnancy, breastfeeding,

- impaired liver and kidney function,

- allergic reactions,

- individual intolerance to the drug,

- it is not recommended that the drug be taken at the same time as antacids, anticholinergics, cimetidine and its analogues.

In addition, during treatment, it is necessary to control the blood picture and liver function. Caution should be observed in case of impaired function of the adrenal cortex and pituitary gland.

Fungicidal external agents are also used in the form of solutions, creams, ointments. For external use, nizoral is available in the form of a cream and is applied to the affected and immediately adjacent area 1-2 times a day, depending on the severity of the lesion.

However, local use of the drug is ineffective, and, in addition to the above disadvantages, local erythema, swelling, and burning sensations are possible when using the cream.

For the effective treatment of onychomycosis, the author offers his own method and a combined preparation based on local treatment, with the artificial creation of a moist, sealed environment in the area of the affected nail, saturated with drugs not only fungicidal, but also keratolytic. This method was used to treat 258 patients with onychomycosis of various ages on the territory of states with a tropical and subtropical climate, in Russia and the CIS countries.

The method is as follows.

In the first procedure, the affected nails are steamed for 20-30 minutes in hot water with sodium chloride dissolved in it in a ratio of 10: 1. Scratch the shiny surface of the nail with scissors or a scalpel until the first appearance of pain. A pre-prepared mixture of crushed tablets of nizoral and aspirin is applied to the affected surface (photo No. 1). The powder is covered with a wet gauze towel in sizes corresponding to the size of the nail bed, and hermetically bandaged with a band-aid with a capture of up to 0.5-1 cm of healthy tissues above eponychium (photo No. 2).

At the second visit, after 4-5 days, the bandage with the patch is removed, the affected surface is again steamed for 20-30 minutes, the torn areas of the nail are removed with a scalpel, washed and dried, then the powder is applied again, covered with a damp cloth and bandaged with adhesive tape.

The procedure is repeated until clean, free of affected areas of the nail bed and the appearance of a new nail.

The course of treatment averages 4 procedures, the duration of treatment does not exceed 5-20 days, depending on the depth of the lesion.

The appearance of a healthy nail on the hands occurs within 2-3 months, on the feet - within 6-12 months.

The combined preparation is made from crushed tablets of aspirin (0.5 g) and nizoral (0.2 g). Nizoral is known to have a fungicidal effect. Aspirin in a humid and warm environment releases acetic and salicylic acid, and salicylic acid has keratolytic properties, and acetic acid enhances antifungal effectiveness. The mixture used has both fungicidal and keratolytic properties, while the rate of keratolytic and fungicidal effect is much higher than the growth time of the mycelium and the spread of infection deep into the adjacent tissue of the affected surface.

In addition, aspirin relieves local inflammation, and its analgesic properties allow painless scraping of the affected nail bed.

It is recommended to store the crushed nizoral and aspirin separately, in tightly sealed containers, in a place protected from moisture and light, at room temperature and mix before use.

Instead of nizoral, orungal or lamisil can be used to prepare the combined preparation.

The proposed method and the combined preparation has a number of advantages:

- treatment of all forms of onychomycosis, regardless of the timing of the onset of the disease, the depth of the lesion and the type of infection;

- accessibility for outpatient treatment of patients of any age;

- ease of preparation of the drug;

- reduction of treatment time;

- low cost of treatment (about 300 rubles);

- lack of relapse;

- the possibility of applying the method in children, pregnant women and the elderly;

- treatment without mandatory laboratory control.

Claims (2)

1. The combined preparation for the treatment of onychomycosis, characterized in that it consists of 0.2 g of nizoral and 0.5 g of aspirin. 2. A method of treating onychomycosis, characterized in that for 20-30 minutes, the nails are steamed in hot water with table salt dissolved in it in a ratio of 10: 1, the affected surface of the nail is scraped off, the preparation is applied according to claim 1, the mixture is covered with wet gauze with a towel the size corresponding to the size of the nail bed, hermetically bandaged with a band-aid with a capture of up to 0.5-1 cm of healthy tissues above the eponychium, after 4-5 days the bandage with the band-aid is removed, the procedure is repeated up to 4 times depending on the depth of the lesion.

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