Kombinationstherapie von schweren Onychomykosen – Empfehlungen eines Expertengremiums

Zusammenfassung

Onychomykosen sind schwer behandelbare Pilzinfektionen des Nagelorgans mit einer hohen Rezidivrate. Klinische Studien zeigen, dass bei gesicherter schwerer Nagelmykose durch Dermatophyten eine Steigerung der kompletten Heilungsrate (mykologisch plus klinisch) durch eine Kombinationsbehandlung mit lokal applizierten und oral verabreichten Antimykotika im Vergleich zur systemischen Monotherapie erreicht werden kann. Am besten untersucht sind Regime mit kontinuierlich täglicher Einnahme von Terbinafin und wöchentlicher Applikation eines Amorolfin-haltigen Nagellacks. Eine topische Monotherapie mit einem Nagellack kommt v. a. bei einer superfiziellen weißen Onychomykose (SWO) oder einer distal-subungualen Onychomykose (DSO) mit einem geringeren Befallsgrad ohne Beteiligung der Matrix infrage. Die mechanische Entfernung des infizierten Nagelmaterials und hygienische Maßnahmen unterstützen die Therapie. Kritisch für die Erfolgsaussichten ist eine hohe Langzeitadhärenz der Patienten. Die Therapie sollte bis zum Auftreten der Erscheinungsfreiheit andauern. Anschließend empfiehlt sich eine dauerhafte Rezidivprophylaxe mit antimykotischem Nagellack.

Abstract

Onychomycoses are difficult-to-treat infections of the nail plate with a high recurrence rate. Clinical studies show an increase of the complete cure rate (mycological plus clinical) of severe onychomycoses for documented dermatophytic onychomycoses with combination therapies of locally applied and orally administered antifungals. The best studied regimens involve continuous daily use of terbinafine and weekly application of amorolfine nail lacquer. A topical monotherapy with a nail varnish may be considered especially for superficial white onychomycosis or distal subungual onychomycosis with a lower percentage of affected nail area without involvement of the nail matrix. Repeated mechanical removal of infected nail material and hygienic measures support the efficacy of the treatment. High long-term adherence is critical for optimal success rates. The treatment should be continued until resolution of signs and symptoms. Subsequent long-term secondary prophylaxis with an antifungal nail lacquer is recommended.

• Literatur

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