From concept to practice, treatment of nail fungal disease is a reasonable

Nail fungus disease is a contagious disease, is beyond reproach, they
shall immediately conduct an appropriate medical treatment. As
It is a world-wide high incidence and high-epidemic diseases, and thus
have public health concerns. True
Vegetative bacteria spread to others a great possibility, but also
possible complications, including generalized dermatophytes
Infection [1,2]. In addition, the nail fungus is not a single disease
[3], in China and other parts of the world,
There is sufficient evidence that a number of dermatophytes, yeasts
and other fungi may be a separate violation of, or joint participation
in pathology
Guo
Cheng [3-12]. In fact the different nail fungal disease pathogens may
be related to the following circumstances. Once the pathogen
Bacteria invade the deck, in a way to escape a natural anti-bacterial
defense and immune surveillance. This situation with the intrusion
Stratum corneum is different from the skin, it has been the host of
antibacterial proteins and for the eradication of fungi in small local
inflammation
Cellular effects.
Fungal culture, histopathology, immunohistochemistry and flow
cytometry is used to identify a common nail fungal diseases of
different
Bacteria [4-6,13]. In Europe, the nail fungus disease is about 75% of
pathogenic dermatophytes, yeasts, and other sp
10% of all bacteria. In addition, two or more kinds of fungi mixed
infection, accounting for only 5% of nail mycosis. A true
Pathogenic bacteria of different diseases, for treatment is a great
challenge, choose the broad-spectrum antifungal itraconazole is
Attractive. In addition, the drug can rapidly penetrate the deck and
can persist in the A of [14].
1, in vitro drug sensitivity test
Antifungal agents in vitro test can first determine the antibacterial
spectrum [15]. In the literature there are various ways to deal with
drug
The proliferation of materials in some media with limited capacity
within the technical difficulties. If they can not properly explain,
for the information and explanations can be produced
Health prejudice.
The current approach is to measure the drug can inhibit fungal growth
and minimal inhibitory concentration (MIC), There is also measured
Minimal bactericidal concentration (MFC) the ability to [16]. MFC of a
fungus and is very close to MIC, the drug has been called
Bactericidal drug for the right bacteria, when the two values is
obviously not in the same time, use the word bacteria.
Used to directly infer the concept of bacteriostatic bactericidal nail
fungus disease of the body can produce the wrong impression. Vitro
Bacterial activity and clinical efficacy is not always coincide.
Laboratory testing is only to assess the efficacy of fungal cell
growth phase
Fruit. Fungi in the body are very different situations, especially in
the A, scalp, palm, plantar fungal disease fungus,
In these areas the growth of mycelium, usually accompanied by joint
spores and other resting cells. After two kinds of cells are
On behalf of any antifungal agents is very sensitive. They almost
always appear in the dermatophytes and other fungal infections of the
deck
China, which explains why in vitro is a bactericidal drug, while in
the body does not show this effect. So
The concept of fungicides has become inconsistent with clinical
practice. Therefore, the need for a better way to detect the in vivo
anti-truth
Bacteria drug efficacy. Determination of biological analysis horny
fungi, hoping to solve this problem [17].
Second, in vitro determination of horny fungal bio-analysis
Using cyanoacrylate skin surface stripping method
(cyanoacrylateskinsurfacestripping, CSS
S) removed from the normal skin stratum corneum [17], use this sample
as a substrate, in vitro will choose the true
The growth of pathogenic bacteria on top. In short, from the beginning
of the medium sand castle on behalf of the culture collection of
conidia, inoculum
In the CSSS central, placed in a wet environment, the temperature
inside train 10d. At this point, the gradual growth of fungi, and the
horny
Layer form a mycelium.
Horny fungi assay used to compare itraconazole (Sporanox, Dr YEUNG
Sum) and terbinafine (Lamisil,
Novartis) is effective [18]. And to explore the pharmacokinetics and
pharmacodynamics of certain aspects. Of dermatophytes experiments,
A few days after oral administration of the two drugs showed the same
effect. Horny fungi assay for Candida albicans and several other
fungi, significantly
Itraconazole has shown anti-fungal toxicity of these [18,19]. This
proves that horny measurement meter is detecting fungal oral
anti-truth
Bacteria drugs on pharmacokinetics and pharmacodynamics of a very good
indication.
Third, in vivo clinical study
Many clinical studies evaluated the itraconazole month 1 week 400mg /
d of intermittent treatment and the impact of treatment programs
Effect [3,20-24], by meta-analysis (Meta � analysis), the cure rate of
up to 75% [23]. Recently
China's studies are almost similar with the nail fungus disease, 89%
clinical cure rate of fingernails, toenails was 74% [25].
Around the world about the application of itraconazole, mostly
controlled study, has more than 5 million people, and certainly the
Itraconazole security. The interaction of drugs to determine their
metabolism related to cytochrome P
450CPY3A4 enzyme.
After 6 months of treatment Mycological cure the failure of refractory
cases, the proposed increase of 1-week itraconazole shocks, that is,
An enhanced oral antifungal treatment (boostedoral antifungal therapy,
BOAT) [26]
. BOAT occur within the deck against the propagation of fungal resting
bodies (spores and spores) of a treatment. And
Compared to the growth of mycelium, which breed in any body on the
current effectiveness of antifungal agents are extremely poor. BOAT in
the oral
Itraconazole plus a sand castle when the medium on the A on the
disease, dormant fungal cells stimulated by the sand castle medium
composition
Be transformed into a mycelium, fungal cells in these growing season
the role of itraconazole is more sensitive [27].
4 Conclusion
In vitro evaluation of antifungal efficacy can not be extended without
reservation to the body. When the treatment of fungal nail disease
When, and not related to the concept of killing fungi. This is also an
evidence of why the nature of using a fungicide resistance
Fungal drugs, you need to continuously take several months. The
reality is that fungi have different degrees of anti-fungal toxicity,
according to real
The nature of bacteria and fungi growth and the biological
characteristics of quiescent cells determined. Whether A is the
primary fungal pathogen
, Or opportunistic pathogen, should be removed [27].
Itraconazole intermittent pulse therapy, and its nails against
refractory mycosis BOAT methods of treatment for the treatment of a
true
Bacterial disease a preferred solution [28]. Both efficient and safe,
the patient accessible.