A modern view on diagnostics and treatment of onychomycoses (literature review)
Authors: Kutasevych Yanina , Oliinyk Iryna , Ishcheikin Kostiantyn , Bilozorov Oleksii , Mashtakova Iryna , Zimina Tetiana , Suprun Kseniia , Chekhovska Hanna 
Published: May 2020

This article provides an overview of current data on the diagnosis and
treatment of onychomycosis. Fungal infection is the cause of 50 % to 60 % of
all nail diseases. In other cases, nail diseases are non-fungal in nature and are
caused by various pathological processes, including chronic and infectious
skin diseases, chronic somatic lesions, endocrine and psychological disorders
caused by hereditary, occupational and traumatic factors. Onychomycosis
constitutes a significant part of the pathology of nails, according to numerous
researchers, onychomycosis accounts for about 20 % of all diseases of the
nails. Known pathogens of onychomycosis are usually divided into three
groups: dermatophytes, yeast-like fungi of the Candida species, and mold
fungi. According to preliminary studies, dermatophytic onychomycosis
accounts for up to 83 % of all infectious lesions of the feet nails and more than
50 % of the nails of the hands. Mixed infections are becoming increasingly
important in the etiology of onychomycosis. Data has appeared on mixed
dermatophytic-bacterial and dermatophytic-viral onychomycoses. Laboratory diagnostics are based on traditional methods: microscopic examination of
pathological material and cultural studies, as well as modern methods (PCR
diagnostics). Molecular genetic research showed the high sensitivity of this
PCR method, which allows researchers to confirm the diagnosis of onychomycosis in just a day and reveals a larger percentage of patients with onychomycosis compared to traditional methods were able to, thus this indicates the
need to revise existing approaches to laboratory diagnosis. Currently, there
are a large number of methods for treating onychomycosis. Etiotropic therapy
is the only effective approach in the onychomycosis treatment. The main
types of therapy are local therapy, systemic and combined. Higher therapeutic
efficacy of combination therapy is associated with different routes of antifungal drugs, their synergistic action, the possibility of using drugs with various
differing mechanisms of action and, consequently, the expansion of the spectrum of action, the creation of a high concentration of antifungal drugs in
the nail plate and surrounding tissues, and the removal of a significant mass
of the spreading infectious agent. In addition, the advantage of combination
therapy in the treatment of onychomycosis is shorter therapy duration, and
therefore a reduction in the likelihood of side effects, as well as epidemiological and economic efficiency, and a high cosmetic effect.
Key words: onychomycosis, polymerase chain reaction, systemic and
topical antimycotics, combination therapy.
For citation: Kutasevych YF, Oliinyk IO, Ishcheikin KY, Bilozorov OP,
Mashtakova IO, Zimina TV, Suprun KH, Chekhovska HS. A modern
view on diagnostics and treatment of onychomycoses (literature review).
Journal of the National Academy of Medical Sciences of Ukraine.
2019;25(3):313–20