角化脱屑型手足癣的诊断和治疗

DIAGNOSIS AND TREATMENT OF TINEA MANUUM AND/OR PEDIS OF SQUAMOUS HYPERKERATOTIC TYPE

目的：寻找更好的方法诊断和治疗角化脱屑型手足癣。方法：对１７４例临床拟诊为角化脱屑型手足癣的患者采用改良ＫＯＮＣＰＡ法进行真菌学检查，并与ＫＯＨ法、真菌培养法进行对照。受试患者随机予以伊曲康唑０．２ｇ，２／ｄ，用７ｄ（Ⅰ组）；０．２ｇ，２／ｄ，用１４ｄ（Ⅱ组）；特比萘芬０．２５ｇ，１／ｄ，用１４ｄ（Ⅲ组）；质量分数为０．０１的萘替芬霜外用３０ｄ（Ⅳ组）及０．０１（质量分数）特比萘芬霜外用３０ｄ（Ⅴ组）进行治疗。结果：ＫＯＨ法检查真菌阳性率为６２．４％，真菌培养法为８６．７８％，改良ＫＯＮＣＰＡ法为１００％（Ｐ＜０．００１）。Ⅰ组治愈８例（８／３０），有效１３例（１３／３０）；Ⅱ组治愈３１例（３１／５１），有效４２例（４２／５１）；Ⅲ组治愈２２例（２２／３３），有效３２例（３２／３３）；Ⅳ组治愈２２例（２２／３６），有效３５例（３５／３６）；Ⅴ组治愈１７例（１７／２４），有效２４例（２４／２４）。结论：（１）改良ＫＯＮＣＰＡ法明显优于ＫＯＨ法与真菌培养法；（２）萘替芬霜或特比萘芬霜可作为首选药；（３）伊曲康唑０．２ｇ，２／ｄ，１４ｄ疗法明显优于７ｄ疗法；

Objective: To find a better method for diagnosis and treatment of tinea manuum and/or pedis of squamous hyperkeratotic type. Methods: 174 patients with squamous hyperkeratotic tinea manuum and/or pedis were examined by improved KONCPA method and compared with KOH method and fungi culture method. These patients were randomly divided into 5 groups. The patients took itraconazole 0.2 g, 2/d, 7 d in group Ⅰ. The patients took itraconazole 0.2 g, 2/d, 14 d in group Ⅱ. The patients took terbinafine 0.25 g, 1/d, 14 d in group Ⅲ. The patients were treated by 0.01 terbinafine cream 30 d in group Ⅳ. The patients were treated by 0.01 naftifine cream 30 d in group Ⅴ. Results: The positive rate of fungi was 62.4% with the KOH method, 86.78% with fungi culture, 100% with the improved KONCPA method ( P <0.001, compared with KOH and fungi culture method). The cure rate was 26.66% and the effective rate was 43.33% in group Ⅰ; the cure rate was 60.78% and the effective rate was 82.35% in group Ⅱ; the cure rate was 66.67% and the effective rate was 96.97% in group Ⅲ; the cure rate was 61.11% and the effective rate was 97.22% in group Ⅳ; the cure rate was 70.83% and the effective rate was 100% in group Ⅴ. Conclusion: (1) The improved KONCPA method is better than KOH method and fungi culture method. (2) There isn't obvious difference between atopic naftifine cream and terbinafine cream. Atopic naftifine cream or terbinafine cream may be used as the first selection in treatment of this disease. (3) Itraconazole 0.2 g , 2/d, 14 d is better than itraconazole 0.2 g, 2/d, 7 d. (4) The clinical response of terbinafine is better than that of itraconazole.