Treatment of onychomycosis aggravated by concomitant hepatitis C

Patient M., 57 years old. She turned to the clinic of skin and venereal diseases with complaints of changes in the nail plates of the feet.

From the anamnesis: has been ill with onychomycosis for more than 30 years, when she first noticed a change in the color of the nail plates of the feet. She turned to a dermatologist, she repeatedly underwent microscopic examination with the detection of pathogenic fungi. According to the patient, only local antifungal agents were prescribed, with the use of which the patient did not observe a significant effect. Over time, the nail plates of the feet deformed, began to crumble.

Concomitant diseases: viral hepatitis C (since 1992), chronic cholecystitis, which is constantly monitored by a hepatologist.

On examination: the clinical picture of lesions of the nail plates of the feet was characterized by thickening, uneven surface, subungual hyperkeratosis, discoloration of the nails (ochre-yellow). The nails looked dull, porous, crumbled along the free edge, and had an unpleasant odor. The patient's KIOTOS index was 9–16 (Fig. 1).

On examination:

• complete blood count: hemoglobin - 143 g/l, erythrocytes - 4.6x1012/l, cirrhosis - 0.9, leukocytes - 4.0x109/l, stab - 1%, segmented - 42%, eosinophils - 6% , lymphocytes - 38%, monocytes - 7%, platelets - 195x109, ESR - 5 mm/h;
• biochemical blood test: ALT - 102 U/l, AST - 94 U/l, total bilirubin - 14.2 µmol/l, gamma-HT - 64 U/l, creatinine - 62 µmol/l, triglycerides - 1 .58 mmol/l, glucose - 5.8 mmol/l, cholesterol - 3.67 mmol/l, alkaline phosphatase - 102 U/l;
• general urinalysis: quantity - 200 ml, color - straw yellow, reaction - acidic, specific gravity - 1030, transparency - slightly transparent, protein, sugar, acetone - none, leukocytes - 1-2 in p /sp., erythrocytes – 0–1 in p/sp.
• Ultrasound of the abdominal organs revealed diffuse changes in the liver, chronic cholecystitis.
• A microscopic examination of the nail plates of the feet was carried out and mycelial filaments of pathogenic fungi were found. During a cultural study on Sabouraud's medium, colonies of fungi - dermatophytes Trichophyton rubrum.

Diagnosis

Based on the clinical and bacterioscopic picture and cultural studies, a diagnosis of onychomycosis of the feet was made. Due to the presence of concomitant hepatitis C in the patient, systemic antimycotics were contraindicated.

The patient underwent laser therapy according to the method - 1 procedure every 2 weeks. for 3 months, and then 1 procedure per month. In total, the patient received 9 procedures during the treatment. The complex therapy included hardware treatment of the nail plates once a month using a Podolog Nova pedicure device (Hellmut Ruck GmbH), as well as daily local therapy with terbinafine in the form of a cream in the interdigital folds and Batrafen varnish 2 times a week. The treatment was well tolerated, without side effects. The treatment of shoes, socks, bed linen was also recommended, the rejection of narrow shoes.

Treatment results: after 2 months. after the start of treatment, the regrowth of healthy nail plates of the feet from the root zone was noted. After 4 months treatment, the patient was noted the growth of healthy nail plates of the feet on 1/3 of its area, and after 6 months. after the start of laser therapy - more than 50% of the nail plate was a healthy pink color (Fig. 2). Laboratory studies after 6 months. treatments (microscopic and culture methods) were negative.

Thus, with the help of laser therapy, without using systemic antimycotic drugs due to concomitant diseases, in a patient after 6 months. treatment without damage to the underlying tissues, a clinical cure of onychomycosis was achieved, laboratory confirmed. This proves that laser treatment is just as effective as medication.

Share: