Suprun K.G. Optimization of complex methods of treatment patients with onychomycosis with absolute and relative contraindications to systemic antifungal therapy. – Qualifying scientific work on manuscript rights. Dissertation for obtaining the degree of Doctor of Philosophy. State institution "Institute of Dermatology and Venereology of the National Academy of Sciences of Ukraine", Kharkiv, 2024. The defense will take place basis of the State institution "Institute of Dermatology and Venereology of the National Academy of Sciences of Ukraine". The work is devoted to optimizing the provision of dermatological care to patients with onyhomycosys in the presence of concomitant pathology. The choice of a treatment taking into account the degree of severity and accompanying pathology significantly increases the therapeutic effectiveness and is a promising direction of research on the optimization of the treatment of this group of patients. The use of the latest molecular genetic methods for the detection of pathological fungi in the researched material will allow to detect the infection at the preclinical stage and control the cure in the process of sanogenesis. To evaluate the proposed differential approach to the therapy of patients with onychomycosis (OM) with absolute and relative contraindications to systemic therapy, 194 patients were recruited, who were divided into three therapeutic groups. Group I included patients with onychomycosis who had no contraindications to taking systemic antimycotics (66 people), group I (63 people) - patients with absolute contraindications to systemic antimycotics, and group III patients (65 people) with relative contraindications to the specified drugs. To determine the therapeutic effectiveness of the developed differentiated therapy of patients with absolute contraindications to systemic antimycotics from the II group of patients, 63 individuals were involved, who were divided into two subgroups. Patients of the Ia subgroup (30) were treated with topical antimycotics 1% Estesifin solution and 1% Estesifin cream. Patients of subgroup Ib (33 people) additionally received mikosan nail kit, volvit, nicotinic acid. The conducted studies showed high therapeutic efficiency of the developed complex method of treatment in patients with OM with contraindications to systemic antimycotics. Group I patients received systemic antimycotic therapy for 12 weeks. Patients with OM with relative contraindications to systemic antimycotics (III group) received combined therapy with removal of the affected nails, use local (analogous to group II) and systemic antifungal agents until clinical and mycological recovery. During the 3rd and 4th weeks of treatment and in the future, mycological examination of the nails was carried out once every two weeks. The clinical condition of the nails of patients with OM was studied according to the following criteria: healing, improvement, absence of changes, deterioration. Worsening of the pathological process was not noted in any patient. Analysis of the dynamics of mycological negativity during treatment showed that the use of combined therapy involving systemic and local antimycotics, agents that improve the structure of the nail plates and the blood circulation of the distal nail phalanges, provides patients with a positive clinical result and mycological elimination in 10-12 weeks in 81.8 % of patients, which is 24.3% more than in patients who received local therapy, and on 5.8% - systemic, shortens the duration of treatment, accordingly reduces the risk of side effects from long-term systemic therapy. The conducted studies showed high therapeutic efficiency of the developed complex method of treatment of patients with OM with contraindications to systemic antimycotics. Next one, the expediency of using non-invasive infrared thermography in patients with OM was established, which allows non-contact in real time to confirm the presence of vascular pathology, to prescribe adequate therapy, which contributes to the faster of clinical and mycological remission. A technique was developed to determine the viability of fungi that can be detected by the PCR method after treating patients. The detection of RNA in the studied material would indicate the viability of the pathogen, but methodically it is a very difficult. To solve this problem, it is proposed to use the definition of complementary DNA (cDNA). cDNA is a DNA copy of an RNA molecule produced by reverse transcriptase, a DNA polymerase that can use RNA as a template. The obtained results indicate that the RT PCR method allows to improve the algorithm of examination after treatment in order to establish the fact of elimination of the causative agent.
Key words: dermatovenerological diseases, infectious dermatoses, mycoses, mycotic lesions, onychomycosis, fungi, thermography, accompanying pathology, terbinafine, itraconazole, biotin, diagnosis, diagnostic methods, treatment, treatment algorithm
