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© All-Russian National Academy of Mycology,
2001
© A. Sergeev, 1999-2001
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Which
factor values in onychomycosis? |
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Much
discrepancies from recent studies in onychomycosis have lead
modern researchers to different ideas of a baseline severity
criterion for adequate evaluation of effectiveness. The majority
of researchers have proposed a single criterion, like area (extent)
of target nail invasion, number of the nails affected or clinical
form and also the growth rate of the nail. Ginter and De
Doncker have achieved different results when treating patients
with different target nail affected and presence or absence
of proximal nail involvement. Hay et al. and later Shuster
have proposed use of affected area or length of affected nail
portion as a point of reference for evaluating treatment effectiveness.
“Slowed nail growth” was mentioned by Seebacher as factor
predicting low cure rates. General idea shared by referred papers
is that clinical approach needed to adequately assess the efficacy
of treatment for onychomycosis may be elaborated and that several
clinical or growth-determining factors may be responsible for
different cure rates, as many of them influence cure rates
separately. Current reviews of comparative trials consider multiple
factors influencing different results. The recommendations for
clinical assessment before treatment are yet discrete and there
is still no way to arrange them for clinical use. Being well-recognized
by investigators, different clinical patterns of onychomycosis
are mentioned in recent trials as "baseline characteristics".
Nevertheless, as clinician doesn’t have a way to stratify the
patients on the basis of all significant factors, there’s still
no well-stratified trials providing real and reproducible results.
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Is
there any solution, after all? |
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