<div><b>기본 상식</b></div> <div><b>연고로 안되면 알약을 먹습니다.</b></div> <div><br></div> <div><b>치료의 목적</b></div> <div>증상을 줄이기 위함. <br></div> <div>이차적인 세균 감염의 위험성을 줄인다. (무좀은 곰팡이, 진균이고 세균은 포도상구균, 사슬알균 같은 것을 뜻한답니다.)</div> <div>무좀 감염이 발 이외의 부위로 번져나가는 것을 막는다.</div> <div>현재는 연고가 대부분의 환자에 있어서 치료의 원칙이다.</div> <div>하지만, 연고가 듣지 않는 환자들은 입으로 먹는 진균제를 복용함으로 신체 전부를 커버해야 한다.</div> <div><br></div> <div>Treatment is recommended to alleviate symptoms (pruritus), reduce risk for secondary bacterial infection, and limit spread of the infection to other body sites or other individuals. Topical antifungal therapy is the treatment of choice for most patients. Systemic antifungal agents are primarily reserved for patients who fail topical therapy.</div> <div><br></div> <div><b>아졸계통 (ketoconazole, itraconazole 등등..) 및 allylamine, -nafine (Terbinafine, butenafine), ciclopirox, amorolfine 등이 효과적인 연고로</b></div> <div><b>이중 amorolfine 은 미국에서는 시판되고 있지 않다.</b></div> <div><b>Allylamine 은 아졸계통 보다 조금 더 효과적이다. (실패 확률이 아졸 실패확률의 60%)</b></div> <div><b>보통 연고는 하루에 1-2번 바르며 4주 동안 꾸준히 바른다.</b></div> <div><b>Terbinafine 1% 연고 또한 효과적으로 1주일 내에 치료가 되는 경우도 꽤 된다.</b><br></div> <p>Topical drugs effective for tinea pedis include azoles, allylamines, <a target="_blank" href="https://www.uptodate.com/contents/butenafine-drug-information?source=see_link" class="drug drug_general" target="_blank">butenafine</a>, <a target="_blank" href="https://www.uptodate.com/contents/ciclopirox-drug-information?source=see_link" class="drug drug_general" target="_blank">ciclopirox</a>, <a target="_blank" href="https://www.uptodate.com/contents/tolnaftate-drug-information?source=see_link" class="drug drug_general" target="_blank">tolnaftate</a>, and amorolfine (<a target="_blank" href="https://www.uptodate.com/contents/image?imageKey=PC%2F76148&topicKey=DERM%2F4030&source=see_link" class="graphic graphic_table graphicRef76148" target="_blank">table 1</a>). Amorolfine is not available in the United States. A meta-analysis of randomized trials published prior to February 2005 supports efficacy of topical therapy, finding strong evidence of superiority of topical antifungal agents (azoles, allylamines, ciclopirox, tolnaftate, butenafine, and undecanoate) over placebo [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/9" class="abstract_t" target="_blank">9</a>]. Allylamines may be slightly more effective than azoles; a meta-analysis of data from 11 trials that compared topical allylamines with topical azoles found slightly higher cure rates with allylamines (risk ratio of treatment failure 0.63, 95% CI 0.42-0.94) [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/9" class="abstract_t" target="_blank">9</a>]. Topical antifungal treatment is generally applied once or twice daily and continued for four weeks. Shorter treatment courses may be effective; high cure rates have been obtained with <a target="_blank" href="https://www.uptodate.com/contents/terbinafine-drug-information?source=see_link" class="drug drug_general" target="_blank">terbinafine</a> 1% cream applied to interdigital tinea pedis for one week [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/10" class="abstract_t" target="_blank">10</a>].</p> <p><b>먹는 무좀약인 Griseofulvin 또한 발 무좀에 효과적이기는 하지만 다른 먹는 항진균제에 비교했을 때 치료를 좀 더 오래 해야 한다.</b></p> <p><b>여러 논문들을 비교해 본 결과, 연고 Terbinafine 이 아닌, 먹는 Terbinafine 이 Griseofulvin 보다 효과가 좋았으며 먹는 itraconazole 과는 비슷한 효과를 보였다.</b><br></p> <p><a target="_blank" href="https://www.uptodate.com/contents/griseofulvin-drug-information?source=see_link" class="drug drug_general" target="_blank">Griseofulvin</a> can also treat tinea pedis but may be less effective than other oral antifungals and requires a longer duration of therapy [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/11" class="abstract_t" target="_blank">11</a>]. In a systematic review, <a target="_blank" href="https://www.uptodate.com/contents/terbinafine-drug-information?source=see_link" class="drug drug_general" target="_blank">terbinafine</a> was found more effective than griseofulvin, while the efficacy of terbinafine and <a target="_blank" href="https://www.uptodate.com/contents/itraconazole-drug-information?source=see_link" class="drug drug_general" target="_blank">itraconazole</a> were similar [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/12" class="abstract_t" target="_blank">12</a>]. Typical adult doses of griseofulvin for tinea pedis are 1000 mg per day of griseofulvin microsize for four to eight weeks or 660 or 750 mg per day of griseofulvin ultramicrosize for four to eight weeks [<a target="_blank" href="https://www.uptodate.com/contents/dermatophyte-tinea-infections/abstract/11" class="abstract_t" target="_blank">11</a>].</p> <p><b>우리의 경험으로 각질이 많이 일어나는 형태의 무좀 환자들은 무좀약에 각질제거제 (티눈 없앨 때 사용하는 salicylic acid) 를 같이 사용함으로 효과를 더 많이 보았다. 또한, 발가락 사이사이에 Burow's wet dressing (1% 알루미늄 크림 등등) 을 하루 3번 20분 정도 사용하거나 솜 또는 거즈를 끼워 넣는 것 또한 수포가 잡히거나 하는 환자들에게 도움을 줄 수 있겠다.</b></p> <p><b>신발에는 무좀약 가루를 도포하고 너무 꽉 끼거나 폐쇄적인 (땀을 못 내보낸다는 의미 같습니다.) 양말이나 신발을 피하는 것이 도움이 될 수 있겠다.</b><br></p> <p>In our experience, patients with hyperkeratotic tinea pedis can benefit from combining antifungal treatment with a topical keratolytic, such as salicylic acid. Burow's (1% <a target="_blank" href="https://www.uptodate.com/contents/aluminum-acetate-drug-information?source=see_link" class="drug drug_general" target="_blank">aluminum acetate</a> or 5% aluminum subacetate) wet dressings, applied for 20 minutes two to three times per day, or placing gauze or cotton between toes may be helpful as an adjunctive measure for patients with vesiculation or maceration. Interventions that may help to reduce recurrences include use of desiccating foot powders, treatment of shoes with antifungal powder, and avoidance of occlusive footwear.</p> <p><br></p> <p>안쓰러워서 글 올립니다.</p> <p>힘내세요.<br></p> <p><br></p>