Hepatotoxicity of antimycotics as a factor limiting onychomycosis treatment in patients with impaired carbohydrate tolerance

Effective therapy of patients with onychomycosis is a real challenge. Difficulties in treatment are caused by genetically determined resistance of micromycetes to drugs and acquired resistance. Antifungal therapy is used to treat multiple lesions of the nail plates. An important factor contributing to onychomycosis is extremity devascularization, which may be caused by diabetes mellitus. However, the problem becomes even more urgent if we take into account the fact that, along with officially registered type 2 diabetes mellitus, in a significant part of the population the diagnosis is undetermined, while many people have impaired glucose tolerance. Systemic antimycotics are known to be toxicants, however, the changes in patients with onychomycosis and impaired carbohydrate tolerance remain poorly understood. The purpose of our study was to compare the changes in blood chemistry value in patients with impaired carbohydrate tolerance and patients without concomitant pathology during systemic antifungal therapy. Materials and Methods. Within three months of therapy with oral antifungal drugs, 98 patients with onychomycosis were examined at Ulyanovsk Regional Clinical Skin and Venereal Diseases Clinic for basic blood chemistry values. Results. It was found that during antifungal therapy, all patients demonstrated a statistically significant increase in liver function tests: AST, ALT, bilirubin, cholesterol, and some patients had a slightly elevated urea and alkaline phosphatase levels. Conclusion. The revealed changes in the hepatobiliary system, which is subjected to a pronounced load in case of impaired carbohydrate metabolism and systemic antimycotic therapy, will help to create an algorithm for onychomycosis diagnosis and treatment in patients with impaired carbohydrate tolerance.