SLR - August 2010 - Samuel Feinberg

Long-Term Follow-up of Toenail Onychomycosis Caused by Dermatophytes After Successful Treatment With Systemic Antifungal Agents

Reference:
Piraccini, B.M., Sisti, A., Tosti, A. (2010). Long-Term Follow-up of Toenail Onychomycosis Caused by Dermatophytes After Successful Treatment With Systemic Antifungal Agents. The American Academy of Dermatology, Inc. (American), 62, 411-414

Scientific Literature Reviews

Resident: Samuel Feinberg, DPM PGY3
Residency Program: University Hospitals Richmond Medical Center/OCPM

Podiatric Relevance: 
This study provides useful data for assessing the recurrence rate of pedal onychomycosis after patients have gone through oral antifungal treatment.

Methods:
This study is a seven-year prospective study, starting in 2000 and ending in 2007. The study included 73 patients that were divided into 2 groups depending on the oral antifungal medication they took. Of the 73 patients, 14 took Itraconazole pulsed at 400mg a day for one week per month for three months. The other 59 patients took Terbinafine 250mg a day for 3 months. The patients were evaluated clinically and mycologically every 6 months by their physician.

Results:
Over the period of the study, 12 of the 73 patients were diagnosed with recurrence of onychomycosis of their toenails with a mean time of 36 months. All of these patients were originally successfully treated with oral antifungals. 5 of the 14 patients (35.7%) that were originally treated with Itraconazole had recurrence, and 7 of the 59 patients (11.9%) that were originally treated with Terbinafine had recurrence.

Conclusion:
On the basis of this study, the authors conclude that patients who are treated with oral Terbinafine have a better chance of long-term success than those treated by Itraconazole. This article also states that there was no significant differences with patients who used nail lacquer as a prophylactic treatment or the dermatophyte strain that caused the fungus in the nails. Even though Terbinafine was demonstrated to be a better oral treatment of onychomycosis vs. Itraconazole, this study shows that there is still an 11.9% recurrence rate with Terbinafine.

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