Therapeutic study of onychomycosis in a tertiary care center

Authors

  • Geetha K. Department of Dermatology, ESIC Medical College and PGIMSR, K.K. Nagar, Tamil Nadu
  • Muthubharathi S. Department of Dermatology, SRM Medical College and Research Institute, Chennai, Tamil Nadu

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20193222

Keywords:

Onychomycosis, Treatment, Terbinafine, Itraconazole

Abstract

Background: Onychomycosis is the fungal infection of nail unit and require long-term treatment to achieve complete cure. This study aims to know the effectiveness of various treatment protocols for onychomycosis.

Methods: This randomized uncontrolled open label study was undertaken in a tertiary care hospital. Patients with onychomycosis were included. Patients who received systemic or topical antifungal therapy in last six months were excluded. After obtaining ethical approval they were subjected to KOH mount and culture from nail clippings. Patients were selected randomly with both KOH and culture positive. Patients were divided into 3 groups. Group-A received oral terbinafine, Group-B received oral terbinafine and topical amorolfine, Group-C received oral itraconazole and topical amorolfine for 6 months. The patients were evaluated and assessed for the growth of the nail plate and were inquired for any adverse effects due to the drugs, at 6, 12 and 24 weeks. The results were recorded and detailed statistical analysis was done.

Results: During the course of study 9 patients were lost in follow up and were excluded from the analysis of results. Mycological cure with negative KOH microscopy and culture were obtained in 56.6%, 73.3% and 70% in groups A, B and C. Clinical cure was observed in 60%, 76.6%, and 73.3% patients in group A, B and C respectively.

Conclusions: There was no statistically significant difference in cure rate among the different treatment groups. Combination therapy achieved better results compared to monotherapy.

Author Biographies

Geetha K., Department of Dermatology, ESIC Medical College and PGIMSR, K.K. Nagar, Tamil Nadu

Associate Professor

Dermatology Department

Muthubharathi S., Department of Dermatology, SRM Medical College and Research Institute, Chennai, Tamil Nadu

Senior Resident

Dermatology Department

References

Pajaziti L, Vasili E. Treatment of Onychomycosis-a clinical study. Med Arch. 2015;69(3):173-6.

Haley L Daniel CR. Fungal infections. In: Scher RK, Daniel CR, eds. Nails: Therapy diagnosis Surgery. 1st ed. Philadelphia: W.B. Saunders; 1990: 106-117.

Elewski BE, Charif MA. Prevalence of Onychomycosis in patients attending a dermatology clinic in northeastern Ohio for other conditions. Arch Dermatol. 1997;133:1172-3.

Zaias N. Onychomycosis. Arch Dermatol. 1972;105:263-74.

Summerbell RC, Kave J, Krajden S. onychomycosis Tinea Pedis and Tinea Manum caused by nondermatophytic filamentous fungi. Mycoses. 1989;32:609-19.

Meinhof W. Kinetics and spectrum of activity of oral antifungals: the therapeutic implications. J Am Acad Dermatol. 1993;29:537-41.

Gupta AK, Sander DN, Shear N. Antifungal agents; an overview Part I. J Am Acad Dermatol. 1994;30:677-98.

Drake L, Babel D, Stewart DM, Rich P, Ling MR, Breneman D, et al. Once weekly fluconazole in the treatment of distal subungual onychomycosis of the finger nail. J Am Acad Dermatol. 1998;38:87-94.

Willemsen M, De Doncker P, Willems J, Van de Velde V, Heykants J, Van Cutsem J, et al. Post treatment itraconazole levels in the nail; new implications for treatment in onychomycosis. J Am Acad Dermatol. 1992;26:731-5.

Ryder NS. Terbinafine: mode of action and properties of the squalence epoxidose inhibition. Br J Dermatol. 1992;126(39):2-7

Haria M, Bryson HM. Amorolfine: A review of its Pharmacological properties and therapeutic potential in the treatment of onychomycosis and other superficial fungal infections. Drugs. 1995;49:103-20.

Faergemann J, Zehender H, Millerioux L. Levels of terbinafine in plasma, stratum corneum, dermis- epidermis, sebum, hair and nails during and after 250mg terbinafine orally once daily for 7 and 14 days. Clin Exp Dermatol. 1994;19:121-6.

Baran R, Sigurguisson B, Berker D, Kaufmann R, Lecha M, Faergemann J et al. A multi centre randomized controlled study of the efficacy, safety and cost effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine dose for the treatment of onychomycosis with matrix involvement. Br J Dermatol. 2007;157:149-57.

Honeyman JF, Talarico FS. Itraconazole versus terbinafine: which is better for treatment of onychomyosis. J Eur Acad Dermatol Venereol. 1997;9:215-21.

Sigurgeirsson B, Olaffson JH, Steinssen JB, Paul C, Billstein S, Evans EG. Longterm effectiveness of treatment with terbinafine Vs itraconazole in onychomycosis; a 5 year blinded prospective follow-up study. Arch Dermatol. 2002138:353-7.

De Doncker P Degreef H, Andre J, Pierard G. The challenge of the future Orlando, Florida, USA: Fifty sith Annual American Academy of Dermatology meeting; 1998.

De Doncker P. Pharmacokinetics of oral antifungal agents. Dermatol Ther. 1997;3:46-57.

Tosti A. Onychomycosis-emedicine. Available at: medscape.com/article/1105, 828-overview. Accessed on 3 January 2019.

Grover S. Clinicomycological evaluation of onychomycosis at Bangalore and Jorhat. Indian J Dermatol Venerol Leprol. 2003;69:284-6.

Downloads

Published

2019-07-24

Issue

Section

Original Research Articles