Treatment failures and relapses in onychomycosis: a stubborn clinical problem.
The therapeutic outcome of onychomycoses is uncertain. Comparative short-term efficacy studies on antifungals abound and report contradictory findings. Few unbiased follow-up studies have scrutinized the long-term outcome. Basically, none of the current antifungals can guarantee cure in all instances. In addition, relapses are not rare. The causes of therapeutic failure in onychomycoses are multiple. The most important are the lack of diagnostic accuracy, inadequate antifungal choice or delivery modality, and presence of dormant conidia, sequestrated mycelium pockets or resistant fungal species. The concept of fungicidal drug derived from selected in vitro studies appears irrelevant in clinical practice.
Department of Dermatopathology, University Medical Center, Liège, Belgium.
Jorge E
JE
Arrese
Gérald E
GE
Piérard
D000284:Administration, Oral; D000287:Administration, Topical; D000935:Antifungal Agents / Q000008:administration & dosage*; D001707:Biopsy, Needle; D018849:Controlled Clinical Trials as Topic; D005260:Female; D005533:Foot Dermatoses; D006229:Hand Dermatoses; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D014009:Onychomycosis / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology*; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D017211:Treatment Failure
D000935:Antifungal Agents