title: Toenail abnormalities and onychomycosis in chronic venous insufficiency of the legs: should we treat?
abstract: BACKGROUND
  Toenail manifestations of chronic venous insufficiency (CVI) may often mimic the nail changes of onychomycosis. The current study aims to determine the frequency of toenails deformations in patients with CVI, onychomycosis prevalence among deformed toenails and the outcome of itraconazole treatment.
  
  
  METHODS
  Patients with clinical evidence of (CVI) were enrolled. All patients with toenails deformations and proven onychomycosis were treated by itraconazole pulse therapy for 4 months and then followed-up for additional 5 to 6 months.
  
  
  RESULTS
  Forty-four patients with CVI entered the study. Thirty-seven patients (84%) had nail deformations; 28 of 37 patients (75%) had onychomycosis; and 24 patients completed the follow-up period. Total cure was achieved in 6 of 24 patients (25%), and 14 patients (58%) had no improvement. Patients' age and CVI duration were significantly correlated to onychomycosis cure rate.
  
  
  CONCLUSIONS
  Nail deformations are more prevalent in CVI patients (84%) then in the general elderly population, and 75% of affected nails had also onychomycosis. In these patients, itraconazole achieved only 25% total cure rate compared with the 60% to 70% cure rate commonly cited in the literature, probably due to irreversible nail deformity caused by the CVI and due to the thickened nail that prevented penetrance of itraconazole into the nail plate. Therefore, before antifungal treatment is started for onychomycosis in patients with CVI, especially in older patients, the caregiver must stress out that the final outcome might not be as desirable as in pure onychomycosis patients.
authors.affiliation: Department of Dermatology, C. Sheba Medical Center, Tel Hashomer, Israel. shemer10@barak.net.il
authors.forename: A
authors.initials: A
authors.lastname: Shemer
authors.forename: N
authors.initials: N
authors.lastname: Nathansohn
authors.forename: B
authors.initials: B
authors.lastname: Kaplan
authors.forename: H
authors.initials: H
authors.lastname: Trau
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000382:microbiology* / Q000473:pathology; D014009:Onychomycosis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D015995:Prevalence; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000150:complications*
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole