Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents.
BACKGROUND
Recurrences (relapse or reinfection) of onychomycosis are not uncommon, with percentages reported in various studies ranging from 10% to 53%.


OBJECTIVE
We sought to determine the prevalence of long-term recurrences of toenail onychomycosis caused by dermatophytes cured after systemic antifungal treatment with terbinafine (T) or itraconazole (I) and identify risk factors for recurrences.


METHODS
This 7-year prospective study, started in 2000 and ended in 2007, included 73 patients periodically followed after successful treatment of toenail onychomycosis using either T, 250 mg daily (59 patients), or I, 400 mg daily, for 1 week per month (14 patients). Patients were evaluated every 6 months, with clinical and mycological evaluations being performed.


RESULTS
Twelve of 73 patients (16.4%) developed a recurrence of onychomycosis a mean time of 36 months after successful treatment. These included 5 of the 14 patients (35.7%) who had taken I and 7 of the 59 (11.9%) who had taken T (P = .046).


CONCLUSIONS
The number of patients treated with T (59 patients) was more than that for I (14 patients).


CONCLUSIONS
The administration of systemic T to treat the first episode of onychomycosis may provide better long-term success than I in those patients with a complete response. Other factors including the presence of predisposing factors, use of nail lacquer as a prophylactic treatment, and the dermatophyte strain isolated were not significantly related to relapse.
Piraccini
Bianca Maria
BM
Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy. biancamaria.piraccini@unibo.it
Sisti
Andrea
A
Tosti
Antonella
A
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D003883:Arthrodermataceae / Q000302:isolation & purification; D005260:Female; D005533:Foot Dermatoses / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D007764:Lacquer; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D009262:Nails / Q000382:microbiology; D009281:Naphthalenes / Q000627:therapeutic use*; D014009:Onychomycosis / Q000188:drug therapy* / Q000382:microbiology*; D011446:Prospective Studies; D012008:Recurrence; D000077291:Terbinafine; D016896:Treatment Outcome
D000935:Antifungal Agents; D009025:Morpholines; D009281:Naphthalenes; D017964:Itraconazole; C038974:amorolfine; D000077291:Terbinafine