title: Efficacy of 5% amorolfine nail lacquer in Neoscytalidium dimidiatum onychomycosis.
abstract: BACKGROUND
  Amorolfine nail lacquer was mentioned as an effective treatment for non-dermatophyte nail infection. Onychomycosis that caused by Neoscytalidium dimidiatum is considered recalcitrant onychomycosis.
  
  
  OBJECTIVE
  This study aimed to demonstrate efficacy and treatment outcomes of amorolfine nail lacquer in N. dimidiatum onychomycosis, compared with topical urea treatment.
  
  
  METHODS
  This was a retrospective study of patients daiagnosed as N. dimidiatum onychomycosis at dermatologic clinic between April 2010 and August 2014. Clinical manifestations and laboratory results were collected. The evaluation included 50% improvement, which meant 50% decrease in subungual hyperkeratosis thickness from original untreated nails. Mycological cure is defined by negative result of both KOH and fungal culture. Moreover, complete cure means infected nails return to its normal condition as well as KOH and fungal culture yield negative results.
  
  
  RESULTS
  Among 53 outpatients of N. dimidiatum infection, 28 (52.8%) were treated by amorolfine nail lacquer and other 26 (47.2%) by conventional topical urea cream with occlusion. Comparison between amorolfine and topical urea groups, mycological cure rate was significantly shown in amorolfine group (89.3% vs. 32%; p < 0.0001). Moreover, 50% clinical improvement and complete cure rate of amorolfine group were significantly higher than those of topical urea group (85.7% vs. 48%; p = 0.003 and 50% vs. 20%; p = 0.023, respectively). Median time to mycological cure and complete cure in amorolfine group was significantly shorter than that of topical urea group (p = 0.001 and p = 0.013, respectively).
  
  
  CONCLUSIONS
  This study supported that amorolfine nail lacquer provided promising efficacy in the treatment of Neoscytalidium onychomycosis as a novel monotherapy regimen which were superior to topical urea cream with occlusion in every aspect.
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Sumanas
authors.initials: S
authors.lastname: Bunyaratavej
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Charussri
authors.initials: C
authors.lastname: Leeyaphan
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Chuda
authors.initials: C
authors.lastname: Rujitharanawong
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Theetat M
authors.initials: TM
authors.lastname: Surawan
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Chanai
authors.initials: C
authors.lastname: Muanprasat
authors.affiliation: a Department of Dermatology , Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
authors.forename: Lalita
authors.initials: L
authors.lastname: Matthapan
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007764:Lacquer; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000008:administration & dosage*; D014009:Onychomycosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D009025:Morpholines; C038974:amorolfine
keywords: Amorolfine; Neoscytalidium dimidiatum; nail lacquer; onychomycosis; topical urea cream