Original article
Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents

https://doi.org/10.1016/j.jaad.2009.04.062Get rights and content

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).

Limitations

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

Conclusion

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.

Section snippets

Methods

The study was approved by our institutional review board.

Results

Twelve of the 73 patients (16.4%) developed a recurrence of onychomycosis during the follow-up period (Table I). This included 9 men and 3 women with age at initial diagnosis of onychomycosis between 21 and 79 years (average age 50 years). The duration of onychomycosis before therapy had been on average 2 years (8 months-5 years). The relapse occurred on average after 3 years from the end of therapy (1-5 years). All patients who relapsed developed a distal subungual onychomycosis of one (10

Discussion

Our study assessed the incidence of long-term relapses of onychomycosis of the toenails caused by dermatophytes and cured by treatment with systemic T or I. We only included patients who were mycologically negative with complete clinical cure 12 months after completion of systemic treatment. We excluded patients who were treated for longer than 3 months, and those who had been treated with both a systemic treatment and a topical antifungal or nail avulsion. Also excluded were patients with

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    Onychomycosis is infection caused by nondermatophytic molds and yeasts: tinea unguium is caused by dermatophytes, which affects 20 % of the population across the world and constituting 50 % of all the nail diseases (Lipner and Scher, 2019). Onychomycosis affects patients with human immunodeficiency virus and further strikes one third of patients with diabetes increasing the severity of foot disorders (Piraccini et al., 2010). Success in treating onychomycosis is overshadowed by several limitations.

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Funding sources: None.

Conflicts of interest: None declared.

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