Onychomycosis with Dermatophytoma Completely Cured after Treatment of Regular Subungual Application of Antifungal Solution with Systemic Antifungal Therapy and Topical Nail Laquer Application / 대한의진균학회지

Systemic antifungal therapy is essential to cure onychomycosis but when used alone, its complete cure rate is less than 50%. Therefore, combination therapy is preferred to achieve higher cure rate of onychomycosis, especially severely infected onychomycosis. For effective treatment of onychomycosis, it is important how antifungal agents reach causative fungi in the nail lesion. If there are dermatophytoma or onycholysis, biofilms and space may disturb antifungal agent to reach the fungi in the nail lesion. If direct antifungal solution is applied to the space, it can be spread with capillary action to the space and fungi. A 57-year old male patient presented onychomycosis with infected nail matrix and dermatophytoma, which had recurred after combination therapy of oral and topical antifungal agents before. He had been treated with subungual antifungal solution added to systemic terbinafine (250 mg/day) and amorolfine nail lacquer for initial 3 months, and with subungual antifungal solution and nail lacquer for the next 4 months, and nail lacquer only for the rest period. After 3 months treatment, totally involved left great toe nail showed 50% of normal healthy nail growing from the proximal nail fold. His infected nails eventually showed complete normal nails 1 year after the initial treatment.

Cure Rate, Duration Required for Complete Cure and Recurrence Rate in Patients with Onychomycosis of Great Toe Nail According to the Extent of Nail Involvement / 대한의진균학회지

BACKGROUND: Despite enormous advances in the treatment of onychomycosis in recent years, many factors such as the extent of nail involvement affect treatment response. OBJECTIVES: The purpose of this study was to evaluate the cure rate, duration required for complete cure and recurrence rate in patients with onychomycosis of great toe nail according to the extent of nail involvement. METHODS: Medical records in patients with onychomycosis on the great toe nail were reviewed retrospectively to obtain the following information: diagnosis, age, sex, presence of systemic diseases, extent of nail involvement, and duration for complete cure. One year after complete cure, patients underwent a follow-up examination of recurrence. RESULTS: The complete cure rate (CCR) as a whole was 78.3%, duration required for complete cure (DC) was 31.7+/-18.4 weeks, recurrence rate (RR) was 36.0%. CCRs were 92.4% in the nail involvement-under-25% group (A), 81.8% in the group involving 25~50% of the nail (B), 72.2% in the group involving 50~75% of the nail (C), 63.9% in the group involving 75~100% of the nail (D) (p<0.05). DCs were 15.8+/-7.8 weeks in group A, 32.9+/-9.8 weeks in group B, 33.5+/-7.5 weeks in group C, and 53.9+/-16.8 weeks in group D (p<0.05). RRs were 12.5% in group A, 44.8% in group B, 52% in group C, and 45.2% in group D (p<0.05). Conclusion: There were statistically significant differences in CCR, DC, and RR depending on the extent of the nail involvement; therefore, it seems important to obtain early treatment.