Combined surgical and systemic treatment of onychomycosis
Dominguez-Cherit, J.; Teixeira, F.; Arenas, R.
British Journal of Dermatology 140(4): 778-780
1999
ISSN/ISBN: 0007-0963 PMID: 10233357 Document Number: 505485
The utility of nail plate removal as an adjunct to systemic terbinafine therapy was assessed in 11 patients (10 women, 1 man; aged 25-56 years) from Mexico, with culture-proven Trichophyton rubrum onychomycosis for 18 months-6 years. Eight subjects had been treated previously with itraconazole, 1 with griseofulvin and 2 with topical application of 1% bifonazole and 40% urea paste, and all had relapsed after a mean period of 8 months. All patients were first treated with a pulse of terbinafine (500 mg/day for 7 days); 2 weeks later they underwent resection of the affected area or the whole nail (patients who had the whole nail removed were instructed to use a prosthetic nail). One week later, oral treatment with terbinafine was resumed, with pulses of 500 mg/day for 7 days, followed by 3 weeks without treatment. Three pulses were used. After surgery there was rapid growth of a thin and transparent nail plate, with complete covering of the nail bed after 3 months in cases of total resection. The patients were followed-up for a total of 27 months. Direct mycological examination and culture were consistently negative in all cases.