Experience of Combination Treatment of Toenail Onychomycosis with Oral Itraconazole and Topical 5% Amorolfine Nail Lacquer
BACKGROUND: Target of oral itraconazole is nail matrix via nail bed diffusion. On the contrary, topical amorolfine directly acts on nail plate through a transungual drug delivery system. When this combination treatment of oral itraconazole and topical amorolfine nail lacquer is applied for onychomycosis, we may expect their synergistic effects. OBJECTIVE: We will discuss our clinical experiences of 78 patients in Chung Ang University hospital about combination treatment of onychomycosis with oral itraconazole and topical 5% amorolfine nail lacquer. METHODS: We treated 135 toenail onychomycosis patients (M/F=79/56) from January 2001 to April 2004. But, among 135 patients, we analyzed only 78 (57.8%) patients (M/F=46/32) treated by combination treatments composed of twice weekly application of topical 5% amorolfine nail lacquer and 3 pulse therapy of oral itraconazole. Efficacies of treatment are composed of clinical cure based on decrement of affected nail area by digital camera recording and mycological cure based on KOH exam, and fungus cultures on after 6 months. RESULTS: Distribution of patients by clinical types is as follows; distal subungual onychomycosis (DSO) : 68 patients (87.2%), whitish superficial onychomycosis (WSO) : 4 patients (5.1%), and total dystrophic onychomycosis (TDO) : 6 patients (7.7%). Reduction rates of affected area by clinical types are DSO: 85.1%, WSO: 83.1%, and TDO: 70.3%. Isolated strains from the fungal culture are T. rubrum: 67 (85.9%), T. mentagrophytes: 5 (6.4%), and Candida spp.: 6 (7.7%). Reduction rate of affected nail area (75.0%) in patients with diabetes mellitus is significantly reduced comparing with that (80.8%) of patients without associated disease. The total reduced rate of affected nail area and cure rate are 81.5%, and 57.4% respectively. CONCLUSION: Oral itraconazole and topical amorolfine nail lacquer combination therapy will be a promising treatment modality for onychomycosis.
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