Distal Subungual Onychomycosis of the Fingernails – Successful Treatment with Terbinafine

  • Home
  • Distal Subungual Onychomycosis of the Fingernails – Successful Treatment with Terbinafine

Distal Subungual Onychomycosis of the Fingernails – Successful Treatment with Terbinafine

1Angel Angelov, 2Ilko Bakardziev, 3Georgi Pehlivanov
1Department of Dermatology and Venereology, Multidisciplinary Hospital for Active Treatment – Shumen
2Medical College, Medical University of Varna
3Multidisciplinary Hospital for Active Treatment „Vita “- Sofia


ABSTRACT

A 62-year-old man presents with pathologically altered nails on the 3rd, 4th and 5th fingers of the right hand, persistent for many years. Trichophyton rubrum was isolated. The clinical diagnosis is distal subungual onychomycosis, which is the most common clinical form of onychomycosis. Systemic treatment with Terbinafine 250 mg tablets and topical therapy with Ciclopirox nail lacquer were carried through, delivering excellent therapeutic effect. The article discusses the current diagnostic and treatment options for onychomycosis of the hands.


KEYWORDS

fingernails, onychomycosis, Terbinafine, Trichophyton rubrum


REFERENCES

1) Aggarwal R, Targhotra M, Kumar B, et al. Treatment and management strategies of onychomycosis. J Mycol Med. 2020; 30: 100949. doi: 10.1016/j.mycmed.2020.100949.
2) Avner S, Nir N, Henri T. Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis. J DermatolTreat. 2005;16(5–6):327– 330. doi:10.1080/09546630500420183.
3) Axler E, Lipner SR. Antifungal Selection for the Treatment of Onychomycosis: Patient Considerations and Outcomes. Infect Drug Resist. 2024; 17: 819-843. doi: 10.2147/IDR.S431526.
4) Bräutigam M. Terbinafine versus itraconazole: a controlled clinical comparison in onychomycosis of the toenails. J Am Acad Dermatol. 1998; 38: S53-6. doi: 10.1016/s01909622(98)70485-2.
5) Effendy I., Lecha M.; Feuilhade de Chauvin M. et al. Epidemiology and clinical classification of onychomycosis, JEADV, 2005, 19(5): 8-12.
6) Elewski B. E., Onychomycosis: Pathogenesis, Diagnosis and Management, Clin. Microbiol. Rev., 1998, 11(3):415-429.
7) Evans EG, Sigurgeirsson B. Double blind, randomised study of continuous terbinafine compared with intermittent itraconazole in treatment of toenail onychomycosis. The LION Study Group. BMJ. 1999;318(7190):1031–1035. doi:10.1136/bmj.318.7190.1031.
8) Garcia-Effron G, Gomez-Lopez A, Mellado E, et al. In vitro activity of terbinafine against medically important non-dermatophyte species of filamentous fungi. J Antimicrob Chemother. 2004;53(6):1086–1089. doi:10.1093/jac/dkh228.
9) Gupta AK, Drummond-Main C, Paquet M. Evidence-based optimal fluconazole dosing regimen for onychomycosis treatment. J Dermatolog Treat. 2013; 24: 75-80. doi:10.3109/09546634.2012.703308.
10) Kemna ME, Elewski BE. A U.S. epidemiologic survey of superficial fungal diseases. J Am Acad Dermatol. Oct 1996; 35(4):539-42.
11) Lateur N, Mortaki A, André J. Two hundred ninety-six cases of onychomycosis in children and teenagers: a 10-year laboratory survey. Pediatr Dermatol 2003; 20:385-388.
12) Leung AKC, Lam JM, Leong KF, et al. Onychomycosis: An Updated Review. Recent Pat Inflamm Allergy Drug Discov. 2020; 14: 32-45. doi: 10.2174/1872213X13666191026090713.
13) Montero-Gei F, Robles-Soto ME, Schlager H. Fluconazole in the treatment of severe onychomycosis. Int J Dermatol. 1996; 35: 587-8. doi: 10.1111/j.1365-4362. 1996.tb03666. x.
14) Sigurgeirsson B, Billstein S, Rantanen T, et al. Study: efficacy and tolerability of continuous terbinafine (Lamisil) compared to intermittent itraconazole in the treatment of toenail onychomycosis. Lamisil vs. Itraconazole in Onychomycosis. Br J Dermatol. 1999;141(56):5–14. doi:10.1046/j.1365-2133.1999.00008.x.
15) Sigurgeirsson B, Olafsson JH, Steinsson JB, et al. Long-term effectiveness of treatment with terbinafine vs itraconazole in onychomycosis: a 5-year blinded prospective follow-up study. Arch Dermatol. 2002; 138: 353-7. doi: 10.1001/archderm.138.3.353.
16) Sigurgeirsson B., Steingrimsson O., Risk factors associated with onychomycosis, J Eur Acad Dermatol Venereol, 2004; 18(1):48-51.
17) Singal A., Khanna D., Onychomycosis: Diagnosis and management. Indian J Dermatol Venereol Leprol. 2011 Nov-Dec;77(6):659-72.
18) Tchernev G, Penev PK, Nenoff P, et al. Onychomycosis: modern diagnostic and treatment approaches. Wien Med Wochenschr. 2013; 163: 1-12. doi: 10.1007/s10354-012-0139-3.
19) Trivedi NA, Shah PC. A meta-analysis comparing efficacy of continuous terbinafine with intermittent itraconazole for toenail onychomycosis. Indian J Dermatol. 2010;55(2):198–199. doi:10.4103/0019-5154.62746.
20) Westerberg DP, Voyack MJ. Onychomycosis: Current trends in diagnosis and treatment. Am Fam Physician. 2013; 88: 762-70. PMID: 24364524.
21) Zhang J, Lin P, Li J, et al. Efficacy of laser therapy combined with topical antifungal agents for onychomycosis: a systematic review and meta-analysis of randomised controlled trials. Lasers Med Sci. 2022; 37: 2557-2569. doi: 10.1007/s10103-022-03561-9.

  • Share

Leave a Reply

Your email address will not be published. Required fields are marked *