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In terms of both diagnosis and treatment, onychomycosis remains a problem in Indonesia. To examine this situation, we performed a retrospective study of the incidence of onychomycosis involving 10 state university hospitals across the country. We collected data from medical records of patients treated at these hospitals in 1997-1998 study 1 and from a 1998-1999 multi-center Indonesian study on pulse-dose itraconazole therapy study 2 , both of which were part of onychomycosis campaigns with the objective of increasing the awareness of physicians of onychomycotic problems. Further, we analyzed data from year 2003 medical records of patients from 4 hospitals in Java study 3. The average incidence of onychomycosis among fungal diseases increased to 4.7% in large cities that, from an average incidence within Indonesia of 3.5% in 1997-1998. At only 0.5%, the incidence of onychomycosis among all skin diseases was low in both study 1 and 3. Female patients outnumbered male patients with a ratio of 1.5:1 to 2:1. In study 2, the fingernail was the site most frequently affected. KOH examinations and fungal culture in study 1 n=557 showed causative organisms to be Candida 50.1% , dermatophytes 26.2% , moulds 3.1% and mixed infections 1.8% , with the remainder 18.7% unidentified. Similar frequency of causative organisms was reported in study 2 n=113 and in study 3 n=183. People's low awareness of nail disease and consequent lack of concern as well as the limited diagnostic ability of KOH examination and fungal culture might influence the low incidence of the disease and the frequency of detection of the causative organisms.

This study compared the efficacy of the new fungicidal allylamine antimycotic, terbinafine, with the triazole antimycotic, itraconazole, in patients with chronic tinea imbricata. Forty-three patients received terbinafine 250 mg daily, and 40 received itraconazole 100 mg daily, for 4 weeks. A total of 72 patients were eligible for follow-up at weeks 5 and 17. Of these, four patients, all from the itraconazole group, did not respond either clinically or mycologically. All of the remaining 68 patients were clinically and mycologically cured. No adverse effects were reported in either group. Terbinafine was assessed as having a superior clinical and mycological cure rate to itraconazole after 4 weeks (P = 0.05) with borderline statistical significance. In addition, after 13 weeks of follow-up, terbinafine provided a significantly reduced rate of reinfection/relapse from further T. concentricum infection compared with itraconazole (P < 0.001). This superior protective effect may be explained by the fungicidal activity and the long persistance in the skin of terbinafine, and indicates the need for higher doses of itraconazole in this particular infection.

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Summary. Duration of therapy is an important factor in determining patients' compliance in dermatomycosis. Terbinafine (Lamisil®) is an allylamine antifungal agent. Its fungicidal properties against dermatophytes should allow physicians to reduce treatment duration without affecting the cure rate. This study was carried out to determine the efficacy and tolerability of terbinafine 1% cream, applied once daily for 7 days, in adult patients with tinea corporis/cruris. In a multicentre, randomized, double‐blind, parallel‐group study, patients with a clinical diagnosis of tinea corporis/cruris confirmed by microscopy and culture received treatment with either terbinafine 1% cream (n = 57) or placebo cream (n = 60). The patients applied the cream once daily for 7 days, and were then observed for a further 7 weeks. The efficacy was assessed at the end of the study by comparing the rates of mycological cure in the two treatment groups. Total clinical signs and symptoms scores, clinical response, and overall treatment efficacy were also measured and compared between the two groups. A 7‐day once‐daily course of terbinafine was significantly more effective than placebo in achieving and maintaining mycological cure (84.2 versus 23.3%, P < 0.001). Terbinafine was also significantly more effective than placebo in terms of clinical response, reduction in signs and symptoms scores, and overall efficacy. The short treatment regimen and the sustained high cure rate should contribute to making terbinafine a valuable treatment option in tinea corporis/cruris.