An evaluation of itraconazole in the management of onychomycosis

Abstract

At present the reported use of itraconazole, a new oral triazole antifungal, has been confined to short-term treatments. This investigation is an appraisal of itraconazole in the treatment of three different forms of onychomycosis. Six patients with nail infections due to Candida albicans not associated with paronychia affecting a total of 20 nails received itraconazole (100 mg daily) for a mean period of 5.9 months. Complete remission was achieved in all cases. Twenty six patients with dermatophyte onychomycosis affecting a total of 45 finger and 80 toe-nails were treated with itraconazole (100-200 mg daily). In 24 cases the causative organism was Trichophyton rubrum. Remission was achieved in 64% of finger and 73% of toe-nails in 5 and 9.4 months, respectively. Treatment failures were experienced in patients with finger-nail infections due to T. violaceum (I) and those concurrently receiving phenytoin and phenobarbitone (3). Three patients with infections due to Hendersonula toruloidea failed to respond to treatment. Adverse effects were experienced by four patients (abdominal discomfort 3, diarrhoea I), but none were serious enough to lead to abandonment of treatment. No persistent changes were seen in serum biochemical values. This study suggests that itraconazole is potentially effective in the long-term treatment of superficial fungal infections such as onychomycosis, and comparative studies with alternatives such as griseofulvin should now be carried out.

Treatment of tinea unguium with medium and high doses of ultramicrosize griseofulvin compared with that with itraconazole

“…Previous trials whose results have been published recently have indicated that itraconazole is effective against onychomycosis involving the toenails (5,15,23). Except for one trial (23), however, griseofulvin either was not investigated in parallel as a reference drug or the numbers of patients were fairly small and the dose of griseofulvin used was low (500 mg of the microsize of drug).…”

“…At every visit (before the start of the study, at monthly intervals during treatment, and, if the patient was cured, at 1, 3, and 12 months thereafter), the investigator clinically rated the signs of disease (dyschromasia, subungual hyperkeratosis, nail dystrophy, paronychia) and recorded the involved area of every nail (5). One of the nails with the most extensive lesions, if possible, the toenail of the big toe, was defined as the test nail which served for the rating of improvement.…”

The systemic treatment of onychomycosis

“…In onychomycosis it has been found effective in patients with previously treated unresponsive dermatophytosis as well as Candida nail infections [16].…”

Therapie der Onychomykose

“…Auch vorausgegangene Untersuchungen wiesen ähnliche Erfolgsraten bei der Itraconazoltherapie der Onychomykose (kontinuierliche oder Intervalltherapie) auf und belegten neben dem zuverlässigen Ansprechen bei Dermatophyteninfektionen in Überein-stimmung mit den In-vitro-Resultaten die ebenfalls gute Wirksamkeit bei Candida-Infektionen [8,37,65]. …”