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Journal of the American Academy of Dermatology
Volume 62, n° 3
pages 411-414 (mars 2010)
Doi : 10.1016/j.jaad.2009.04.062
accepted : 14 April 2009
Original Articles

Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents

Bianca Maria Piraccini, MD, PhD , Andrea Sisti, MD, Antonella Tosti, MD
Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Bologna, Italy 

Reprint requests: Bianca Maria Piraccini, MD, PhD, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy.

Recurrences (relapse or reinfection) of onychomycosis are not uncommon, with percentages reported in various studies ranging from 10% to 53%.


We sought to determine the prevalence of long-term recurrences of toenail onychomycosis caused by dermatophytes cured after systemic antifungal treatment with terbinafine (T) or itraconazole (I) and identify risk factors for recurrences.


This 7-year prospective study, started in 2000 and ended in 2007, included 73 patients periodically followed after successful treatment of toenail onychomycosis using either T, 250 mg daily (59 patients), or I, 400 mg daily, for 1 week per month (14 patients). Patients were evaluated every 6 months, with clinical and mycological evaluations being performed.


Twelve of 73 patients (16.4%) developed a recurrence of onychomycosis a mean time of 36 months after successful treatment. These included 5 of the 14 patients (35.7%) who had taken I and 7 of the 59 (11.9%) who had taken T (P  = .046).


The number of patients treated with T (59 patients) was more than that for I (14 patients).


The administration of systemic T to treat the first episode of onychomycosis may provide better long-term success than I in those patients with a complete response. Other factors including the presence of predisposing factors, use of nail lacquer as a prophylactic treatment, and the dermatophyte strain isolated were not significantly related to relapse.

The full text of this article is available in PDF format.

Key words : amorolfine nail lacquer, dermatophytes, itraconazole, systemic antifungal, terbinafine, toenail onychomycosis

Abbreviations used : FDA, I, T

 Funding sources: None.
 Conflicts of interest: None declared.

© 2009  American Academy of Dermatology, Inc.@@#104156@@
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