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

Background: Recurrences (relapse or reinfection) of onychomycosis are not uncommon, with percentages reported in Various studies ranging from 10% to 53%. Objective: 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 (1) and identify risk factors for recurrences. Methods: 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 1; 400 mg daily, for 1 week per month (14 patients). Patients were evaluated every 6 months,. with clinical and mycological evaluations being performed. Results: Twelve of 73 patients (16.4%) developed a recurrence of onychomycosis a mean dine of 36 months after successful treatment. These included 5 of the 74 patients (35.7%) who had taken I and 7 of the 59 (11.9%) who had taken T (P = .046). Limitations: The number of patients treated with T (59 patients) was more than that for I (14 patients). Conclusion: 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. (J Am Acad Dermatol 2010;62:411-4.)