Treatment of Toenail Onychomycosis with Oral Terbinafine Plus Aggressive Debridement

Jennings, Maureen; Pollak, Richard; Harkless, Lawrence B.; Kianifard, Farid; Tavakkol, Amir

doi:10.7547/0960465

Cited by 41 publications

(23 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nail avulsion may help drug penetration and consequently reduce the fungal load [29] . To our knowledge, the efficacy of nail avulsion as a preliminary method to enhance the efficacy of topical antifungal treatment has not previously been formally validated [30] .…”

Section: Discussionmentioning

confidence: 99%

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

Paul

Coustou²,

Lahfa

et al. 2013

Dermatology

View full text Add to dashboard Cite

Background: The efficacy of topical antifungals is controversial. Objective: To compare the efficacy and safety of a sequential (SEQ) treatment with chemical nail avulsion and topical antifungals to amorolfine nail lacquer in dermatophytic onychomycosis. Methods: This was a randomized, parallel-group, controlled study comparing a 36-week SEQ treatment with chemical nail avulsion with RV4104A ointment (class I medical device containing 40% urea) followed by ciclopirox cream for 8 weeks and ciclopirox nail lacquer for 25 weeks (SEQ group) to amorolfine nail lacquer for 36 weeks (AMO group). Patients had to have a big toenail onychomycosis, sparing the matrix. The primary efficacy criterion was complete cure at week 48. A cost-effectiveness analysis was performed. Results: A total of 142 patients were randomized. The complete cure rate at week 48 was significantly higher in the SEQ group than in the AMO group (36.6 vs. 12.7%, p = 0.001). Clinical cure at week 48 was observed in 53.5% of patients in the SEQ group versus 17% in the AMO group (p < 0.01). The cost of cure per patient was 50% lower with SEQ treatment (EUR 33) compared with amorolfine (EUR 76). Conclusion: A treatment of onychomycosis comprising chemical avulsion of the pathological nail, ciclopirox cream and nail lacquer is significantly more effective than amorolfine nail lacquer.

show abstract

Section: Discussionmentioning

confidence: 99%

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

Paul

Coustou²,

Lahfa

et al. 2013

Dermatology

View full text Add to dashboard Cite

show abstract

“…[115][116][117] The combination of daily terbinafi ne doses (250 mg) with chemical or mechanical removal of the nail offers little to no additional increase in effi cacy over terbinafi ne alone. 118,119 Similarly, only limited increases in effi cacy are observed when daily oral therapy is combined with adjunctive therapy including once-weekly topical amorolfi ne or once-daily topical ciclopirox. [120][121][122][123] In each study topical therapy appeared to confer slight improvements in response; however, limited sample sizes restrict their signifi cance and superiority over terbinafi ne alone could not be determined.…”

Section: Onychomycosismentioning

confidence: 99%

Update on terbinafine with a focus on dermatophytoses

Newland¹,

Abdel‐Rahman

2009

CCID

View full text Add to dashboard Cite

Since terbinafi ne was introduced on the world market 17 years ago, it has become the leading antifungal for the treatment of superfi cial fungal infections, aided by unique pharmacologic and microbiologic profi les. This article reviews mode of action, antimycotic spectrum and disposition profi le of terbinafi ne. It examines the data, accumulated over 15 years, on the comparative effi cacy of terbinafi ne (vs griseofulvin, itraconazole, fl uconazole) in the management of the infections for which it is primarily indicated (eg, dermatophytoses) and provides a brief discussion on its use for the treatment of non-dermatophyte infections. Finally, the available data on the newest topical and systemic formulations are introduced.

show abstract

“…Agents such as oral terbinafine have been shown to be safe and effective in the treatment of onychomycosis in diabetic patients [44]. By combining topical nail lacquers with concurrent oral medications as a combination can improve cure rates further [45], particularly if the affected toe nails are mechanically reduced prior to therapy [46]. Reoccurrence rates for FFI are high through skin re-infection and therefore prophylactic use of topical agents should be encouraged to prevent further spread to the nails.…”

Section: Fungal Infectionsmentioning

confidence: 98%

Non-ulcerative skin pathologies of the diabetic foot

Bristow

2008

Diabetes Metab. Res. Rev.

View full text Add to dashboard Cite

Many of the complications of the diabetes are well studied but robust research documenting the cutaneous effects of the disease remains sparse. Various studies have suggested that the majority of patients with diabetes will suffer a skin disorder during the course of their disease and for some, the skin changes may even precede the diagnosis of diabetes. Cutaneous pathology of the diabetic foot and lower leg can arise as a result of the direct or indirect effects of diabetic complications. The most common manifestations include fungal and bacterial skin infection, nail disease and diabetic dermopathy. Other less commonly observed conditions include diabetic bullae, necrobiosis lipoidica diabeticorum (NLD), granuloma annulare and reddening of the soles. For many of the less common disorders, there is little in the way of effective treatment. However, much can be done in the clinical setting in the management of the more common manifestations such as bacterial and fungal infection. Fungal infection, in particular, although relatively inconspicuous, is a very common foot problem and if left untreated can threaten tissue viability in the diabetic foot leading to secondary bacterial infection and cellulitis. Management of fungal disease is often considered difficult due to high relapse and re-infection rates, although by introducing a combination of therapies including mechanical and pharmacological the success in treating this stubborn condition can be greatly improved.

show abstract

Treatment of Toenail Onychomycosis with Oral Terbinafine Plus Aggressive Debridement

Cited by 41 publications

References 20 publications

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

Update on terbinafine with a focus on dermatophytoses

Non-ulcerative skin pathologies of the diabetic foot

Contact Info

Product

Resources

About