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October 8, 1997

Contempo 1997: Dermatology

Author Affiliations

Las Vegas Skin and Cancer Clinics Las Vegas, Nev

JAMA. 1997;278(14):1148. doi:10.1001/jama.1997.03550140040025

To the Editor.  —As a dermatologist, I would like to comment on a few of the statements made in the Contempo article on dermatology by Drs Dover and Arndt.1The first relates to the comment regarding "pulse terbinafine, 500 mg daily for 1 week a month for 3 months" for toenail onychomycosis. The referenced article2 was a small study that was not statistically conclusive regarding efficacy. In addition, 4 pulses of terbinafine were administered, not 3 pulses as stated by Dover and Arndt. To address "pulsed terbinafine" treatment, it is important to clarify that adequate dosage duration finding studies and safety evaluations have not been published.Second, Dover and Arndt state that "while fewer studies have been reported with fluconazole, 150 mg 1 day per week for up to 9 months produced cure rates of almost 90%," referring to treatment of toenail dermatophyte onychomycosis. The referenced article3 included 20 patients