We read with interest the analysis of disease-free nail frequency after onychomycosis treatment by Epstein.1 We share Epstein's concern that a mycological cure does not equate with a clinical cure and that issues of reinfection have not been adequately addressed. Treatment costs may not be justified if there is only a temporary remission before reinfection.
An educational handout of an antifungal pharmaceutical company2 states that "... well-worn footwear should be thrown away, as they may be heavily contaminated with fungus," creating a source for reinfection. Many patients cannot afford an entirely new shoe wardrobe, so we were intrigued by the suggestion that was made at a recent guest lecture by a clinical mycologist that mothballs might be effective in the eradication of dermatophytes from shoes. An exhaustive literature search yielded no previous studies of mothballs and fungus, so we decided to investigate further.
Warshaw E, Ahmed D. Are Mothballs Helpful in Preventing Onychomycosis Reinfection?. Arch Dermatol. 1999;135(9):1120-1121. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-9-dlt0999