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The Best of the Best
June 20, 2011

Top Accessed Article: Successful Treatment of Trichophyton rubrum Nail Bed (Distal Subungual) Onychomycosis

Author Affiliations

Author Affiliation: Department of Dermatology, Henry Ford Hospital, Detroit, Michigan.

Arch Dermatol. 2011;147(6):716. doi:10.1001/archdermatol.2011.117

Zaias N, Rebell G. Successful treatment of Trichophyton rubrum nail bed (distal subungual) onychomycosis. Arch Dermatol. 2004;140(6):691-695

The article by Zaias and Rebell describes an open-label, prospective, nonrandomized study evaluating pulse dosing with terbinafine at different intervals for the treatment of distal subungual onychomycosis. The authors postulate that terbinafine pulsed over 12 months would provide treatment until the entire mycotic portion of the nail is replaced by normal nail.

Thirty-nine of 42 patients (93%) treated with weekly pulses at 1-, 2-, or 3-month intervals achieved clinical cures based on visual inspection of mycosis-free nails. Patients treated at 4-month intervals had significantly more failures, with 10 of 17 patients clinically cured. Phase 3 studies with terbinafine, 250 mg/d for 12 weeks, a Food and Drug Administration–approved protocol, showed a 39% clinical plus mycological cure rate after 36 weeks of follow-up.1,2

This small study has sparked great interest in the possibility of better efficacy with lower drug exposure and reduced drug cost. Patient compliance over a longer treatment period (12 months) clearly needs to be assessed.

From August 2009, through August 2010, this article was viewed 1772 times on the Archives of Dermatology Web site.

Contact Dr Stein-Gold at the Department of Dermatology, Henry Ford Health Systems, 3031 W Grand Blvd, Ste 800, Detroit, MI 48202 (lstein1@hfhs.org).

Drake  LAShear  NHArlette  JP Oral terbinafine in the treatment of toenail onychomycosis: North American multicenter trial. J Am Acad Dermatol 1997;37 (5, pt 1) 740- 745PubMedArticle
 Lamisil (terbenafine hydrochloride) tablets [package insert].  East Hanover, NJ Novartis Pharmaceuticals Corp1992;