Itraconazole Pulse Therapy in Childhood Onychomycosis

Kwon, Kyung Sool; Lee, Jae Bong; Chin, Hyun Woo; Oh, Chang Keun; Jang, Ho Sun; Lim, Jae Young

Abstract

BACKGROUND
Although in managing childhood onychomycosis, it is reported that continuous therapy of itraconazole is effective and safe, pulse therapy seems to be preferred to enhance patient's compliance and tolerability. Still, there is a relatively limited data regarding clinical characteristics and efficacy of itraconazole pulse therapy in childhood onychomycosis. OBJECTIVE: The purpose of this study was to evaluate the clinical characteristics of childhood onychomycosis and efficacy of itraconazole pulse therapy in childhood onychomycosis. METHODS: The study has been processed from 1999 August to 2003 April regarding total 28 patients, age under 14 years old. Clinical evaluation was performed on the bases of age, sex, site, clinical type, risk factors and existence of other concomitant fungal infections. Diagnosis was confirmed by KOH mount and fungal culture. Fungal slide culture was performed to identify the causative organism. Itraconazole was administered 5mg/weight (kg) 2 pulses for finger nail infection and 3 pulses for toe nail infection. Then the follow up was done as scheduled, and we evaluated clinical improvement and adverse effect regularly at every visit. RESULTS: Twenty five patients (male 16, female 9; mean age 8.7 years) completed the follow-ups. 6 patients (24%) had lesions on the finger nail and 19 patients (76%) on the toe nail. Studied clinical type were distolateral subungual onychomycosis (DLSO) and whitish superficial onychomycosis (WSO), but predominantly DLSO; 3 patients on the finger nail and 18 on the toe nail, 21 (84%) totally presenting the most commonly involved. Tinea unguium and tinea pedis-related family history was found in 18 patients (72%). Other concomitant fungal infections were found in 21 patients (84%). As causative organism, only Trichophyton (T.) rubrum was identified in 17 patients (68%). Clinical cure rate was 84%, while treatment failure was 16%. CONCLUSION: Childhood onychomycosis showed similar clinical chracteristics with adulthood and itraconazole pulse therapy was effective for childhood onychomycosis.