Korean J Med Mycol.
2005 Sep;10(3):83-90.
A Study of Treatment and Compliance on Onychomycosis
- Affiliations
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- 1Department of Dermatology, College of Medicine, Dongguk University, Gyeongju, Korea.
- 2Department of Dermatology, College of Medicine, Yonsei University, Seoul, Korea.
- 3Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea. kjahn@kuh.ac.kr
- 4Department of Dermatology, College of Medicine, Konkuk University, Seoul, Korea.
- 5Department of Dermatology, College of Medicine, Youngnam University, Seoul, Korea.
Abstract
- Onychomycosis is a common infection of the nail, with its prevalence estimated at 20 percent. However, a significant proportion of patients, perhaps as high as 20~40%, is classified as treatment failures and/or relapse following treatment. Several factors such as antifungal resistance, dermatophytoma, preexisting nail dystrophy, reinfection from the surrounding infected tissue can influence the success of a particular monotherapy. Therefore, the combination of antifungal drugs to produce synergistic activity is one possible advance towards achieving higher cure rates. The combination therapies have been known to increase antifungal spectrum and potency of drugs, facilitate drug delivery and reduce fungal load in nail plate. Their final goals are to increase a tolerance and maximize the therapeutic efficacy. Considering the special circumstance of the nail, the oral/topical combination is the most appropriate, for it increases drug concentration in the nail plate by mutual complementary cooperation. Treatment of onychomycosis requires long-term systemic medication of antifungal agent, and its complete cure rates were only 30~50%. Clinical success rate is determined by patients compliance which depends on treatment method and period. In practice, compliance of long-term treatment was very low, possibly attributable to longer treatment duration. Another challenge was relapse and/or reinfection after cure. The authors have attempted to address the issue concerning the method of treatment and duration of action for oral antifungal agents commonly used in practice today, and whether there is a statistically significant difference among those drugs, based on the studies analyzing patient compliance.
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