Comparison of Compliance and Cure Rate of Systemic Antifungal Therapy vs. Combination Therapy with Systemic and Topical Agent in Toenail Onychomycosis

Kim, Hyun Chull; Jung, Ki Baek; Shin, Dong Hoon; Choi, Jong Soo; Kim, Ki Hong

Abstract

BACKGROUND: Treatment of toenail onychomycosis requires long term oral medication of antifungal agent and its compliance was about 30% in outpatient base.
OBJECTIVE
The objective of this study was to evaluate the efficacy and compliance of combined treatment with systemic and topical antifungal agent in toenail onychomycosis. METHOD: Medical records of 402 patients with toenail onychomycosis were analysed. They were diagnosed by positivity in KOH or fungus culture. Two hundred forty patients took systemic antifungal agent (terbinafine or itraconazole) only (oral treatment group). One hundred sixty two patients took combined treatment with systemic antifungal agent and topical antifungal agent (ciclopirox 8% nail lacquer) (combined treatment group). Compliance, complete cure rate, revisiting rate and follow up period were compared between oral treatment group and combined treatment group.
RESULTS
Completely treated rate was higher in combined treatment group (48.2%, 78 out of 162) than in oral treatment group (20.8%, 50 out of 240) (p=0.000, c2). Complete cure rate after complete treatment was higher in combined treatment group (34.6%, 43 out of 78) than in oral treatment group (22.0%, 11 out of 50) (p=0.127, c2). Revisiting rate after complete treatment was higher in combined treatment group (60.5%, 43 out of 71) than in oral treatment group (22.2%, 10 out of 45) (p=0.000, c2).
CONCLUSION
All these findings suggested that combined treatment with systemic and topical agent in toenail onychomycosis can increase compliance and cure rate.