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Itraconazole pulse therapy for dermatophyte onychomycosis in children
1Department of Pediatrics, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Ill. 60614, USA.
Background:
Onychomycosis, or fungal infection of the nail, can occur in prepubertal children. However, its diagnosis is often missed or the condition is inappropriately treated with topical medication. Griseofulvin has been the therapy of choice, but even long-term treatment is associated with a poor cure rate and high rate of relapse. Trials with adult patients have shown that itraconazole pulse therapy for onychomycosis requires a shorter duration of total therapy than griseofulvin treatment and is rarely associated with adverse reactions, suggesting that it may be the treatment of choice for pediatric patients with onychomycosis.
Design:
We retrospectively reviewed the courses of prepubertal patients with dermatophyte onychomycosis who initiated treatment with itraconazole pulse therapy between January 1995 and June 1998.
Setting:
Urban and suburban pediatric dermatology clinics of a children's hospital.
Patients:
Seventeen prepubertal patients met the enrollment and follow-up criteria. These included fungal infection of the nail(s), documented by fungal culture and/or positive potassium hydroxide mounts of nail scrapings; at least 1 follow-up visit; and contact by telephone or clinic visit within 2 months prior to compilation of data. In 59% of patients, a relative living at the home had onychomycosis at the time of diagnosis.
Intervention:
Patients were treated with daily to twice-daily pulses of itraconazole, administered for 1 week of each of 3 to 5 months.
Main Outcome Measures:
Clinical cure after itraconazole therapy in patients with documented onychomycosis and clinical and mycologic relapse after initial cure. Fungal cultures were not repeated if clinical cure was noted.
Results:
All but 1 patient responded fully to therapy, showing improvement within a few months and subsequently clearance (94% clinical cure rate). No patients experienced any clinical adverse reactions. No relapses occurred after clinical cure during a follow-up period of 1 to 4.25 years after initiation of therapy.
Conclusions:
Itraconazole pulse therapy is effective and safe for the treatment of onychomycosis in children. The relapse rate in pediatric patients is lower than in adults, although the high frequency of onychomycosis in non-pediatric family members suggests that the recurrence risk is increased if other family members are not treated concomitantly.
Insights
Itraconazole pulse therapy offers a safe and effective treatment for pediatric onychomycosis, achieving a high cure rate with no adverse reactions. This approach shows a lower relapse rate in children compared to adults.
Area of Science:
- Dermatology
- Pediatric Medicine
- Mycology
Background:
- Onychomycosis, a fungal nail infection, is often overlooked or mistreated in children.
- Traditional treatments like griseofulvin have limited efficacy and high relapse rates.
- Itraconazole pulse therapy presents a promising alternative for pediatric onychomycosis.
Purpose of the Study:
- To evaluate the efficacy and safety of itraconazole pulse therapy for treating onychomycosis in prepubertal children.
- To compare the outcomes of itraconazole pulse therapy with existing treatments for pediatric onychomycosis.
Main Methods:
- Retrospective review of 17 prepubertal patients with confirmed dermatophyte onychomycosis.
- Treatment involved itraconazole pulse therapy (1 week/month for 3-5 months).
- Outcomes assessed included clinical cure and relapse rates.
Main Results:
- A 94% clinical cure rate was achieved with itraconazole pulse therapy.
- No patients reported clinical adverse reactions during treatment.
- No relapses were observed during a follow-up of 1 to 4.25 years.
Conclusions:
- Itraconazole pulse therapy is a safe and effective treatment for pediatric onychomycosis.
- Pediatric patients exhibited a lower relapse rate than adults.
- Concomitant treatment of infected family members may reduce recurrence risk.