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Published on: February 14, 2018
Prediction of outcome in the treatment of onychomycosis
S Sommer1, R A Sheehan-Dare, M J D Goodfield
1Department of Dermatology, Leeds General Infirmary, and Mycology Reference Laboratory, Department of Microbiology, University of Leeds, UK.
Abstract:
Patients with toenail onychomycosis remain a therapeutic challenge despite the introduction of new systemic therapies. Around 20% of patients remain uncured even with optimal oral therapy, but the reasons for treatment failure are unclear. Thus far there are no data to suggest that treatment failures can be identified on the basis of their presenting features or progress during treatment. In a series of patients, we have attempted to identify clinical parameters that determine the patient response to 12 weeks of oral terbinafine for confirmed dermatophyte onychomycosis. As part of a dose-defining randomized multicentre study, 35 patients were followed for 48 weeks. The unaffected nail length, growth rate, hyperkeratosis, onycholysis and presence of a dermatophytoma were assessed prospectively. To confirm our findings, at the end of the study period we analysed retrospectively photographs that had been taken regularly throughout the trial. The average degree of hyperkeratosis was less severe in the group achieving a disease-free nail, meaning clinical and mycological cure. For mycological cure alone, no predictive factors could be identified.
Insights
Fewer cases of severe hyperkeratosis predicted successful treatment for toenail fungus (onychomycosis) with oral terbinafine. However, no clinical factors identified patients likely to achieve mycological cure alone.
Area of Science:
- Dermatology
- Mycology
- Pharmacology
Background:
- Toenail onychomycosis presents a persistent therapeutic challenge, with approximately 20% of patients experiencing treatment failure despite optimal oral antifungal therapy.
- The clinical predictors of treatment failure in onychomycosis remain poorly understood, hindering personalized treatment strategies.
Purpose of the Study:
- To identify clinical parameters that predict patient response to 12 weeks of oral terbinafine for dermatophyte onychomycosis.
- To investigate potential correlations between presenting nail features and treatment outcomes.
Main Methods:
- Prospective assessment of clinical parameters including unaffected nail length, growth rate, hyperkeratosis, onycholysis, and dermatophytoma in 35 patients.
- Retrospective analysis of serial photographs to confirm findings from a randomized multicenter study.
- Patients were followed for 48 weeks post-treatment.
Main Results:
- A less severe average degree of hyperkeratosis was observed in patients who achieved a disease-free nail (clinical and mycological cure).
- No specific predictive factors were identified for achieving mycological cure alone.
- The study explored various clinical features to correlate with treatment success.
Conclusions:
- Reduced hyperkeratosis severity may be a predictor of successful clinical and mycological cure in toenail onychomycosis treated with oral terbinafine.
- Further research is needed to identify reliable predictors for mycological cure in onychomycosis.
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