Fluconazole (Fungolon) in the treatment of onychomycoses

Onychomycoses are fungal infections of the hand and foot nails, caused by dermatophytes, yeasts and molds. These conditions are difficult to treat, spontaneous remissions are rare and recurrences are not infrequent.

The present study aimed at establishing the efficacy of pulse fluconazole therapy (200 mg once weekly for 4 months) in cases of hand nails infections and 200 mg once weekly for 6 months in cases of feet nail infections.

The study comprised 36 patients--23 with hand onychomycosis and 13 with feet onychomycosis (patients' age ranging from 22 to 67 years). More than 25% of the nail bed was affected in all cases. Diagnosis was based on direct microscopy of KOH treated specimens and by culturing on Sabouraud medium.

Treatment outcome was categorized as follows: clinical cure--in 91.3% of the cases with hand onychomycosis and improvement--in 8.7% of the cases; eradication of fungal infection--in 95.6% of the cases. Feet onychomycosis--clinical cure--61.5% of the patients, improvement--in 38.5% and eradication of fungal infection--in 69.2 % of the cases. Fluconazole (Fungolon) has only been recently used in the treatment of nail fungal infections. So far, no standard dosage has been established.

On the basis of the accumulated evidence it is concluded that pulse fluconazole (Fungolon) therapy--200 mg once weekly is effective and safe. However, for better disease outcome, especially in cases of foot nail infections--dosage of 300 mg once weekly and 300-450 mg once weekly (if molds are the offending agents) is recommended.