Treatment of onychomycosis by partial nail avulsion and topical miconazole

13 patients with distal subungual onychomycosis in a total of 48 dermatophyte-infected nails were treated with chemomechanical, partial nail avulsion followed by topical miconazole for 8 weeks. On examination, 6 months after cessation of therapy, 42% of the nails were cured by clinical and mycological criteria. The therapeutic response was related to the pretreatment extension of subungual hyperkeratosis. Periungual skin irritation was common during the initial avulsion period. Miconazole solution was well tolerated and this treatment modality proved to be a valuable alternative to other remedies for the treatment of onychomycosis limited to a few number of nails.