griseofulvin and Onychomycosis

Fungal infection of the toenails, also called onychomycosis, is a common problem that causes damage to the nail's structure and physical appearance. For those severely affected, it can interfere with normal daily activities. Treatment is taken orally or applied topically; however, traditionally topical treatments have low success rates due to the nail's physical properties. Oral treatments also appear to have shorter treatment times and better cure rates. Our review will assist those needing to make an evidence-based choice for treatment.. To assess the effects of oral antifungal treatments for toenail onychomycosis.. We searched the following databases up to October 2016: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). We sought to identify unpublished and ongoing trials by correspondence with authors and by contacting relevant pharmaceutical companies.. RCTs comparing oral antifungal treatment to placebo or another oral antifungal treatment in participants with toenail onychomycosis, confirmed by one or more positive cultures, direct microscopy of fungal elements, or histological examination of the nail.. We used standard methodological procedures expected by Cochrane.. We included 48 studies involving 10,200 participants. Half the studies took place in more than one centre and were conducted in outpatient dermatology settings. The participants mainly had subungual fungal infection of the toenails. Study duration ranged from 4 months to 2 years.We assessed one study as being at low risk of bias in all domains and 18 studies as being at high risk of bias in at least one domain. The most common high-risk domain was 'blinding of personnel and participants'.We found high-quality evidence that terbinafine is more effective than placebo for achieving clinical cure (risk ratio (RR) 6.00, 95% confidence interval (CI) 3.96 to 9.08, 8 studies, 1006 participants) and mycological cure (RR 4.53, 95% CI 2.47 to 8.33, 8 studies, 1006 participants). Adverse events amongst terbinafine-treated participants included gastrointestinal symptoms, infections, and headache, but there was probably no significant difference in their risk between the groups (RR 1.13, 95% CI 0.87 to 1.47, 4 studies, 399 participants, moderate-quality evidence).There was high-quality evidence that azoles were more effective than placebo for achieving clinical cure (RR 22.18, 95% CI 12.63 to 38.95, 9 studies, 3440 participants) and mycological cure (RR 5.86, 95% CI 3.23 to 10.62, 9 studies, 3440 participants). There were slightly more adverse events in the azole group (the most common being headache, flu-like symptoms, and nausea), but the difference was probably not significant (RR 1.04, 95% CI 0.97 to 1.12; 9 studies, 3441 participants, moderate-quality evidence).Terbinafine and azoles may lower the recurrence rate when compared, individually, to placebo (RR 0.05, 95% CI 0.01 to 0.38, 1 study, 35 participants; RR 0.55, 95% CI 0.29 to 1.07, 1 study, 26 participants, respectively; both low-quality evidence).There is moderate-quality evidence that terbinafine was probably more effective than azoles for achieving clinical cure (RR 0.82, 95% CI 0.72 to 0.95, 15 studies, 2168 participants) and mycological cure (RR 0.77, 95% CI 0.68 to 0.88, 17 studies, 2544 participants). There was probably no difference in the risk of adverse events (RR 1.00, 95% CI 0.86 to 1.17; 9 studies, 1762 participants, moderate-quality evidence) between the two groups, and there may be no difference in recurrence rate (RR 1.11, 95% CI 0.68 to 1.79, 5 studies, 282 participants, low-quality evidence). Common adverse events in both groups included headache, viral infection, and nausea.Moderate-qualit. We found high-quality evidence that compared to placebo, terbinafine and azoles are effective treatments for the mycological and clinical cure of onychomycosis, with moderate-quality evidence of excess harm. However, terbinafine probably leads to better cure rates than azoles with the same risk of adverse events (moderate-quality evidence).Azole and griseofulvin were shown to probably have a similar effect on cure, but more adverse events appeared to occur with the latter (moderate-quality evidence). Terbinafine may improve cure and be associated with fewer adverse effects when compared to griseofulvin (low-quality evidence).Only four comparisons assessed recurrence rate: low-quality evidence found that terbinafine or azoles may lower the recurrence rate when compared to placebo, but there may be no difference between them.Only a limited number of studies reported adverse events, and the severity of the events was not taken into account.Overall, the quality of the evidence varied widely from high to very low depending on the outcome and comparison. The main reasons to downgrade evidence were limitations in study design, such as unclear allocation concealment and randomisation as well as lack of blinding.

Topics: Administration, Oral; Adult; Aged; Antifungal Agents; Azoles; Female; Foot Dermatoses; Griseofulvin; Humans; Male; Middle Aged; Naphthalenes; Onychomycosis; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention; Terbinafine

Topics: Adolescent; Adult; Antifungal Agents; Child; Child, Preschool; Female; Griseofulvin; Humans; Male; Microsporum; Onychomycosis; Randomized Controlled Trials as Topic; Tinea Capitis; Trichophyton

Topics: Antifungal Agents; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Topics: Antifungal Agents; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Onychomycosis is a common nail disease that is often chronic, difficult to eradicate, and has a tendency to recur. The most common oral therapies for dermatophyte toenail onychomycosis include terbinafine, itraconazole and fluconazole.. A cumulative meta-analysis of the randomized controlled trials (RCTs) for antimycotic agents was performed to determine whether the pooled estimate of the cure rates has remained consistent over the years. Furthermore, for each agent we compared the overall meta-analytical average of both mycological and clinical response rates of RCTs vs. open studies.. We searched MEDLINE (1966 to November 2002) for relevant studies evaluating the efficacy of the oral antifungal agents terbinafine, itraconazole (pulse or continuous), fluconazole and griseofulvin for treating dermatophyte toenail onychomycosis. Studies included in this meta-analysis required a standard accepted dosage regimen, treatment duration and follow-up period. To determine the cumulative meta-analytical average, studies were sequentially pooled by adding one study at a time according to the date of publication (i.e. earliest to the most recent).. There were 36 studies included in the analyses. For RCTs the change in efficacy of mycological cure rates from the first trial to the overall cumulative meta-average for each drug comparator is as follows (with 95% confidence interval): terbinafine, 78 +/- 6% (n = 2 studies, 79 patients) to 76 +/- 3% (n = 18 studies, 993 patients) (P = 0.68); itraconazole pulse, 75 +/- 10% (n = 1 study, 20 patients) to 63 +/- 7% (n = 6 studies, 318 patients) (P = 0.25); itraconazole continuous, 63 +/- 5% (n = 1 study, 84 patients) to 59 +/- 5% (n = 7 studies, 1131 patients) (P = 0.47); fluconazole, 53 +/- 6% (n = 1 study, 72 patients) to 48 +/- 5% (n = 3 studies, 131 patients) (P = 0.50); and griseofulvin, 55 +/- 8% (n = 2 studies, 109 patients) to 60 +/- 6% (n = 3 studies, 167 patients) (P = 0.41). The cumulative meta-analytical average of mycological cure rates when comparing RCTs vs. open studies was: terbinafine, 76 +/- 3% (n = 18 studies, 993 patients) vs. 83 +/- 12% (n = 2 studies, 391 patients) (P = 0.0028); itraconazole pulse, 63 +/- 7% (n = 6 studies, 318 patients) vs. 84 +/- 9% (n = 3 studies, 194 patients) (P = 0.0001); and fluconazole, 48 +/- 5% (n = 3 studies, 131 patients) vs. 79 +/- 3% (n = 3 studies, 208 patients) (P = 0.0001).. The cumulative meta-analysis of cure rates for RCTs suggests that over time, as new RCTs have been conducted, the efficacy rates have remained consistent. The efficacy rates of open studies are substantially higher compared with RCTs and may therefore overestimate cure rates.

Topics: Antifungal Agents; Fluconazole; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Randomized Controlled Trials as Topic; Terbinafine; Treatment Outcome

The systemic treatment of fungal infections has changed considerably over the past 10 to 20 years. Though griseofulvin was introduced in the late 1950s and was at the time the only Food and Drug Administration (FDA)-approved drug in the United States for the systemic treatment of onychomycosis, its cure rate seldom exceeds 40%. Newer drugs appear to be reducing treatment times, improving cure rates with a minimum of side effects, and achieving long-term remissions in recalcitrant infections. Itraconazole was FDA approved in 1995, and terbinafine was FDA approved in 1996. Both have been used safely for many years, demonstrating efficacy in short-term treatment with a low incidence of side effects. Fluconazole, though not yet FDA approved for onychomycosis, has also shown efficacy in many situations. Direct-to-the-public advertising has raised interest in patients to seek treatment. There are also some new investigational drugs for fungal infections that may augment or supplant current therapy.

Topics: Antifungal Agents; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Onychomycosis has been treated for years with oral antifungal agents, and more recently in the United States with a topical nail lacquer. Griseofulvin was the first significant oral agent available to manage onychomycosis. The introduction of the azoles (ketoconazole, itraconazole, and fluconazole) and the allylamine, terbinafine, led to improved cure rates and a broad spectrum of activity. Pharmacokinetic studies have shown that the newer oral agents penetrate the nail within approximately one to two weeks after the start of therapy and remain for several months after the end of treatment. This article reviews the oral antifungal agents used to treat onychomycosis.

Topics: Administration, Oral; Antifungal Agents; Drug Interactions; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Terbinafine, itraconazole, and fluconazole are effective and well tolerated for treating onychomycosis in children. Dosage depends on body weight. Duration of treatment is the same for adults.

Topics: Antifungal Agents; Child; Child Welfare; Diagnosis, Differential; Drug Administration Schedule; Griseofulvin; Humans; Onychomycosis

In summary, terbinafine is a broad-spectrum allylamine, which has been used to treat superficial fungal infections including onychomycosis, and some systemic mycoses in adults. With a fungicidal activity, low minimum inhibitory concentration value, and high selectivity for fungal squalene epoxidase, terbinafine has demonstrated good efficacy in superficial fungal infections. Its lipophilic nature provides excellent, widespread absorption into hair, skin, and nails where it can eradicate fungal infection. Terbinafine has been shown to be effective and safe in several studies of the treatment of tinea capitis and onychomycosis in children. When treating Trichophyton tinea capitis the length of therapy may be 2 or 4 weeks. Microsporum tinea capitis may require somewhat higher or longer doses of terbinafine for adequate efficacy. These regimens still tend to be shorter than treatment with griseofulvin, and terbinafine may provide a higher compliance and a more cost-effective means of managing tinea capitis. It is possible that even higher cure rates and a shorter duration of therapy may be achieved following further optimization of treatment regimens that use a higher daily dosage of terbinafine than is currently recommended. The evidence is strongly in favor of using terbinafine to treat superficial fungal infections in children.

Topics: Administration, Oral; Antifungal Agents; Child; Child Welfare; Drug Administration Schedule; Griseofulvin; Humans; Naphthalenes; Onychomycosis; Terbinafine; Tinea Capitis

This study attempted to determine the cost-effectiveness of therapies for dermatophyte toenail onychomycosis in the United States in 2001. The antimycotic agents evaluated were ciclopirox 8% nail lacquer and the oral agents terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A treatment algorithm for the management of onychomycosis was developed, and a meta-analysis was carried out to determine the average mycologic and clinical response rates for the various agents. The cost of the regimen was figured as the sum of the costs of drug acquisition, medical management, and management of adverse effects. The expected cost of management and disease-free days were determined, and a sensitivity analysis was conducted. It was concluded that ciclopirox 8% nail lacquer, which has recently become available in the larger size of 6.6 mL, is a cost-effective agent for the management of toenail onychomycosis.

Topics: Administration, Topical; Antifungal Agents; Ciclopirox; Drug Costs; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Pyridones; Terbinafine; United States

To identify and synthesize the evidence for the efficacy of oral treatments for fungal infections of the toenails.. Systematic review of randomized controlled trials.. Oral treatments for dermatophyte infections of the toenails.. Cure confirmed by microscopy and culture results in patients with clinically diagnosed fungal infections. Data relating to the clinical cure rates were also extracted from the trials.. A pooled analysis of 2 trials comparing mycological cure rates from continuous treatment with terbinafine (250 mg/d for 12 weeks) and continuous treatment with itraconazole (200 mg/d for 12 weeks) found a statistically significant difference in 11- and 12-month outcomes in favor of terbinafine (risk difference, -0.23 [95% confidence interval, -0.32 to -0.15]; number needed to treat, 5 [95% confidence interval, 4 to 8]). An analysis of clinical cure rates was not possible because of the diversity of definitions used in researching the effectiveness of oral antifungal drugs for onychomycosis. Only 3 trials gave a clear definition of clinical cure and presented data for these outcomes.. There is good evidence that a continuous regimen of terbinafine (250 mg/d) for 3 months is the most effective oral treatment for fungally infected toenails. Consensus among researchers evaluating oral antifungal drugs for onychomycosis is needed to establish meaningful definitions of clinical cure. Most trials were funded by the pharmaceutical industry; we found little independent research, and this may have introduced bias to the review.

Topics: Administration, Oral; Antifungal Agents; Dose-Response Relationship, Drug; Drug Administration Schedule; Evidence-Based Medicine; Female; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Ketoconazole; Male; Naphthalenes; Onychomycosis; Prognosis; Randomized Controlled Trials as Topic; Sensitivity and Specificity; Terbinafine; Treatment Outcome

Historically, there has been a general resistance to treating onychomycosis on the basis that such treatments were protracted and of uncertain outcome. However, modern treatments act more promptly and reliably.. To carry out a meta-analysis to evaluate the efficacy and safety of terbinafine in comparison with placebo, itraconazole and griseofulvin.. The analysis used data from published trials, supplemented where necessary by reference to the original trial reports.. Three trials were included in which terbinafine was compared with placebo. From four trials comparing terbinafine with itraconazole, a statistically significant advantage in favour of terbinafine was observed for negative culture and microscopy at the end of the trials. Furthermore, both patients and physicians reported terbinafine to be better tolerated than itraconazole. From two trials comparing terbinafine with griseofulvin, a significantly higher rate of negative microscopy and culture was observed with terbinafine.. A significant advantage in favour of treatment with terbinafine was observed.

Topics: Antifungal Agents; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Randomized Controlled Trials as Topic; Terbinafine

Onychomycosis is a fungal infection of the nail unit, most commonly caused by the anthropophilic dermatophyte fungi. It is generally accepted that this disease is increasing in prevalence despite the introduction of new and efficacious antifungal drugs. Several studies have documented health-related quality-of-life issues associated with onychomycosis and it is clear that patient treatment is both necessary and desirable. The aetiology and pathogenesis of onychomycosis is coming under increasing scrutiny and work in this field has grown substantially in recent years. This is reflected by the increased assurance with which clinicians can now prescribe treatment and be confident of improvement in a majority of their patients. However, a significant proportion of patients, perhaps as many as 25-40% of those encountered in clinical practice, are classified as treatment failures. Clinical indicators for poor prognosis include the development of residual foci of subungual fungal growth, onycholysis and severe disease. These observations have led to a resurgence of interest in combination treatments for use in patients at risk of failure/relapse. Several types of combination can be considered, including the use of oral or topical drugs and the concomitant use of surgical techniques, all of which have a place in the treatment of onychomycosis.

Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Combined Modality Therapy; Drug Therapy, Combination; Griseofulvin; Humans; Itraconazole; Nails; Naphthalenes; Onychomycosis; Patient Satisfaction; Prevalence; Quality of Life; Terbinafine; Treatment Failure

Topics: Administration, Oral; Antifungal Agents; Clinical Trials as Topic; Dermatomycoses; Drug Administration Schedule; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Recently a novel topical nail lacquer, ciclopirox solution 8%, has been approved for the treatment of onychomycosis.. This was undertaken to determine the most cost-effective treatment for the treatment of dermatophyte onychomycosis of the toes in the United States in 2000.. The nature of the problem was defined. The drug comparators were ciclopirox nail lacquer, terbinafine, itraconazole (pulse), itraconazole (continuous), fluconazole, and griseofulvin. A decision analytic model that reflected the manner in which pedal tinea unguium is managed was produced. Studies that have evaluated the efficacy of the nail lacquer and the oral antifungal agents for this indication were identified. Appropriate studies were used in a meta-analysis to determine the mycologic and clinical response rates when the drug comparators are used for the treatment for toe dermatophyte onychomycosis. For each drug comparator a cost of regimen analysis was carried out. This is the sum of the drug acquisition cost, the cost of medical management, and the cost of managing adverse effects. Next, the expected cost of management was calculated, disease free days were determined, and a sensitivity analysis was conducted.. For each comparator the meta-analytic average mycologic cure (MC) rate and clinical response (CR) rates were: ciclopirox nail lacquer (MC: 52.6 +/- 4.2%, CR: 52.4 +/- 9.0%), griseofulvin (MC: 41.1 +/- 20.4%, CR: 33.7 +/- 14.1%), itraconazole (continuous) (MC: 66.3 +/- 4.2%, CR: 70.3 +/- 4.2%), itraconazole (pulse) (MC: 70.8 +/- 5.7%, CR: 73.6 +/- 4.6%), terbinafine (MC: 77.2 +/- 4.0%, CR: 75.3 +/- 2.9%), and fluconazole (MC: 65.6 +/- 7.1%, CR: 66.5 +/- 11.7%). The cost of regimen for the drug comparators was: ciclopirox nail lacquer $325.2, griseofulvin $1413.1, itraconazole (continuous) $1410.2, itraconazole (pulse) $811.7, terbinafine $890.1, and fluconazole $966.8. The cost/mycologic cure rate and expected cost/expected symptom free day were, ciclopirox nail lacquer ($618.2, 1.69), griseofulvin $3438.2, 5.3), itraconazole (continuous) ($2126.9, 3.52), itraconazole (pulse) ($1146.4, 2.01), terbinafine ($1153.0, 2.14), and fluconazole ($1473.7, 2.10). The relative cost-effectiveness was ciclopirox nail lacquer 1.00, itraconazole (pulse) 1.19, fluconazole 1.24, terbinafine 1.27, itraconazole (continuous) 2.08, and griseofulvin 3.13. Sensitivity analysis indicated that ciclopirox nail lacquer was a cost effective alternative compared with the oral regimens of terbinafine, itraconazole (continuous), and griseofulvin when clinical response rate was used as the primary efficacy parameter.. Ciclopirox nail lacquer solution 8% is a recent addition to the armamentarium of therapies available to the physician and patient for the treatment of onychomycosis. The nail lacquer is a cost effective agent compared with the oral antifungal therapies, terbinafine, itraconazole, fluconazole, and griseofulvin.

Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Arthrodermataceae; Ciclopirox; Costs and Cost Analysis; Drug Costs; Economics, Pharmaceutical; Female; Fluconazole; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Male; Models, Economic; Naphthalenes; Onychomycosis; Pyridones; Randomized Controlled Trials as Topic; Terbinafine; United States

The number of patients with tinea unguium accounts for 0.5% to 2% of the total number of outpatients in Japan. The diagnosis of tinea unguium can be relatively easily made on the basis of clinical symptoms and direct microscopic findings. However onychomycosis due to fungi other than dermatophytes should always be suspected if no dermatophytes are cultured despite positive findings in direct microscopy. In such cases, it is necessary to repeat cultures and conduct histopathological evaluation using PAS-staining technique or enzyme antibody technique. At present, oral administration of griseofulvin and terbinafine are the treatments covered by health insurance in Japan. In the future, however, other orally active antifungal drugs such as itraconazole and fluconazole will become available for use by in-patients who do not respond to griseofulvin. It is essential to patiently continue treatment even if oral therapy is impossible, because other therapies such as ODT therapy using topical antifugal agents and urea ointment or abrading affected nails as much as possible with a file or dental drill may be effective without oral therapy.

Topics: Administration, Oral; Aged; Antifungal Agents; Diagnosis, Differential; Female; Fluconazole; Griseofulvin; Humans; Itraconazole; Japan; Male; Onychomycosis

Topics: Administration, Oral; Antifungal Agents; Cost-Benefit Analysis; Drug Costs; Economics, Pharmaceutical; Fluconazole; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Terbinafine; United States

To review the use of the new oral antifungal agents, itraconazole, terbinafine and fluconazole for the treatment of onychomycosis of the toenails.. Until about 10 years ago the two oral agents available to treat onychomycosis were griseofulvin and ketoconazole. Since then the new oral antifungal agents have superseded the traditional oral agents for the management of toenail onychomycosis.. Literature review.. Itraconazole, terbinafine and fluconazole have been used approximately 100 million times to treat superficial mycoses. These agents are more effective than the traditional antimycotics for the treatment of pedal onychomycosis; furthermore, the new agents have a broader spectrum of action than griseofulvin. In general, itraconazole, terbinafine and fluconazole have a favorable adverse-effects profile with drug interactions that are usually predictable and manageable. The new oral antifungal agents have a high benefit-to-risk ratio when used to treat toenail onychomycosis.

Topics: Administration, Oral; Antifungal Agents; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Fluconazole; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Male; Naphthalenes; Onychomycosis; Terbinafine; Treatment Outcome

Onychomycosis is a common infectious disease. The diagnosis always requires proof of the presence of fungi by culture. Nail psoriasis and onychodystrophy of another origin are clinically very similar to onychomycosis. There is a choice of topical and systemic antimycotics available for treatment. The modern antimycotic nail lacquars are well suited for the treatment of distal onychomycosis. If more than 2/3 of the nail plate and/or the nail matrix are infected, the treatment must be systemic. There is a choice of griseofulvin, terbinafine and itraconazole.

Topics: Administration, Topical; Antifungal Agents; Diagnosis, Differential; Drug Administration Schedule; Fluconazole; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Terbinafine; Treatment Outcome

The authors discuss the traditional approaches to treatment of onychomycosis in podiatric medicine: debridement, traditional oral agents, and topical medication. Although the newer systemic antifungal agents have proven to be both safe and effective, many podiatric physicians believe that for many patients, it is better to treat in a conservative manner.

Topics: Administration, Topical; Antifungal Agents; Debridement; Foot Dermatoses; Griseofulvin; Humans; Ketoconazole; Onychomycosis

Onychomycosis, the infection of the nail unit by any fungus, far from being just a cosmetic problem, has significant psychological, physical, social, and financial implications. Further, it has experienced a dramatic rise in incidence in recent years. The introduction of newer systemic antifungal drugs (itraconazole, fluconazole, and terbinafine) offer an increased cure rate, a broader spectrum of activity, shortening of the treatment period, and increased safety, compared with the traditional systemic antifungal drugs griseofulvin and ketoconazole. Because the fungi involved are difficult to eradicate from the floors of communal bathing facilities, where the infection is often contracted, an effective treatment is likely to have a significant impact on disease prevalence.

Topics: Aged; Antifungal Agents; Child; Enzyme Inhibitors; Female; Griseofulvin; HIV Infections; Humans; Imidazoles; Male; Naphthalenes; Onychomycosis; Terbinafine; Triazoles

The systemic treatment of fungal infections has changed considerably over the past 10 to 20 years. Griseofulvin, the only drug approved by the Food and Drug Administration for the systemic treatment of onychomycosis, has a cure rate that seldom exceeds 40%. Many new drugs are targeting the three main kinds of drug therapy for fungal nails: reduction of treatment times, improvement of cure rates with a minimum of side effects, and the achievement of long-term remissions in recalcitrant infections. As the public becomes aware of newer therapies, we will see more patients with nail infections. Although these new agents for superficial fungal infections are not yet approved in the United States, they have been used extensively in Europe.

Topics: Administration, Oral; Antifungal Agents; Fluconazole; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Oral griseofulvin has been the first-line drug in the therapy of dermatophyte onychomycosis for many years. Even when used long-term, it is effective in only about 30% of patients. Ketoconazole is not much more effective than griseofulvin in toenail infections, and there are significant problems with hepatotoxicity. Recently the triazoles, itraconazole and fluconazole, and the allylamine, terbinafine, were introduced and are believed to be potentially suitable for the oral treatment of fungal nail infection. Terbinafine is particularly effective in the treatment of dermatophyte onychomycosis, with a much shorter treatment period than griseofulvin. Cure rates of well over 80% have been noted in fingernail and toenail infection during treatment periods of 6 and 12 weeks, respectively. Itraconazole, 200 mg/day, has been noted in some studies to be similarly effective in the same treatment period. Few studies of fluconazole in nail infection have been carried out. These new agents appear to be safe, and results thus far suggest that they will soon overtake griseofulvin as the drug of choice in the oral therapy of nail infection.

Topics: Administration, Oral; Allylamine; Antifungal Agents; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Microbial Sensitivity Tests; Naphthalenes; Onychomycosis; Terbinafine; Time Factors; Treatment Outcome

An economic analysis of the oral antifungal drugs griseofulvin (GRI), ketoconazole (KET), and terbinafine (TER), currently registered and used in treating onychomycosis of fingernails and toenails, was performed using a model that incorporates elements of both meta-analysis and pharmacoeconomics. The meta-analysis of published studies determined rates of success, relapse and side-effects. The perspective taken for the analysis was that of the government payer, with expected total cost and cost-effectiveness being calculated. A multiphase approach was used. The studies of onychomycosis of the fingernails showed that TER had a 95.0% success rate, KET 80.9%, and GRI 59.6%. GRI had the lowest acquisition costs. The success rates for onychomycosis of the toenails were: TER 78.3%, KET 40.8%, and GRI 17.5%. GRI had the lowest acquisition costs. However, expected cost comparison showed TER had the lowest cost because of shorter treatment duration. The expected cost of therapy with a 100% government payer perspective for fingernail onychomycosis was the lowest for TER ($439.83), followed by GRI ($480.80), then KET ($755.46). Toenail onychomycosis showed the same order for the comparators, with TER $1049.77, GRI $1388.54 and KET $1936.48. When compared with TER, fingernail cost-effectiveness ratios for GRI and KET were 1.51 and 2.00. Toenail cost-effectiveness ratios were 2.49 and 2.48, respectively. For both fingernail and toenail onychomycosis, TER had the greatest number of disease-free days (973 for fingernails; 1073 for toenails), followed by KET (837; 798), then GRI (702; 569).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Antifungal Agents; Canada; Cost-Benefit Analysis; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Due to increased interest in economic evaluation and the rapid international spread of new healthcare technologies across borders, there is a need to interpret economic evaluations on a worldwide basis. We conducted a multinational cost-effectiveness analysis, from a government payer perspective, comparing four primary oral treatment regimens for onychomycosis of the fingernails and toenails: griseofulvin, itraconazole, ketoconazole and terbinafine. We used a four-step pharmacoeconomic research model which includes all relevant factors affecting costs in 13 countries: Austria, Belgium, Canada, Finland, France, Germany, Greece, Italy, The Netherlands, Portugal, Spain, Switzerland and the U.K. A worldwide meta-analysis of published clinical data served as the statistical input for the pharmacoeconomic model, and demonstrated that terbinafine had the highest success rates (95.0% and 78.3%) of the clinical comparators for fingernails and toenails, respectively. We found that terbinafine was the most effective therapy in relation to cost (therefore giving it the lowest cost-effectiveness ratio) for both infections in all health-care systems analysed.

Topics: Antifungal Agents; Cost-Benefit Analysis; Decision Support Techniques; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Ketoconazole; Models, Econometric; Naphthalenes; Onychomycosis; State Medicine; Terbinafine

The management of onychomycosis has changed considerably in the past few years. The main trends have been improvement in the choice of evidence and cover of infections other than dermatophytosis, shortening of periods of oral therapy, and introduction of topical agents designed to treat nail disease. At present there have been almost no comparative studies of these different approaches, and choice is therefore largely based on enlightened guesswork coupled with personal experience. It is hoped that within the next few years such studies will be carried out to allow dermatologists to make an accurate choice based on appropriate scientific data.

Topics: Administration, Cutaneous; Administration, Oral; Antifungal Agents; Candidiasis, Cutaneous; Fluconazole; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Terbinafine

Tinea unguium, especially of the feet, for ages has been looked on as an incurable disease. Today, therapeutic outcome is still controversial. To evaluate the present state of antifungal therapy of dermatophytoses of the nails, a survey of the pertinent literature has been performed.. The introduction of griseofulvin three decades ago was first considered a major breakthrough. Today, however, conventional griseofulvin treatment regimens must be called disappointing in terms of clinical and microbiological cure to be achieved. Cure rates of 40% to 100% have been reported for fingernail infections, but only 3% to 38% for toenail tinea. Microbiological cure rates look only slightly better. Limited experience suggests that additional measures such as surgical nail avulsion or topical antifungal treatment might improve therapeutic outcome. Toenail avulsion increases cure rates to 47% to 82%. The lack of an adequate follow up, however, makes all statements questionable.. Results are only limited with respect to newly developed oral antifungal agents. Whereas ketoconazole treatment had to be omitted due to its hepatotoxic effect, its congener, intraconazole, is under investigation. High cure rates have been obtained in a preliminary study with oral terbinafine, 0.25 g/d, for 12 months, which have cleared toenail tinea in 15 of 17 patients. The value of topical treatment alone has not yet been definitely established. The application of a topical azole (bifonazole) in combination with chemical nail avulsion, using urea paste under occlusion, has resulted in negative cultures in 62% of the patients 3 months after the end of treatment.

Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Griseofulvin; Humans; Onychomycosis

Oral terbinafine is an effective therapy for dermatophyte onychomycosis, presumably because it reaches the infected areas of the nail rapidly and in fungicidal concentrations. For planning optimal clinical dosage regimes, it is necessary to know the rate of terbinafine movement through the nail plate, the concentrations achieved, and the persistence in the nail plate after stopping treatment. In a study of 12 patients receiving terbinafine at 250 mg/day for up to 48 weeks, measurement of terbinafine in distal nail clippings demonstrated that the drug was first detectable 3-18 weeks after starting therapy. A level of 0.25-0.55 ng/mg was quickly achieved and remained stable. Concentrations of terbinafine in distal clippings of unaffected nails were similar to those in affected nails. Although the average nail concentrations are within the fungicidal range for dermatophytes, the anatomy of an infected nail may result in relatively protected areas of infection. This results in the occasional persistence or recurrence of dermatophytic infection observed in some cases. However, the results of this study justify further trials of 'short-term' oral terbinafine therapy for onychomycosis. A current study is addressing the relationship of oral dosage to nail drug concentration and its later persistence in the nail plate.

Topics: Antifungal Agents; Azoles; Griseofulvin; Humans; Nails; Naphthalenes; Onychomycosis; Terbinafine

Topics: Arthrodermataceae; Candida; Diagnosis, Differential; Griseofulvin; Humans; Ketoconazole; Onychomycosis

Topics: Candidiasis; Candidiasis, Chronic Mucocutaneous; Candidiasis, Oral; Chemical Phenomena; Chemistry; Chromoblastomycosis; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Drug Interactions; Griseofulvin; Histoplasmosis; Humans; Ketoconazole; Onychomycosis; Paracoccidioidomycosis; Sporotrichosis; Tinea Versicolor

Topics: Adolescent; Adult; Age Factors; Aged; Antifungal Agents; Arthrodermataceae; Child; Child, Preschool; Female; Fungi; Griseofulvin; Humans; Imidazoles; Infant; Ketoconazole; Male; Middle Aged; Onychomycosis; Piperazines; Sex Factors; Yeasts

Topics: Acremonium; Arthrodermataceae; Aspergillus; Candida; Fingers; Fusarium; Griseofulvin; Humans; Mitosporic Fungi; Nails; Onychomycosis; Proteus; Pseudomonas aeruginosa; Recurrence; Toes

Topics: Griseofulvin; Hair; Headache; Humans; Nails; Nausea; Onychomycosis; Porphyrins; Tinea; Tinea Capitis; Tinea Pedis; Trichophyton; Vomiting

Scopulariopsis brevicaulis is a common non-dermatophyte mould that can cause onychomycosis.. To evaluate the efficacy and safety of the oral antifungal agents griseofulvin, ketoconazole, itraconazole, fluconazole and terbinafine in the treatment of S. brevicaulis.. In a prospective, comparative, parallel-group, single-blinded, randomized, non-industry-sponsored study, patients with toe onychomycosis caused by S. brevicaulis sp. were randomized and treated with one of 5 oral antifungal agents, i.e. griseofulvin, ketoconazole, itraconazole (pulse), fluconazole or terbinafine. The treatment regimens were: griseofulvin 600 mg twice daily for 12 months, ketoconazole 200 mg daily for 4 months, itraconazole pulse therapy given for 3 pulses, with each pulse consisting of 200 mg twice daily for 1 week with 3 weeks off between successive pulses, terbinafine 250 mg daily for 12 weeks and fluconazole 150 mg daily for 12 weeks.. There were 59 patients (48 males, 11 females, mean age 35.6 years, range 25-53 years). All patients had clinical evidence of distal and lateral onychomycosis, with moderate to severe disease of the target nail. Between the treatment groups there was no significant difference in the mean age of the patients or the mean area of involvement with onychomycosis at baseline. The efficacy parameters were clinical cure (CC) and mycological cure (MC). At month 12 after the start of treatment, the response was: griseofulvin, CC 3/11, MC 0/11, CC + MC 0/11; ketoconazole, CC 10/12, MC 8/12, CC + MC 8/12; itraconazole, CC 12/12, MC 12/12, CC + MC 12/12; terbinafine, CC 12/12, MC 11/12, CC + MC 11/12, and fluconazole, CC 8/12, MC 8/12, CC + MC 8/12. Adverse effects consisted of: griseofulvin, gastro-intestinal symptoms, allergic reaction, photodermatitis, hepatic and renal dysfunction in 11 patients with discontinuation of treatment in 3 patients; ketoconazole, hepatic dysfunction but no symptomatic changes in 2 patients; itraconazole, nausea and vomiting in 2 patients; terbinafine, taste disturbance in 2 patients, nausea in 3 patients, and fluconazole, severe gastro-intestinal events in 5 patients. None of the patients receiving ketoconazole, itraconazole, terbinafine or fluconazole discontinued treatment.. Itraconazole and terbinafine demonstrate efficacy against some cases of S. brevicaulis toe onychomycosis. These agents also appear to be safe in the course of therapy for toe onychomycosis. Griseofulvin is ineffective against toe onychomycosis caused by S. brevicaulis. Ketoconazole is not recommended for toe onychomycosis given its potential for adverse effects, particularly with the availability of the newer antifungal agents.

Topics: Adult; Antifungal Agents; Female; Fluconazole; Follow-Up Studies; Foot Dermatoses; Gastrointestinal Diseases; Griseofulvin; Humans; Itraconazole; Male; Middle Aged; Mitosporic Fungi; Naphthalenes; Nausea; Onychomycosis; Photosensitivity Disorders; Prospective Studies; Single-Blind Method; Terbinafine; Treatment Outcome; Vomiting

Onychomycosis is a common fungal disease infecting up to 20% of the population over age 40. The major causative agent of onychomycosis is Trichophyton rubrum. Uncontrolled infection may eventually lead to penetration of the newly forming nail plate. In spite of the encouraging cure rate with recent antifungal agents such as the allylamines (terbinafine) and azoles (itraconazole and fluconazole) some patients inevitably fail therapy. In this investigation, a group of patients from a multi-center study designed to assess the efficacy of terbinafine with known cases of onychomycosis were selected for evaluation. Nail samples from this patient group were colonized with T. rubrum throughout the terbinafine therapy. Antifungal susceptibility testing was performed on these T. rubrum isolates to detect change in MIC values. Strain relatedness was examined using random amplified polymorphic DNA (RAPD) technique. Our results revealed failure of patients to clear T. rubrum is not related to the development of resistance to the drug. While species determination was possible, we were not able to identify differences that would indicate reinfection with a new strain. Analysis of patient demographic data revealed that 70% of patients were over 45 years old, 56.6% were previously treated with antifungals, 60% came from family history with onychomycosis and 13% were diabetic. In conclusion, our data indicate that patients' failure to clear onychomycosis was not associated with resistant development. Failure of terbinafine therapy may be dependent on host-related factors.

Topics: Adult; Antifungal Agents; Female; Fluconazole; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Male; Microbial Sensitivity Tests; Middle Aged; Naphthalenes; Onychomycosis; Polymerase Chain Reaction; Random Amplified Polymorphic DNA Technique; Terbinafine; Trichophyton

A parallel-group double-blind study was carried out which compared the efficacy of chemical avulsion of affected nail by urea 40% and bifonazole 1% cream alone with that of the same local therapy combined with short-term oral griseofulvin in onychomycosis. A total of 120 patients were included in the study. Patients' characteristics were comparable in both treatment groups. Of the 98 patients fully evaluated, 91 had toenail involvement and only seven had fingernail involvement. Forty-six of the patients were men and 51 were women. The mean age of the patients was 47.14 +/- 13.84 years (range 17-80 years). The duration of onychomycosis was for more than 1 year in 96 patients and for 3 months duration in only one patient, who was in the placebo group. Forty patients had received different previous therapies. All topical treatments were discontinued for at least 2 weeks and oral therapy for at least 2 months prior to the beginning of the study. The diagnosis was confirmed by positive mycologic cultures. Trychophyton rubrum was identified as the pathogen in 90 patients, 45 in each group, T. tonsurans in four patients, two in each group, and T. mentagrophytes in three patients, two in the griseofulvin treated group, and one in the placebo group. The first phase of treatment given to all patients consisted of occlusive dressing every 24 h with urea 40% and bifonazole 1% ointment until the infected nail became completely detached. Subsequently, in the second phase bifonazole 1% cream was applied to the nail ped every 24 h for 4 weeks. In addition, concomitantly with the bifonazole cream the patients were randomly allocated to a daily oral double-blind treatment with griseofulvin 500 mg or placebo, for 4 weeks. Clinical and mycologic evaluations were carried out at baseline, immediately after removal of the nail, and at 3 days, 4 weeks, and 4 months after the end of treatment with bifonazole cream and griseofulvin/placebo tablets. Mycologic examination included identification of fungi by KOH preparation and culture on potato dextrose agar. Positive cultures were transfered for identification on Sabouraud's. Criteria for evaluation of efficacy comprised: "cure" defined as clinical and mycologic cure (fresh specimen and culture negative) at both investigation times after the end of treatment; "late cure" defined as mycologic cure at both investigation times after the end of treatment, clinical clearing of the nail only 4 months after the end of treatment; "improvem

Topics: Administration, Oral; Administration, Topical; Adolescent; Adult; Aged; Antifungal Agents; Double-Blind Method; Female; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Imidazoles; Male; Middle Aged; Onychomycosis; Urea

Thirty-six patients with onychomycoses of their toe-nails were included in a double-blind, parallel-group comparative study of fluconazole 150 mg once weekly and griseofulvin 1,000 mg once daily for 12 months, or earlier if cured. Every month during treatment and in cured patients 3 and 6 months after stop of treatment one toe-nail was clipped and serum samples were taken. In patients treated with fluconazole the concentration of fluconazole was measured in serum and nails. We found a very high concentration of fluconazole in nails (peak 8.54 micrograms/g) and the nail concentration was statistically significantly higher than serum concentrations (p < 0.001). In cured patients fluconazole was still present in high concentrations 3 (1.7 micrograms/g) and 6 (1.4 micrograms/g) months after stop of treatment. These results indicate that fluconazole should be effective in the treatment of onychomycosis in a dose of 150 mg once weekly. The results also indicate that the treatment period could be shortened because fluconazole is still present in high concentrations 6 months after stop of therapy. The concentration of fluconazole found in nails is much higher than that found in the case of terbinafine and itraconazole, indicating that fluconazole should be at least as effective as these drugs in the treatment of tinea unguium.

Topics: Antifungal Agents; Double-Blind Method; Fluconazole; Griseofulvin; Humans; Nails; Onychomycosis; Time Factors

The fungicidal mode of action of terbinafine should make it feasible to reduce treatment duration in onychomycosis. For this reason, a randomized, double-blind study in 195 patients with severe dermatophyte infections of the toenails was performed comparing a 24-week treatment with terbinafine (250 mg/d) with a 48-week treatment with micronized griseofulvin (1000 mg/d).. After 48 weeks, effective treatment was achieved in 67% of the patients treated with terbinafine and in 56% of those treated with griseofulvin (two-tailed P = .120). At a follow-up visit 24 weeks later, cure rates had decreased to 60% in the terbinafine group and to 39% in the griseofulvin group (two-tailed P = .006). At the same time, the mycological cure rate was 81% with terbinafine and 62% with griseofulvin (two-tailed P = .02).. This study has demonstrated the longterm therapeutic superiority of terbinafine to high-dose griseofulvin in the treatment of toenail mycosis. Furthermore, with the new antifungal terbinafine, treatment is no longer necessary until all affected nail material has grown out.

Topics: Adult; Aged; Aged, 80 and over; Antifungal Agents; Double-Blind Method; Female; Griseofulvin; Humans; Male; Middle Aged; Naphthalenes; Onychomycosis; Oxygenases; Terbinafine; Toes

Topics: Antifungal Agents; Fingers; Griseofulvin; Hand Dermatoses; Humans; Naphthalenes; Onychomycosis; Terbinafine

Griseofulvin has been used in the treatment of toenail onychomycosis with limited success. Evidence suggests that terbinafine may be more effective.. In a double-blind, parallel-group study we compared 250 mg/day terbinafine for 16 weeks with 500 mg/day griseofulvin for 52 weeks (or for shorter periods in cured patients) in patients with toenail onychomycosis.. Eighty-nine patients with culture-proved tinea unguium were included, and 43 in the terbinafine group and 41 in the griseofulvin group were assessable for efficacy. Patients who had not improved after 16 weeks were entered into an open study and were given 250 mg/day terbinafine for 16 weeks with the study code still blinded and were then followed up for 20 weeks.. Terbinafine was significantly more effective than griseofulvin, with 42% being completely cured and 84% mycologically cured compared with only 2% with total cure and 45% with mycologic cure in the griseofulvin-treated group. The number of side effects was significantly lower in the terbinafine group (11%) compared with the griseofulvin group (29%).. Terbinafine is significantly more effective than griseofulvin in the treatment of toenail onychomycosis.

Topics: Adolescent; Adult; Aged; Antifungal Agents; Double-Blind Method; Female; Foot Dermatoses; Griseofulvin; Humans; Male; Middle Aged; Naphthalenes; Onychomycosis; Terbinafine

Dermatophytic infections of the fingernail can be effectively treated with oral antifungal agents; however, a long duration of treatment, generally several months, is required for cure.. Our purpose was to compare the efficacies of short-duration treatment with terbinafine and griseofulvin in the management of fingernail dermatophytosis.. In this randomized, double-blind study 180 patients with fingernail dermatophytosis were treated with daily doses of either terbinafine, 250 mg/day, or microsized griseofulvin, 500 mg/day, for 12 weeks. Patients subsequently received placebo for 12 weeks and were observed for an additional 24 weeks. Drug efficacy was assessed by mycologic examination and measurement of the growth of unaffected nail.. At the end of the study 76% of the group who received terbinafine and 39% of those who received griseofulvin were found to be completely cured (p = 0.001). Drug tolerability was equally good in both treatment groups, without any clinically relevant changes in laboratory biochemical values.. Short-duration treatment (3 months) for fingernail dermatophytosis with terbinafine and griseofulvin is well tolerated. However, terbinafine was associated with a higher cure rate.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alanine Transaminase; Antifungal Agents; Double-Blind Method; Drug Eruptions; Female; Fingers; Follow-Up Studies; Gastrointestinal Diseases; Germany; Griseofulvin; Humans; Male; Middle Aged; Naphthalenes; Onychomycosis; Terbinafine; Time Factors; Treatment Outcome

Topics: Adult; Antifungal Agents; Double-Blind Method; Female; Griseofulvin; Humans; Male; Middle Aged; Naphthalenes; Onychomycosis; Terbinafine

Toenail tinea is a very recalcitrant dermatosis. Griseofulvin at > or = 500 mg/day is the current medication of choice, but it is minimally successful. In a controlled open trial ultramicrosize griseofulvin (UMSG) at doses of 660 and 990 mg/day was compared with itraconazole at 100 mg/day in 109 patients. At 4-week intervals, the patients were evaluated for their clinical and mycological statuses and adverse reactions. Treatment was given for up to 18 months. Compliance was checked by tablet counting. Response (cure, partial cure, marked improvement) was analyzed by the intent-to-treat method. Cured and partially cured patients were followed up. Except for one early dropout, the toenails (mean, 6 to 7) were involved. Cure or partial cure was found in 6% (UMSG at 660 mg), 14% (UMSG at 990 mg), and 19% (itraconazole at 100 mg) of patients (P = 0.2097); marked improvement was found in 36, 44, and 39% of patients in the three treatment groups, respectively. Most patients had to be treated for 18 months. Failure was related to short medication periods (adverse drug reactions, dropout). While stable cure was not obtained with UMSG at 660 mg, the higher dose of UMSG and itraconazole gave stable cures in the other patients. Side effects of nausea, diarrhea, and headache were found in 20, 26, and 11 patients, respectively (P = 0.0028), and the numbers in whom medication had to be discontinued differed, too (P = 0.0137). While there was no major difference with glutamic-pyruvic transaminase and gamma-GT, total and low-density lipoprotein cholesterol levels declined slightly in the itraconazole group (P = 0.0357 and P = 0.0639, respectively, at 3 months). More than 70% of the patients had an average compliance of > or = 90%; four patients (two dropouts) were poor compliers. In conclusion, it appears questionable whether griseofulvin can continue to be considered the "gold standard" in the treatment of toenail tinea. At present, itraconazole at 100 mg shows better efficacy and is better tolerated.

Topics: Adult; Chemistry, Pharmaceutical; Dose-Response Relationship, Drug; Female; Griseofulvin; Humans; Itraconazole; Male; Middle Aged; Onychomycosis; Particle Size; Patient Compliance

Sixty-one patients with a clinical diagnosis of onychomycosis in finger or toe nails were treated with itraconazole 100 mg/day or griseofulvin 500 mg/day for six to nine months. The infective causes were Trichophyton rubrum, Trichophyton mentagrophytes, or Trichophyton violaceum, and in two cases Candida albicans. A total of 27 finger and 390 toe nails were infected. Statistically significant intragroup reductions from baseline symptom severity values were seen at endpoint (month 6 or 9) for both treatment groups for all parameters: colour change, thickness, brittleness and unaffected area. No clinically or statistically significant differences between the treatment groups were seen at endpoint. However, the itraconazole group continued to improve during the follow-up, while the mean symptom severity ratings remained the same in the griseofulvin group. All itraconazole patients and 85% of griseofulvin patients were rated as cured or markedly improved at endpoint. Nineteen out of 26 evaluable itraconazole patients (73%) remained cured during the three month follow-up period, compared with 12 out of 17 griseofulvin patients (71%). The rather large number of drop-outs, especially among griseofulvin patients, makes it difficult to draw definitive conclusions of the symptom recurrence. Two itraconazole patients stopped medication due to an adverse event, compared to four patients in the griseofulvin group. The clinical laboratory data on itraconazole-treated patients did not show any statistically or clinically significant changes. In conclusion, itraconazole was at least as effective as griseofulvin in the treatment of onychomycosis. The itraconazole group continued to improve after the treatment was stopped. The results show that itraconazole 100 mg/day is safe and efficient in the long-term treatment of fungal nail infections.

Topics: Adolescent; Adult; Aged; Antifungal Agents; Arthrodermataceae; Dermatomycoses; Drug Administration Schedule; Female; Griseofulvin; Humans; Itraconazole; Ketoconazole; Male; Middle Aged; Onychomycosis; Single-Blind Method

The rate of success in treating onychomycosis with 40% urea ointment containing 1% bifonazole, with and without oral griseofulvin, was evaluated. Most patients had onychomycosis of the toes. 11 patients (group A: 5 men and 6 women, average age 48.5) were treated locally under occlusion with the ointment until dissolution of most of the nail, and then with 1% bifonazole cream for a total of 6 months. 11 others (group B: 3 men and 8 women, average age 42.5) received, in addition, griseofulvin 500 mg/day orally during that period. Treatment with the ointment alone did not give higher cure rates than the average of reported cure rates for griseofulvin alone. However, the results of treatment with 40% urea and 1% bifonazole ointment concomitantly with oral griseofulvin seemed superior to those of either of these agents alone, with full cure, partial cure and failure in group A of 22.2, 33.3 and 44.5%, respectively, and in group B, 45.4, 27.3 and 27.3%. This therapeutic experiment should be repeated in larger series of patients.

Topics: Administration, Oral; Adult; Antifungal Agents; Drug Therapy, Combination; Female; Griseofulvin; Humans; Imidazoles; Male; Middle Aged; Ointments; Onychomycosis; Urea

An open, comparative, randomized study was conducted using griseofulvin or itraconazole for the treatment of onychomycosis of the foot. Group I (45 patients) received itraconazole and Group II (45 patients) received griseofulvin. Each group was divided into three subgroups that received different topical treatment: antimycotic cream (isoconazole 1%), keratolytic cream (urea 40%), or placebo cream. The itraconazole group showed complete clearance in combination with isoconazole cream in 73.3% (11 of 15 patients), in combination with keratolytic cream in 78.5% (11 of 14 patients), and in combination with placebo cream in 91.6% (11 of 12 patients). The griseofulvin group showed complete clearance in combination with isoconazol cream in 46.1% (7 of 15 patients), in combination with keratolytic cream in 42.8% (6 of 15 patients), and in combination with placebo cream in 26.6% (4 of 15 patients). The itraconazole group showed better results compared with the griseofulvin group when the chi-square statistical method was used.

Topics: Administration, Topical; Adult; Antifungal Agents; Drug Therapy, Combination; Emollients; Female; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Keratolytic Agents; Ketoconazole; Male; Middle Aged; Onychomycosis; Prospective Studies

In an open study 58 patients with chronic dermatophytosis mainly caused by Trichophyton rubrum and five patients with Tinea capitis were treated with ketoconazole. The indications were ineffectiveness of or side effects to griseofulvin. Response to treatment varied from 1 week in scalp infections to 11 weeks in toe-nail lesions. Dermatophytosis of hands and feet were cured in 25%, marked improvement observed in further 30%. Toe- and finger-nail infections were cured in 20% and 43%, respectively, and marked improvement seen in further 36% and 14%, respectively. All scalp infections were cured without relapse. Recurrence of infections before 6 months after treatment was seen in 55-60% of hand and foot lesions and 33-38% of finger and toe-nail infections. In a double-blind study 20 patients with onychomycosis caused by T. rubrum the efficacy of ketoconazole was compared to that of griseofulvin. Cure rates in the griseofulvin group were 25% for finger-nails and zero for toe-nails, while 50% and 57% experienced marked improvement. In the ketoconazole group, 25% of finger-nail infections were cured and 75% markedly improved, while the corresponding figures for toe-nails were 11% and 89%, respectively. Adverse reactions to ketoconazole were seen in 29 (46%) of the patients in the open study and in 2 (20%) in the double-blind study and comprised mainly minor complaints. Side effects caused discontinuation in 12 patients, in two of whom due to toxic hepatitis.

Topics: Administration, Oral; Adult; Child; Clinical Trials as Topic; Dermatomycoses; Double-Blind Method; Griseofulvin; Humans; Ketoconazole; Onychomycosis; Random Allocation; Tinea; Tinea Capitis

A new method for assessing drug effectiveness in onychomycosis is presented. It is based on the clinical experience when three systemic antifungal drugs (griseofulvin, thiabendazole, and ketoconazole) are used against onychomycosis. These drugs act clinically as a barrier to the invasion of the fungus toward the proximal areas of the nail plate. A monthly quantity of normal nail plate should be produced by a given subject after the administration of an effective dose of the antifungal being tested. This quantity is best measured at monthly intervals, and this in fact reflects the normal monthly nail plate growth for the individual. Although there is a slight variation among individuals, most normal healthy subjects grow 1.5 to 2 mm of nail plate per month from their large toenails and 3 to 4 mm of nail plate per month from their fingernails. Utilizing this quantitative system, ketoconazole and griseofulvin ultramicrosize were compared in the treatment of distal subungual onychomycosis by Trichophyton rubrum. In a double-blind study, sixteen patients were treated. It appears that both griseofulvin and ketoconazole can eradicate the episode of onychomycosis. One-year use of a topical antifungal cream after clinical cure of onychomycosis prevented reinfection in the 12-month follow-up period. The use of ketoconazole in long-term therapy may result in serious side effects and should be considered carefully prior to treatment.

Topics: Adolescent; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Foot Dermatoses; Griseofulvin; Humans; Ketoconazole; Male; Middle Aged; Nails; Onychomycosis; Thiabendazole

Topics: Adolescent; Adult; Aged; Balanitis; Child; Child, Preschool; Clinical Trials as Topic; Clotrimazole; Dermatomycoses; Drug Evaluation; Female; Griseofulvin; Humans; Imidazoles; Infant; Male; Middle Aged; Onychomycosis; Tinea

Topics: Clinical Trials as Topic; Female; Griseofulvin; Humans; In Vitro Techniques; Male; Onychomycosis; Trichophyton

Fungal nail infection (Onychomycosis) often requires prolonged treatment and is associated with a high risk of resistance to treatment. Here in this contribution, we introduce a novel approach to enhance penetration and antifungal activity of the antifungal drug griseofulvin (GF). Solid dispersions were prepared with hydroxypropyl methylcellulose acetate succinate (HPMCAS) and combined with surfactant (either sodium dodecyl sulphate (SDS), dodecyl trimethylammonium bromide (DTAB), or Pluronic F127) using mechanochemical activation. The prepared powders were then suspended with spray-dried silica-coated silver nanoparticles and applied onto infected bovine hooves to assess permeability and antifungal activity. The results showed that the prepared nanosuspensions significantly suppressed fungal activity causing disruption of fungal biofilms. Raman mapping showed enhanced permeation while dynamic vapor sorption (DVS), and particle size measurements showed varied effects depending on the type of surfactant and milling conditions. The prepared nanosuspensions displayed enhanced solubility of the poorly soluble drug reaching approximately 1.2 mg/mL. The results showed that the dispersions that contained DTAB displayed maximum efficacy while the inclusion of colloidal silver did not seem to significantly improve the antifungal activity compared to other formulations.

Topics: Animals; Antifungal Agents; Bromides; Cattle; Drug Compounding; Excipients; Griseofulvin; Metal Nanoparticles; Onychomycosis; Particle Size; Poloxamer; Quaternary Ammonium Compounds; Silicon Dioxide; Silver; Sodium Dodecyl Sulfate; Solubility; Surface-Active Agents

Topics: Dermatomycoses; Griseofulvin; Humans; Onychomycosis; Terbinafine

Topics: Dermatomycoses; Griseofulvin; Humans; Onychomycosis; Terbinafine

1) Fungal nail infection, or onychomycosis, mainly affects toenails. Infections are generally asymptomatic. Spontaneous regressions, but also complications, appear to be rare. Discomfort and cosmetic complaint are occasionally reported; 2) After a review of the literature based on the standard Prescrire procedure, we examined the diagnosis and management of fungal nail infections; 3) Clinical signs of fungal nail infections are non-specific. Alternative diagnoses include psoriasis and nail microtrauma. Nail hyperkeratosis and leukonychia are useful diagnostic pointers. Matrix involvement has important implications in the choice of treatment; 4) Detection of fungal structures by direct examination of a nail sample is strongly suggestive of fungal nail infection. In contrast, cases of negative direct examination with positive culture must be interpreted with caution, as contamination is frequent; 5) Antifungal lacquers (5% amorolfine and 8% ciclopirox) applied to the nails cure about 30% of fungal infections and sometimes cause mild irritation. There is no firm evidence that these solutions are any more effective than other topical antifungals applied daily to the affected nail. Trimming, filing or grinding the nail, in addition to these drug treatments, is likely to be beneficial, but these measures have not been evaluated; 6) Chemical nail destruction with a combination of urea and bifonazole, followed by treatment with an antifungal ointment, can be used when the nail is markedly thickened. Non-comparative trials have shown cure rates close to 70% at three months when the matrix is not involved, and 40% with matrix involvement. Drug application is inconvenient and local reactions are frequent. Surgical nail avulsion carries a risk of local infection and permanent nail dystrophy; 7) Oral terbinafine is effective in more than 50% of cases but its cutaneous, hepatic and haematological adverse effects are severe in about 1 in 2000 patients and can be life-threatening; 8) It is better to treat Candida nail infections with oral azoles (ketonazole, itraconazole) than with terbinafine. These treatments carry a risk of serious adverse effects and numerous drug interactions; 9) Fungal nail infections are usually mild. Treatments with potentially severe adverse effects must therefore be used with caution. It is better not to treat fungal nail infections if the risks outweigh the expected benefits.

Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Azoles; Candidiasis; Drug Therapy, Combination; Griseofulvin; Humans; Lacquer; Naphthalenes; Occlusive Dressings; Onycholysis; Onychomycosis; Urea

Onychomycosis is an infection of the finger-and/or toenails by fungal microorganisms. If untreated, the process advances and destroys the nail plate. It may spread to involve the skin and does not heal spontaneously. There are different clinical presentations of onychomycosis which vary with the nature of the fungus and how it invades the nail unit. These different clinical forms require different therapeutic approaches. The successful treatment of onychomycosis requires special knowledge of the various clinical presentations, of the differential diagnosis and of recent advances in medical mycology. Therefore onychomycosis is best treated by dermatologists.

Topics: Antifungal Agents; Ciclopirox; Debridement; Diagnosis, Differential; Drug Therapy, Combination; Fluconazole; Griseofulvin; Humans; Imidazoles; Itraconazole; Morpholines; Mycological Typing Techniques; Naphthalenes; Onychomycosis; Pyridones; Terbinafine; Time Factors

The treatment of dermatophytoses is a complex process influenced by the properties of the antimycotic and the causative agent as well as by patient-related factors. Both the minimal inhibition concentration and the drug concentration in the infected tissue influence treatment success. Dermatophytes can be present as arthrospores in the skin, nails or hair. Non-proliferating dermatophytes (arthrospores) are less susceptible to antimycotics than proliferating ones, particularly to antibiotics which act through the inhibition of fungal ergosterol synthesis. Non-proliferating dermatophytes do not synthesize ergosterol, a essential component of fugal cell membranes. Also, dermatophytes accumulating in hollow spaces mostly in the nail plate, cannot be reached by antimycotics. The concentration of terbinafine and itraconazole is very high in sebum. This is of importance in the treatment of dermatophytoses localized to in the stratum corneum and in or around the hair. Preadolescent children do not have functioning sebaceous glands; this explains the difficulties in the treatment of pediatric tinea capitis.

Topics: Antifungal Agents; Arthrodermataceae; Child; Dermatomycoses; Fluconazole; Griseofulvin; Humans; Itraconazole; Ketoconazole; Microbial Sensitivity Tests; Naphthalenes; Onychomycosis; Terbinafine; Time Factors

These guidelines for management of onychomycosis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

Topics: Administration, Topical; Antifungal Agents; Candidiasis; Dermatomycoses; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Terbinafine; Treatment Failure

Antifungal agents and therapeutic approaches for tinea unguium have been increasing in number. Itraconazole, terbinafine and fluconazole were developed in the 1990s, and many useful methods with them for tinea unguium have been reported, including pulse therapy and short duration therapy. There have been many reports of not only oral treatments but also contrived topical treatments, in most of which improvement rates were high. However, each treatment has had some drawbacks and did not seem to gain the complete compliance of patients. Many patients dropped out, still having affected nails. It seems important to us to understand thoroughly the merits and demerits of each diversified treatment for tinea unguium and to provide the preferential treatment for each patient.

Topics: Administration, Oral; Antifungal Agents; Combined Modality Therapy; Fluconazole; Griseofulvin; Humans; Itraconazole; Naphthalenes; Occlusive Dressings; Onychomycosis; Pulse Therapy, Drug; Terbinafine

The "complete cure" of onychomycosis requires long-term treatment with a systemic antifungal agent. Therefore, to properly assess the effects of an antifungal agent on onychomycosis requires a long follow-up. We have conducted a retrospective analysis of the patients treated with griseofulvin (GRF) from 1962 to 1992 and a clinical study to compare the long-term effect of GRF with that of a new oral antifungal agent, itraconazole (ITCZ), for patients who received treatment from 1992 to 1995. For the retrospective study, 281 patients who were microscopically diagnosed as having onychomycosis at the Department of Dermatology, Faculty of Medicine, University of Tokyo, and received GRF administration in 1962, 1972, 1982, and 1992, were evaluated for cure rate and dropout rate. The total cure rate was 29.2%, but the cure rate was 68.8% for the patients who continued their medication for more than one year. For the comparative study, 139 patients who received the treatment at the same institution between 1992 and 1995 were evaluated. The cure rate and the dropout rate for GRF were found to be 23.8% (23/97) and 52.6% (51/97) respectively. The cure rate and the dropout rate for ITCZ were found to be 50.0% (21/42) and 38.1% (15/42). When the two treatment protocols were compared for their long-term effects, we found that most of the patients treated with ITCZ were cured within 3 years, and about 30% of the patients treated with GRF remained uncured even after long-term administration of the agent. Furthermore, from a multiple regression analysis, the GRF/ITCZ administration required to cure onychomycosis was estimated to be 3.92 + 0.161 [Age (years)] + 0.635 [Number of infected toenails] months. The results of this study suggest that the biggest problem associated with the treatment of onychomycosis with an oral antifungal agent is compliance in long-term therapy. Notably, the final cure rate of ITCZ therapy went over 90%, suggesting that the low dose continuous therapy, the standard treatment protocol in Japan, was a key contributing factor for the higher cure rate for ITCZ.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Child; Child, Preschool; Female; Follow-Up Studies; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Itraconazole; Male; Middle Aged; Onychomycosis; Regression Analysis; Retrospective Studies; Treatment Outcome

Fungal infections of the skin as well as of the nails and hair due to dermatophytes or due to yeasts or moulds still form a major portion of skin diseases overall. Effective therapy of mycoses is not always simple to achieve. In less severe cases topical therapy can be sufficient, but in extensive cutaneous infections, previous resistance to treatment and especially hyperkeratotic tinea and onychomycosis, systemic therapy can be mandatory. For systemic therapy, in particular azoles, i.e. itraconazole and fluconazole as well as the allylamine terbinafine are worth considering. The older antimycotics, i.e. griseofulvin and also ketoconazole are more and more replaced by other, newer drugs. For optimal treatment of a given mycosis, therapy can and should correspond to the individual situation. This applies both to the type of drug and its mode of application. The treatment of choice is the one with the best benefit to risk ratio and the best benefit to cost ratio. Unfortunately, as yet, a cure cannot be expected in every single case.

Topics: Administration, Cutaneous; Administration, Oral; Antifungal Agents; Cost-Benefit Analysis; Dermatomycoses; Fluconazole; Griseofulvin; Hair Diseases; Humans; Itraconazole; Ketoconazole; Naphthalenes; Odds Ratio; Onychomycosis; Terbinafine; Tinea

Topics: Administration, Oral; Antifungal Agents; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Reproducibility of Results; Terbinafine; Treatment Outcome

Two studies on the pharmacokinetics of fluconazole in skin and nails are reported here. In 1 study, 12 healthy volunteers received fluconazole 50 mg once daily for 12 days and 11 healthy volunteers received fluconazole 150 mg once weekly for 2 weeks. Fluconazole assays were performed on samples of serum, stratum corneum, dermis-epidermis, and eccrine sweat. In a second study, 36 patients with toenail onychomycosis received either fluconazole 150 mg once weekly or griseofulvin 1000 mg once daily for 12 months. Fluconazole assays were performed on nail clippings and serum samples from the patients receiving fluconazole. Tissue concentrations of fluconazole regularly exceeded plasma concentrations in these studies. In the skin study, the highest concentrations were achieved in stratum corneum, with accumulation occurring up to the end of dosing. Subjects who received 50 mg once daily had higher levels of fluconazole in stratum corneum, sweat, and epidermis-dermis than those subjects who received 150 mg once weekly. In the toenail study, fluconazole concentrations increased for the first 6 months, reaching levels much higher than serum concentrations (P < .001), with no significant difference between healthy and diseased nails.

Topics: Administration, Oral; Adult; Antifungal Agents; Fluconazole; Griseofulvin; Humans; Male; Nails; Onychomycosis; Skin; Sweat

Topics: Administration, Oral; Administration, Topical; Adult; Antifungal Agents; Child; Dermatomycoses; Griseofulvin; Humans; Naphthalenes; Onychomycosis; Terbinafine

Topics: Antifungal Agents; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Otitis Externa

Onychomycosis of the toenails is a condition that responds poorly to griseofulvin. The introduction of terbinafine in Canada in May 1993 resulted in a marked shift in the choice of treatment for pedal onychomycosis.. A questionnaire survey was carried out in 1996 among Canadian dermatologists regarding the management of onychomycosis.. There were 160 respondents from the roughly 350 practicing dermatologists. The dermatologists saw 8 +/- 0.6 patients per week (average +/- standard error (SE) with suspected or diagnosed onychomycosis, with 5 +/- 0.5 patients per week consulting the dermatologists for the first time. Most dermatologists performed mycological testing prior to starting treatment for onychomycosis. The management options for onychomycosis (mean +/- SE) were oral systemic antifungal therapy 51 +/- 3%, no therapy 31 +/- 3%, and nondrug therapy 9 +/- 2%. The majority of dermatologists (83%) used terbinafine as first-line therapy if, indeed, they used oral antifungal agents. In contrast, griseofulvin and ketoconazole were used as first-line therapy in 5% and 1% of cases, respectively. In Canada, there are no monitoring requirements when using oral terbinafine for onychomycosis. Therefore, it is not surprising that only 30% of dermatologists performed monitoring with terbinafine. In contrast, the frequency of monitoring with griseofulvin and ketoconazole was 40% and 80%, respectively. The subset of dermatologists who reported monitoring carried it out in only a fraction of their patients: 47%, 53% and 83% for terbinafine, griseofulvin, and ketoconazole, respectively. Therefore, the overall number of patients in whom regular monitoring was performed was 14.1% 21.2%, and 71.4% for terbinafine, griseofulvin, and ketoconazole, respectively. The perceived cure rates with terbinafine and griseofulvin (mean +/- SE) were 83.7 +/- 1% and 41 +/- 3.1%, respectively.. In May 1996, within three years of the introduction of terbinafine to Canada, this agent has become the drug of choice for the treatment of pedal onychomycosis (at the time of the survey neither itraconazole or fluconazole were approved for onychomycosis). Terbinafine has been found to be very effective and safe, and only a minority of dermatologists perform regular monitoring with this drug.

Topics: Administration, Oral; Antifungal Agents; Canada; Dermatology; Female; Foot Dermatoses; Griseofulvin; Humans; Ketoconazole; Male; Naphthalenes; Onychomycosis; Practice Patterns, Physicians'; Surveys and Questionnaires; Terbinafine

Analysis of the computer records of 100 general practices from the CompuFile Doctors Independent Network revealed 1492 patients receiving treatment for onychomycosis in the first 6 months of 1994 with terbinafine, tioconazole, amorolfine or griseofulvin. These records indicated the average treatment time for each agent, number of general practitioner consultations and incidence of hospital referrals and minor surgery. Applying standard costs to this resource consumption gave the direct costs for each of these four agents. Published clinical and mycological cure rates allowed a cost per success to be calculated. These were as follows: terbinafine (n = 511) pound258, amorolfine (n = 315) pound312, griseofulvin (n = 196) pound356 and tioconazole (n = 470) pound520. Sensitivity analysis showed that terbinafine remained the most cost-effective option despite variations in resource costs. The cost impact on a typical practice for switching from a less to a more cost-effective treatment is discussed.

Topics: Antifungal Agents; Cost-Benefit Analysis; England; Family Practice; Griseofulvin; Humans; Imidazoles; Morpholines; Naphthalenes; Onychomycosis; Referral and Consultation; Retrospective Studies; Terbinafine

Until a few years ago, griseofulvin and ketoconazole were the only 2 oral agents available for the treatment of dermatophyte onychomycosis of the toenails. With the availability of the newer antifungal agents, such as itraconazole, terbinafine and fluconazole, the armamentarium of drugs available to treat onychomycosis has expanded. The objective of this study was to determine the relative cost effectiveness of the most commonly used oral antifungal agents in the US for the treatment of dermatophyte onychomycosis of the toenails from the perspective of a third-party payer. The time horizon was 3 years. A 5-step approach was used in this pharmacoeconomic analysis. First, the purpose of the study, the comparator drugs and their dosage regimens were defined. In step II, the medical practice and resource-consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was performed on all studies meeting prespecified criteria, and the mycological cure rates of the comparator drugs were determined. In step IV, the treatment algorithm for the management of onychomycosis was constructed for each drug. The cost-of-regimen analysis for each comparator incorporated the drug acquisition cost, medical-management cost and cost of managing adverse drug reactions. The expected cost per patient, number of symptom-free days (SFDs), cost per SFD and the relative cost effectiveness for the comparator drugs were calculated. In step V, a sensitivity analysis was performed. The drug comparators for this study were griseofulvin, itraconazole (continuous and pulse), terbinafine and fluconazole. The mycological cure rates [mean +/- standard error (SE)] from the meta-analysis were griseofulvin 24.5 +/- 6.7%, itraconazole (continuous) 66.4 +/- 6.1%, itraconazole (pulse) 76 +/- 9.3%, terbinafine 74 +/- 7% and fluconazole 59%. The cost per mycological cure was griseofulvin $US8089, itraconazole (continuous) $US1877, itraconazole (pulse) $US991, terbinafine $US1125 and fluconazole $US1506. The corresponding cost per SFD was griseofulvin $US7.05, itraconazole (continuous) $US2.18, itraconazole (pulse) $US1.26, terbinafine $US1.28 and fluconazole $US2.12. The resulting ratios of cost per SFD relative to itraconazole (pulse) [1.00] were terbinafine 1.02, itraconazole (continuous) 1:73, fluconazole 1.69 and griseofulvin 5.62. In conclusion, in this analysis, itraconazole (pulse) and terbinafine were the most cost-effective therapies for der

Topics: Antifungal Agents; Costs and Cost Analysis; Foot Dermatoses; Griseofulvin; Humans; Itraconazole; Naphthalenes; Onychomycosis; Terbinafine; United States

This analysis was conducted at HIP Health plan of New Jersey (a Northeastern group model health maintenance organization) to determine the most cost-effective therapy among the three currently available oral antifungal drugs that are indicated for the treatment of onychomycosis: griseofulvin, itraconazole, and terbinafine. Costs of an appropriate and complete treatment regimen were calculated for each of the three drugs based on average wholesale price. Efficacy was determined by meta-analysis of the published literature for those studies where appropriate treatment regimens for onychomycosis were put to use. Efficacy outcome measures were limited to mycologic cure rates in the more recalcitrant cases of toenail onychomycosis. From these measures of cost and efficacy, a cost/efficacy ratio was calculated for each drug by dividing the cost per treatment by the weighted average mycological cure rate. This ratio represents the cost per mycologically cured infection. The final outcome measure (the cost per mycologically cured infection) was $2,721.28, $1,845.05, and $648.96, for griseofulvin, itraconazole, and terbinafine continuous therapies, respectively. For itraconazole and terbinafine pulse therapy, the costs were $855.88 and $388.50, respectively. For both continuous and pulse therapy, terbinafine is apparently the most cost-effective drug, followed by itraconazole and then by griseofulvin. Terbinafine has the fewest drug interactions and the highest treatment success rate.

Topics: Antifungal Agents; Clinical Laboratory Techniques; Cost-Benefit Analysis; Drug Costs; Drug Interactions; Griseofulvin; Health Maintenance Organizations; Humans; Itraconazole; Naphthalenes; New Jersey; Onychomycosis; Outcome Assessment, Health Care; Recurrence; Terbinafine; Transaminases

Topics: Antifungal Agents; Clinical Trials as Topic; Dose-Response Relationship, Drug; Follow-Up Studies; Foot Dermatoses; Griseofulvin; Humans; Naphthalenes; Onychomycosis; Terbinafine

Topics: Antifungal Agents; Child; Female; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Microsporum; Naphthalenes; Onychomycosis; Terbinafine; Tinea Capitis; Trichophyton

Thirty-two strains of Trichophyton rubrum and 16 strains of Trichophyton mentagrophytes isolated from patients with tinea unguium in various parts of Germany were subjected to a microdilution test with six systemic or topical antimycotic agents. Apart from griseofulvin, there were no species-specific differences between the two species. Terbinafine was the most active antimycotic agent, with a MIC not exceeding 0.05 micrograms/ml.

Topics: Antifungal Agents; Germany; Griseofulvin; Humans; Microbial Sensitivity Tests; Onychomycosis; Species Specificity; Trichophyton

Topics: Griseofulvin; Humans; Male; Middle Aged; Muscle Contraction; Muscle, Skeletal; Muscular Diseases; Onychomycosis

Determination of the most cost-effective oral drug treatment of onychomycosis of the toenails in the Dutch situation, by comparing griseofulvin, itraconazole, ketoconazole and terbinafine.. Calculation of cost prices using a published meta-analysis.. The Netherlands.. Published efficacy and adverse reactions of treatment with griseofulvin, itraconazole, ketoconazole or terbinafine were related to 1993 Dutch cost prices of treatment.. Itraconazole and terbinafine offered similar chances of success, but itroconazole treatment had to be repeated more often. On average, the costs of the treatment with itraconazole were 1.5 times as high as those of treatment with terbinafine. Griseofulvin treatment was cheapest but required the longest treatment course.. A treatment with terbinafine is the most cost-effective, provided that onychomycosis has actually been established mycologically and all possible measures have been taken to prevent recurrence. It remains to be seen whether this drug treatment should be offered to all people affected by this essentially cosmetic problem.

Topics: Administration, Oral; Antifungal Agents; Cost-Benefit Analysis; Drug Costs; Griseofulvin; Humans; Itraconazole; Ketoconazole; Naphthalenes; Onychomycosis; Oxygenases; Terbinafine; Toes

Drug-alcohol interactions in patients who present to emergency departments with a severe "disulfiram-like" illness (including vomiting, diarrhea, flushing, tachycardia, and hypotension) must be recognized and treated appropriately. We report a case of such an interaction caused by oral griseofulvin and alcohol. Emergency physicians should be aware of this potential interaction.

Topics: Drug Synergism; Ethanol; Flushing; Griseofulvin; Humans; Hypotension; Male; Middle Aged; Onychomycosis; Paresthesia; Tachycardia; Vomiting

Topics: Cyclosporins; Drug Interactions; Griseofulvin; Humans; Kidney Transplantation; Male; Middle Aged; Onychomycosis

The neutrophilic phagocytic activity (absorption and enzymic bactericidal) is intensified in rubromycosis patients treated with nizoral vs. those administered griseofulvin. it is advisable to combine griseofulvin therapy with biogenic stimulants (pyrogenal, aloe, fiBS, vitreous body).

Topics: Biological Products; Blood Bactericidal Activity; Combined Modality Therapy; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Neutrophils; Onychomycosis; Phagocytosis; Tinea Pedis

This is a study to modify and simplify the classical laboratory procedures of mycological diagnosis of Tinea unguium. By means of a tube KOH digestion technique for microscopic examination of nail clippings and a paper disc transfer technique using a more uniform wool-fiber-yeast extract culture fluid as inoculum for all tests necessary for fungal identification, dermatophytes can be identified to a species level. To authenticate the advantage of the etiologic diagnosis of Tinea unguium by mycological studies, the promising result of our previous clinical therapeutic trial with Griseofulvin was presented.

Topics: Adolescent; Adult; Female; Griseofulvin; Humans; Male; Methods; Middle Aged; Onychomycosis; Trichophyton

Topics: Foot Dermatoses; Griseofulvin; Humans; Ketoconazole; Onychomycosis

Topics: Administration, Oral; Administration, Topical; Adult; Antifungal Agents; Drug Therapy, Combination; Female; Foot Dermatoses; Griseofulvin; Humans; Imidazoles; Male; Middle Aged; Onychomycosis

There is a wide variety of highly effective topical antifungal agents available for the treatment of dermatophytosis. In more widespread infections or those involving hair or nails oral therapy with griseofulvin or ketoconazole can be used. With both forms of therapy certain types of dermatophyte infection are clinically resistant to treatment. These include onychomycosis, infections of the sole caused by T.rubrum and certain forms of tinea capitis (e.g. favus) or tinea corporis. In future consideration needs to be given to find the optimum duration and frequency of treatment and better methods of allowing penetration of drugs into nails and heavely keratinised sites.

Topics: Administration, Oral; Administration, Topical; Griseofulvin; Humans; Imidazoles; Ketoconazole; Onychomycosis; Phenyl Ethers; Tinea; Tinea Capitis; Tinea Pedis; Tolnaftate

The imidazoles have been appreciated for approximately fifteen years as a family of antifungals. Most derivatives, like the protype compounds, miconazole and clotrimazole, are effective only in a topical dose form. The topical imidazoles are generally thought to be superior to other topical antifungals. The first orally available imidazole, ketoconazole has ushered in a new era of potent, oral, broad-spectrum antifungal therapy. The imidazoles as a class are the treatment of choice for four dermatophyte infection syndromes. They are the preferred alternative therapy in another six syndromes. There is insufficient data to recommend one topical azole over the other. The topicals are inadequate for control of six clinical-anatomical infection syndromes. Griseofulvin remains the standard oral therapy in all situations except chronic, extensive dermatophytosis, where ketoconazole has proven to be more efficacious. The recognition of potential significant adverse effects, namely an idiopathic hepatitis and dose-dependent adrenal and testicular dysfunction have reduced ketoconazole's potential role in the dermatophytoses. Ketoconazole is a useful alternative to griseofulvin when oral therapy is required and the causative organism is insensitive to griseofulvin, or infection fails to respond to griseofulvin, or griseofulvin is contraindicated due to allergy, photosensitivity, porphyrinuria, intolerance, etc.

Topics: Administration, Oral; Administration, Topical; Antifungal Agents; Griseofulvin; Humans; Imidazoles; Ketoconazole; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Topics: Griseofulvin; Humans; Laser Therapy; Nails; Onychomycosis; Prognosis

This article summarizes the diseases of the nail caused by fungi. The clinical appearance of the diseases are the key to understanding their causes. Therapy is updated. Specifically discussed are distal subungual onychomycosis, white superficial onychomycosis, proximal subungual onychomycosis, and onychomycosis in chronic mucocutaneous candidiasis.

Topics: Adult; Candida albicans; Candidiasis, Chronic Mucocutaneous; Foot Dermatoses; Glutaral; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Middle Aged; Onychomycosis; Recurrence

Ketoconazole 200-400 mg was given once daily for a maximum period of 12 months to 31 patients with chronic (mean duration, 12 years) dermatophyte infections of the hands and/or feet. Griseofulvin had previously been withdrawn due to intolerance or lack of effect. All skin and nail infections improved clinically. Fifty percent of the patients with skin infections and 26% of those with nail infections became clinically clear and culture-negative. Six months later, relapses had occurred in 8 of 12 patients (67%) with cleared skin lesions, and in 2 of 5 (40%) with cleared nail infections. Ketoconazole was discontinued in one patient due to headache and in another due to asymptomatic transient elevation of hepatic laboratory tests. Ketoconazole is an alternative when a replacement for griseofulvin is required, provided the degree of disability justifies the risk of drug toxicity.

Topics: Female; Griseofulvin; Hand Dermatoses; Humans; Ketoconazole; Male; Middle Aged; Onychomycosis; Recurrence; Time Factors; Tinea; Tinea Pedis

Topics: Gastrointestinal Hemorrhage; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Adult; Drug Therapy, Combination; Female; Griseofulvin; Hand Dermatoses; Humans; Male; Middle Aged; Onychomycosis; Pentoxyl; Placental Extracts; Tinea Pedis; Trichophyton; Uracil

We describe a case of tinea unguis in a 20 year old female student from Caracas. The peri-ungual skin of a thumb appeared altered first and, since 6 months, the lamina was being progressively invaded and destroyed. At the direct mycologic examination numerous, regular and irregular, hyaline fungal hyphae were visible. Culture was performed 9 times: several molds did grow, among which, eight times, we got numerous colonies of a strain that has been identified to Nannizzia gypsea (+). Owing to the rarity of the observation the bases for the diagnosis are discussed and the pertinent literature is reviewed.

Topics: Adult; Female; Griseofulvin; Hand Dermatoses; Humans; Miconazole; Microsporum; Onychomycosis

Ketoconazole is an effective treatment for chronic superficial candidiasis as well as chronic dermatophytosis. In the latter group of infections the best results were obtained in patients with tinea corporis who were not responsive to griseofulvin. It is possible to maintain some patients with chronic mucocutaneous candidiasis in remission without using prophylactic ketoconazole, although relapses may occur. However, the responses of patients with Hendersonula and Scytalidium infections as well as those with subcutaneous mycoses, such as eumycetoma, were disappointing. Patients who have an inadequate response to ketoconazole may also have subnormal serum levels of the drug and the value of such estimations in routine management needs further evaluation.

Topics: Adolescent; Adult; Antifungal Agents; Candidiasis; Candidiasis, Chronic Mucocutaneous; Dermatomycoses; Female; Griseofulvin; Humans; Imidazoles; Ketoconazole; Kinetics; Male; Microbial Sensitivity Tests; Middle Aged; Mitosporic Fungi; Mycoses; Onychomycosis; Piperazines; Tinea

Topics: Griseofulvin; Humans; Ichthyosis; Infant; Male; Onychomycosis; Tinea

Patients with onychomycosis (tinea) of finger- and toenails underwent combined treatment: avulsion of nail plate, local antimycotic and systemic griseofulvin treatment. Avulsion of the involved nails was performed by the patients themselves chemo-mechanically using 50% KI-ointment. 1,500 nails were successfully removed. Out of 250 patients 101 were clinically and mycologically cured after a median delay of 6.5 months. Only 50% of the 101 patients remained cured up to one year after cessation of therapy. Atraumatic nail avulsion in combination with chemotherapy is a reliable, inexpensive, painless, and effective alternative method to surgical excision treating onychomycosis.

Topics: Adult; Female; Griseofulvin; Humans; Male; Ointments; Onychomycosis; Potassium Iodide

Topics: Adult; Candidiasis; Dermatomycoses; Griseofulvin; Humans; Imidazoles; Nail Diseases; Onychomycosis; Paronychia; Selenium; Tinea Capitis; Tinea Pedis; Tinea Versicolor

Presented herein are two cases of dermatomycosis that occurred in Indiana. The causative agent in each case was Trichophyton verrucosum. The first patient had onychomycosis, tinea pedis, and tinea cruris. Although of long duration, his condition cleared readily after the administration of griseofulvin. The second patient, a recent immigrant from Yugoslavia, had erythematous, minimally scaling lesions was more typical, since T. verrucosum is commonly found on exposed parts of the skin. In this patient, also, lesions cleared after the administration of griseofulvin therapy.

Topics: Female; Griseofulvin; Humans; Indiana; Male; Middle Aged; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Topics: Adolescent; Adult; Aged; Female; Foot Dermatoses; Griseofulvin; Hand Dermatoses; Humans; Male; Middle Aged; Nails; Onychomycosis; Russia; Urban Population

The diagnosis and management of dermatophytic fungal infections depends upon a knowledge of the causative organism fungi, the morphological patterns which can be produced and the type, extent and duration of treatment necessary to effect cure.

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Humans; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Chronic generalized trichophytosis in a 44-year-old female is reported. The disease began when she was 15 and gradually spread from the scalp. Surviving hairs on the scalp and eyebrows showed an endothrix invasion. Enlargement and fistulization of the cervical and axillary lymph nodes were also present. Trichophyton schoenleinii was cultured from the scalp while Trichophyton violaceum was isolated from the body skin, the nail and lymph nodes. Griseofulvin produced significant improvement with occasional relapses. The possible role of the basic cell-mediated immune defect, as revealed by the decreased number of the T and B cells, is discussed.

Topics: Adult; Chronic Disease; Female; Griseofulvin; Humans; Onychomycosis; Tinea Capitis; Trichophyton

Topics: Adult; Aged; Dimethyl Sulfoxide; Female; Griseofulvin; Humans; Iodobenzoates; Male; Middle Aged; Onychomycosis; Salicylates

Therapeutic failure of griseofulvin therapy are fairly common, espcially when toe nail infections are treated. The reasons for the failures remain largely unknown. The aim of the present investigation was to study whether pharmacokinetic factors may be responsible. At first, single-dose and steady-state pharmacokinetics of griseofulvin were analysed in volunteers by means of a gas-chromatographic technique. It was found that there was no difference in plasma levels of the three brands of griseofulvin commercially available in Sweden, whereas there was a singificant difference of absorption between individuals. The plasma half-life varied considerably from day to day in the same individual. In the second part of the investigation griseofulvin plasma concentrations were determined in 27 patients treated with griseofulvin for onychomycosis and related to the therapeutic result. All patients but one were initially improved but the therapeutic effect faded in 15 patients after 5-20 months of treatment ("partially healed" patients). In 11 patients the nail infections were clinically healed after 6-24 months. However, no statistically significant difference of the plasma griseofilvin levels could be demonstrated between the healed and partially healed groups. Some possible reasons for the therapeutic failure are discussed.

Topics: Adolescent; Adult; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Time Factors

The occurrence of cholestatic jaundice in a patient receiving griseofulvin is described. The clinical manifestations, laboratory features, and pathological lesion of drug-induced hepatotoxicity are discussed. Complete recovery followed the discontinuation of drug administration. The potential hepatotoxicity of griseofulvin and the importance of close monitoring of liver function studies in patients receiving this drug are emphasized.

Topics: Biopsy, Needle; Cholestasis; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Female; Griseofulvin; Humans; Infant; Onychomycosis; Toes

Topics: Adult; Female; Follow-Up Studies; Germany, East; Griseofulvin; Humans; Male; Onychomycosis; Recurrence

Topics: Adult; Drug Evaluation; Female; Follow-Up Studies; Griseofulvin; Humans; Middle Aged; Onychomycosis; Tinea Pedis

Topics: Adult; Candidiasis, Cutaneous; Female; Griseofulvin; Humans; Onychomycosis; Tinea

Topics: Antifungal Agents; Candidiasis; Child; Dermatomycoses; Diagnosis, Differential; Fluorescence; Griseofulvin; Humans; Microsporum; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis; Tinea Versicolor; Trichophyton

Topics: Animals; Antifungal Agents; Arthrodermataceae; Culture Media; Dermatomycoses; Disease Reservoirs; Epidermophyton; Griseofulvin; Guinea Pigs; Humans; Microsporum; Onychomycosis; Tinea; Tolnaftate; Trichophyton

Topics: Adult; Aged; Antifungal Agents; Arteriosclerosis Obliterans; Endarteritis; Female; Foot Diseases; Griseofulvin; Humans; Leg; Male; Middle Aged; Onychomycosis

Topics: Candida albicans; Candidiasis; Cells, Cultured; Dermatomycoses; Epidermophyton; Fungi; Griseofulvin; Humans; Microsporum; Mycoses; Onychomycosis; Skin; Tinea; Trichophyton

Topics: Adult; Aged; Antifungal Agents; Female; Griseofulvin; Humans; Male; Middle Aged; Mitosporic Fungi; Onychomycosis

Topics: Amphotericin B; Griseofulvin; Humans; Natamycin; Onychomycosis; Tinea; Tinea Pedis

Topics: Adult; Female; Griseofulvin; Humans; Mycoses; Onychomycosis; Tinea Capitis; Trichophyton

Topics: Dimethyl Sulfoxide; Female; Griseofulvin; Humans; Male; Mycoses; Onychomycosis; Solutions

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Humans; Onychomycosis; Quaternary Ammonium Compounds; Tinea

Topics: Adult; Aspergillus; Drug Resistance, Microbial; Female; Griseofulvin; Humans; Male; Mitosporic Fungi; Onychomycosis; Penicillium

Topics: Griseofulvin; Humans; Liver Function Tests; Onychomycosis; Porphyrins; Tablets

Topics: Aspartate Aminotransferases; Erythrocytes; Griseofulvin; Humans; Iron; Liver; Liver Function Tests; Long-Term Care; Onychomycosis; Photosensitivity Disorders; Porphyrias; Porphyrins; Time Factors

Topics: Agar; Diagnosis, Differential; Edible Grain; Epidermophyton; Fingers; Griseofulvin; Humans; Hydroxides; Methods; Microscopy; Nails; Onychomycosis; Potassium; Tellurium; Time Factors; Toes; Trichophyton

Topics: Adult; Drug Resistance, Microbial; Female; Griseofulvin; Humans; Onychomycosis; Tinea; Trichophyton

Topics: Adolescent; Adult; Griseofulvin; Humans; Methods; Middle Aged; Onychomycosis

Topics: Arm; Arteries; Blood Volume; Blood Volume Determination; Cold Temperature; Electronics; Female; Griseofulvin; Hot Temperature; Humans; Leg; Male; Methods; Onychomycosis; Pulse; Skin; Tinea

Topics: Dermatomycoses; Griseofulvin; Humans; Onychomycosis; Time Factors; Tinea Pedis

Topics: Adult; Griseofulvin; Humans; Infertility, Male; Male; Onychomycosis; Spermatozoa

Topics: Adult; Aged; Antifungal Agents; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Adult; Aged; Austria; Factor Analysis, Statistical; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Adult; Aged; Austria; Factor Analysis, Statistical; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Adult; Baths; Carbon Dioxide; Clothing; Female; Fingers; Griseofulvin; Humans; Male; Massage; Onychomycosis; Sterilization; Toes; Trichophyton

Topics: Adult; Female; Griseofulvin; Herpes Zoster; Humans; Male; Middle Aged; Onychomycosis; Tinea; Tinea Pedis

Topics: Griseofulvin; Humans; Iodine; Onychomycosis; Trichophyton

Topics: Antifungal Agents; Griseofulvin; Humans; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis; Trichophyton

Topics: Antifungal Agents; Copper; Griseofulvin; Humans; Onychomycosis; Ultraviolet Rays

Topics: Adolescent; Adult; Cystine; Female; Gelatin; Griseofulvin; Humans; Male; Middle Aged; Nails; Onychomycosis; Vitamin A

Topics: Antifungal Agents; Culture Media; Dimethyl Sulfoxide; Drug Synergism; Epidermophyton; Griseofulvin; Humans; Microscopy, Phase-Contrast; Microsporum; Onychomycosis; Trichophyton

Topics: Body Temperature; Drug Resistance, Microbial; Griseofulvin; Humans; Onychomycosis

Topics: Fingers; Griseofulvin; Humans; Onychomycosis; Toes

Topics: Adolescent; Adult; Antifungal Agents; Child; Child, Preschool; Dermatologic Agents; Female; Griseofulvin; Humans; Male; Onychomycosis; Tinea

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Griseofulvin; Humans; Onychomycosis; Tinea

Topics: Arthrodermataceae; Candida; Fingers; Follow-Up Studies; Griseofulvin; Humans; Nails; Onychomycosis; Toes

Topics: Adolescent; Adult; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Outpatient Clinics, Hospital; USSR

Topics: Adolescent; Adult; Aged; Child; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Griseofulvin; Humans; Nails; Onychomycosis

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Adult; Antifungal Agents; Female; Griseofulvin; Humans; Male; Onychomycosis

Topics: Adult; Aged; Ambulatory Care; Antifungal Agents; Female; Griseofulvin; Humans; Lactates; Male; Middle Aged; Ointments; Onychomycosis; Salicylates

Topics: Adult; Antifungal Agents; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Adult; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Tinea Pedis

Topics: Aged; Chronic Disease; Griseofulvin; Humans; Onychomycosis

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Adrenal Cortex Hormones; Griseofulvin; Humans; Nails; Nystatin; Onychomycosis; Paronychia; Psoriasis; Sulfacetamide; Thymol

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Adolescent; Adult; Aged; Child; Female; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis

Topics: Animals; Griseofulvin; Humans; Liver Diseases; Mice; Onychomycosis; Porphyrias; Porphyrins

Topics: Dermatomycoses; Griseofulvin; Humans; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Topics: Adult; Ambulatory Care; Female; Griseofulvin; Humans; Middle Aged; Nurses; Onychomycosis; Physical Therapy Modalities; Schools, Nursery; Tinea Pedis; USSR

Topics: Drug Therapy; Griseofulvin; Humans; Ointments; Onychomycosis

Topics: Buttocks; Drug Therapy; Griseofulvin; Humans; Onychomycosis; Tinea; Tinea Pedis; Trichophyton

Topics: Drug Therapy; Griseofulvin; Humans; Long-Term Care; Onychomycosis

Topics: Griseofulvin; Humans; Nails; Onychomycosis; Surgical Procedures, Operative

Topics: Griseofulvin; Humans; Nails; Onychomycosis; Particulate Matter; Silicones; Tinea Pedis; Trichophyton

Topics: Adult; Antifungal Agents; Female; Foot Diseases; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Toes

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Adolescent; Adult; Aged; Child; Female; Fingers; Griseofulvin; Humans; Male; Middle Aged; Onychomycosis; Toes; Trichophyton

Topics: Dermatomycoses; Griseofulvin; Hand Dermatoses; Hospitals, Municipal; Humans; Netherlands; Onychomycosis

Topics: Antifungal Agents; Griseofulvin; Humans; Onychomycosis; Radiotherapy

Topics: Candidiasis, Cutaneous; Dermatomycoses; Foot Diseases; Griseofulvin; Humans; Onychomycosis; Tinea Pedis

Topics: Benzoates; Dermatomycoses; Griseofulvin; Humans; Microsporum; Nails; Onychomycosis; Salicylic Acid; Thumb; Thymol; Tinea; Tinea Pedis; Trichophyton; Veterinary Medicine

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Dermatomycoses; Drug Therapy; Griseofulvin; Humans; Japan; Onychomycosis; Tinea Pedis

Topics: Dermatomycoses; Drug Therapy; Griseofulvin; Onychomycosis

Topics: Drug Therapy; Female; Griseofulvin; Humans; Onychomycosis; Pruritus Ani; Pruritus Vulvae

Topics: Griseofulvin; Humans; Onychomycosis; Surgical Procedures, Operative

Topics: Drug Therapy; Griseofulvin; Onychomycosis; Skin Diseases; Tinea; Tinea Favosa

Topics: Animals; Child; Drug Therapy; Griseofulvin; Humans; Lepidoptera; Onychomycosis; Tinea; Tinea Capitis; Tinea Favosa; Toxicology; USSR

Topics: Drug Therapy; Fungi; Griseofulvin; Humans; Mycoses; Onychomycosis

Topics: Drug Therapy; Griseofulvin; Humans; Infant; Onychomycosis

Topics: Drug Therapy; Exanthema; Gastrointestinal Diseases; Griseofulvin; Headache; Onychomycosis; Toxicology

Topics: Drug Therapy; Griseofulvin; Onychomycosis

Topics: Dermatomycoses; Drug Therapy; Follow-Up Studies; Griseofulvin; Onychomycosis; Toxicology

Topics: Griseofulvin; Humans; Onychomycosis; Tinea; Tinea Pedis

Topics: Dermatomycoses; Griseofulvin; Onychomycosis

Topics: Griseofulvin; Onychomycosis; Tinea Pedis

Topics: Griseofulvin; Humans; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis

Topics: Blood Chemical Analysis; Data Collection; Feces; Griseofulvin; Humans; Metabolism; Onychomycosis; Porphyrins

Topics: Combined Modality Therapy; Griseofulvin; Hand Dermatoses; Humans; Leg Dermatoses; Manipulation, Osteopathic; Onychomycosis

Topics: Animals; Dermatomycoses; Griseofulvin; Humans; Lepidoptera; Onychomycosis; Tinea; Tinea Pedis

Topics: Edema; Griseofulvin; Macula Lutea; Macular Edema; Onychomycosis; Toxicology

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Actinomycosis; Antifungal Agents; Blastomycosis; Dermatomycoses; Drug Therapy; Egypt; Fungi; Griseofulvin; Humans; Mycoses; Nocardia Infections; Onychomycosis; Tinea Capitis; Tinea Favosa; Tinea Pedis

Topics: Antifungal Agents; Caryophyllaceae; Drug Therapy; Griseofulvin; Humans; Onychomycosis; Paronychia; Radiotherapy; Tinea Pedis

Topics: Griseofulvin; Humans; Onychomycosis

Topics: Fungi; Griseofulvin; Humans; Mycoses; Onychomycosis; Tinea; Tinea Capitis; Tinea Pedis; Toxicology

Topics: Clinical Protocols; Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Griseofulvin; Humans; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis

Topics: Griseofulvin; Mycoses; Nails; Onychomycosis

Topics: Cardiovascular Physiological Phenomena; Cardiovascular System; Griseofulvin; Heart Rate; Humans; Onychomycosis; Pulse; Spasm; Vascular Diseases

Topics: Griseofulvin; Onychomycosis

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea; Tinea Pedis

Topics: Griseofulvin; Mycoses; Nail Diseases; Nails; Onychomycosis

Topics: Griseofulvin; Mycoses; Nail Diseases; Nails; Onychomycosis; Research

Topics: Dermatomycoses; Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Griseofulvin, a new orally administered antifungal antibiotic which has proved to be effective for the treatment of a wide variety of superficial fungus infections of man, was used in the treatment of 51 patients with infections of the toenails due to T. rubrum. Thirty-four of the patients were treated with griseofulvin alone and seven were treated with griseofulvin combined with surgical avulsion of all involved toenails. The remaining ten had bilateral infections, and avulsion was done on one foot but not the other before griseofulvin therapy was begun. Of 34 patients who were treated with griseofulvin alone, few had complete cure even after prolonged treatment. Some nails showed improvement for a time, then no further gain; some showed no improvement; some showed resistant wedges of infection which penetrated proximally toward the posterior nail fold.In the instances of surgical avulsion, clinically normal nails regrew during griseofulvin therapy. This simple procedure, with thorough removal of all underlying keratinous debris, apparently did away with foci of possible reinfection. The results of the study indicated that surgical avulsion of the toenails in combination with griseofulvin therapy is an effective and practical method of treating onychomycosis of the toenails due to T. rubrum.

Topics: Antifungal Agents; Dermatomycoses; Foot; Fractures, Bone; Griseofulvin; Humans; Male; Mycoses; Nail Diseases; Nails; Onychomycosis

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Administration, Oral; Dermatomycoses; Griseofulvin; Onychomycosis; Tinea

Topics: Griseofulvin; Humans; Nail Diseases; Nails; Onychomycosis; Tinea; Trichophyton

Topics: Griseofulvin; Nail Diseases; Nails; Onychomycosis; Tinea

Topics: Griseofulvin; Humans; Nail Diseases; Nails; Onychomycosis; Psoriasis; Tinea

Topics: Griseofulvin; Humans; Onychomycosis