Itraconazole pulse therapy in the treatment of disto-lateral subungual onychomycosis

Objective: To assess the efficacy of itraconazole pulse therapy in disto-lateral subungual onychomycosis. Design: Quasi interventional study. Place and Duration of Study: The study was conducted at the Department of Dermatology, KEMC/Mayo Hospital, Lahore, during the period from 1996-1998. Subjects and Methods: Sixty-seven patients, ages ranging from 19 to 55 years, with disto-lateral subungual onychomycosis were enrolled in the study period. Therapy was started with short pulse doses of itraconazole 200 mg twice daily for one week followed by a medicine-free interval of three weeks. Pulses were administered for two consecutive months in fingernail and three months for toenail onychomycosis. Patients were followed upto six months for fingernail onychomycosis and nine months for toenail onychomycosis. Results: Out of 67 cases, there were 62 evaluable patients. Trichophyton rubrum was the most common pathogen, isolated in 42 (67.8%) followed by Candida in 11 (17.8%), T. violaceum in 5 (8%), T. interdigitale in 3 (4.8%) and Epidermophyton floccosum in one (1.6%). Fingernails were affected in 46 cases whereas 16 had toenail infection. Clinical cure in finger and toenail onychomycosis was seen in 41 (89%) and 13 (81.2%) patients, respectively while mycological cure in 43 (93.5%) and 14 (87.5%) patients, respectively with itraconazole pulse therapy. Conclusion: Itraconazole was found to be effective, well-tolerated and safe therapy for disto-lateral subungual onychomycosis.