Abstract
Recently, itraconazole pulse therapy (400 mg/day) has become standard therapy for tinea unguium because the drug concentration in nails remains above the MIC after completion of pulse therapy. Nonetheless, since replacement of the affected nails with new, intact nails is often incomplete by the end of this therapy, close follow-up is essential for reliable evaluation of the therapeutic outcome. We recently conducted a study in which patients rated as responders to this therapy at 6 months after the start of treatment were followed for a longer period of time (3 years) after completion of therapy to evaluate treatment outcome (cure or recurrence /relapse) at this time-point. None of the patients had recurrence or relapse later than 12 months after the 6-month assessment of therapeutic response. In all cases, the affected nails were completely replaced with new, intact nails by 18 months. Then these patients were retrospectively compared with patients treated with two other regimens using itraconazole therapy that were used before 400 mg/day pulse therapy was approved, i.e., 200 mg/day pulse therapy and 100 mg/day continuous therapy. The comparison revealed that 400 mg/day pulse therapy was more effective than either of the other two previously used therapies, particularly for severe tinea unguium.
