Toenail Onychomycosis in Diabetic Patients
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Diabetes mellitus may be associated with serious sequelae, such as renal disease, retinopathy, and diabetic foot. A recent large prospective study has shown that onychomycosis is among the most significant predictors of foot ulcer. As the severity of onychomycosis may be associated with the length of time the individual has had the infection, early intervention is advisable owing to the progressive nature of the fungal infection. If left untreated, toenails can become thick, causing pressure and irritation, and thus act as a trigger for more severe complications.
In the treatment of onychomycosis, compliance and drug interactions are important considerations, as diabetic patients frequently take concomitant medications. Terbinafine and itraconazole have been investigated for the treatment of onychomycosis in diabetic patients and have been shown to have efficacy and safety profiles comparable to those in the nondiabetic population. Data from clinical trials and postmarketing surveillance suggest that drug interactions resulting in hypoglycemia may not be an important issue when itraconazole and terbinafine are used to treat diabetic patients receiving concomitant hypoglycemic medications. Patient advice and education in improved foot care are an integral part of onychomycosis management, and help achieve long-term cure and reduce the complications of diabetic foot.
KeywordsDiabetic Patient Fluconazole Itraconazole Terbinafine Glipizide
No sources of funding were used to assist in the preparation of this review. Prof. Mayser has spoken at symposia sponsored by sanofi aventis, Novartis and Janssen-Cilag. Drs Freund and Budihardja have no conflicts of interest that are directly relevant to the content of this review.
- 5.Boyko WL, Doyle JJ, Ryu S, et al. Onychomycosis and its impact on secondary infection development in the diabetic population. 4th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR); 1999 May 23-26; Arlington (VA)Google Scholar
- 36.Kill J. Treatment options for onychomycosis [online]. Available from URL: http://www.infectiousdiseasenews.com/article/33478.aspx [Accessed 2009 Apr 28]Google Scholar
- 41.Rich F, Karchmer A, Atillasoy ES. The safety and efficacy of oral terbinafine in the treatment of onychomycosis in diabetic patients. J Eur Acad Dermatol Venereol 1999; 12 Suppl. 2: 229Google Scholar
- 42.Bohannon NJ, Streja L. Effectiveness of terbinafine therapy for toenail onychomycosis in persons with diabetes. Diabetes 2000; 49 Suppl. 1: A195Google Scholar
- 43.Baran R, Sigurgeirsson B, de Berker D, et al. A multicentre, randomized, controlled study of the efficacy, safety and cost-effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine alone for the treatment of onychomycosis with matrix involvement. Br J Dermatol 2007; 157: 149–57PubMedCrossRefGoogle Scholar
- 48.Pollak R, Billstein SA. Safety of oral terbinafine for toenail onychomycosis. J Am Podiatr Med Assoc 1987; 87: 565–70Google Scholar