Results of a New Therapeutic Regimen in the Treatment of Onychomycosis

Abstract

The aim of the study reported was to investigate the simplest way to remove mycotic nails using a cream containing 40% urea and 1% bifonazole. A total of 38 patients with 79 affected nails were treated. Atraumatic removal of affected ungual plates required 12 days on average. The additional nail bed treatment included application of bifonazole 1% cream for 4 weeks. Therapeutic results were followed up for 12 months. No adverse side effects were observed. The aforementioned procedure aimed at the removal and treatment of affected nails resulted in a cure in 89% of cases, and the recurrence rate (11%) allows the conclusion that such atraumatic nail removal could be considered the method of choice.

Therapeutic problems related to mycotically altered nails have been attracting the dermatovenereologists’ attention for a long time. Oral griseofulvin treatment and, more recently, ketoconazole treatment are time-consuming procedures that are tolerated poorly and carried out unsystematically by patients. Further disadvantages of such a treatment are well known, toxic side effects and reports on resistant cases appearing more and more frequently.

Surgical removal of mycotically altered nails is the most rapid therapeutic method. However, it is accompanied by the risks of local anesthesia, intraoperative and postoperative pain, bleeding, possible secondary infection, etc. This type of invasive treatment must not be employed, for instance, in diabetics, in patients suffering from peripheral circulatory disorders or neurotrophic lesions in view of the risk of late sequels caused by a terminal arterial arch lesion manifesting itself in the form of gangrene of the fingers operated upon by this method.

Topical antifungal treatment does not produce satisfactory results due to the thickness and compactness of the horny ungual plate. Chemical atraumatic removal of nails by means of potassium iodine ointment followed by supplementary treatment of the fungal infection was introduced by Aravijski (1963) [5, 6]. KleineNatrop (1974) [5,6] modified this method and initiated its application on a large scale. In the meantime, less successful results in the softening and removal of nails have been reported [2, 3, 4, 8]: by means of 20% pyrogallic acid or by perforating altered nails and instilling dichloracetic acid into the holes (Brem) [2]. Farber and South (1978) introduced urea-containing ointment as the most suitable preparation aimed at an atraumatic nail removal [1, 7, 8]. Our efforts represent an additional step forward because we applied a combination of urea with the antifungal bifonazole. In the course of an open study we used 20% or 40% urea-containing cream with the addition of 1% bifonazole for the treatment of mycotically altered nails in out-patients.