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2016 ; 2
(1-2
): 83-87
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Onychomycosis: Practical Approaches to Minimize Relapse and Recurrence
#MMPMID27843933
Tosti A
; Elewski BE
Skin Appendage Disord
2016[Sep]; 2
(1-2
): 83-87
PMID27843933
show ga
INTRODUCTION: Toenail onychomycosis is a common disease in which treatment
options are limited and treatment failures and disease recurrence are frequently
encountered. It usually requires many months of treatment, and recurrence may
occur in more than half of the patients within 1 year or more after the infection
has been eradicated. Data on long-term treatment, follow-up and recurrence are
limited. OBJECTIVE: Our objective is to interpret these data and recommend
practical approaches that should minimize recurrence based on our clinical
experience. RESULTS: Several factors have been suggested to play a role in the
high incidence of recurrence, but only the extent of nail involvement and
co-existing diabetes mellitus have been shown to have a significant impact.
CONCLUSION: The use of topical antifungals to prevent recurrences after complete
cure was achieved has been suggested by various workers and used successfully in
our practice. However, it has never been validated through clinical studies.
Topical prophylaxis once weekly or twice monthly would seem appropriate in those
patients most at risk. Prompt treatment of tinea pedis is essential, as is
ensuring family members are free from disease. Patient education and
pharmacologic intervention are equally important, and there are a number of
simple strategies patients can employ. Managing onychomycosis is a significant
long-term commitment for any patient, and minimizing recurrence is critical to
meet their expectations.