Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy.
J Am Acad Dermatol. 2010 Mar;62(3):411-4. doi: 10.1016/j.jaad.2009.04.062.
Recurrences (relapse or reinfection) of onychomycosis are not uncommon, with percentages reported in various studies ranging from 10% to 53%.
We sought to determine the prevalence of long-term recurrences of toenail onychomycosis caused by dermatophytes cured after systemic antifungal treatment with terbinafine (T) or itraconazole (I) and identify risk factors for recurrences.
This 7-year prospective study, started in 2000 and ended in 2007, included 73 patients periodically followed after successful treatment of toenail onychomycosis using either T, 250 mg daily (59 patients), or I, 400 mg daily, for 1 week per month (14 patients). Patients were evaluated every 6 months, with clinical and mycological evaluations being performed.
Twelve of 73 patients (16.4%) developed a recurrence of onychomycosis a mean time of 36 months after successful treatment. These included 5 of the 14 patients (35.7%) who had taken I and 7 of the 59 (11.9%) who had taken T (P = .046).
The number of patients treated with T (59 patients) was more than that for I (14 patients).
The administration of systemic T to treat the first episode of onychomycosis may provide better long-term success than I in those patients with a complete response. Other factors including the presence of predisposing factors, use of nail lacquer as a prophylactic treatment, and the dermatophyte strain isolated were not significantly related to relapse.
甲真菌病的复发（复发或再感染）并不少见，在不同的研究中报告的百分比范围从 10%到 53%。
我们旨在确定特比萘芬（T）或伊曲康唑（I）系统抗真菌治疗后治愈的甲真菌病患者长期复发的患病率，并确定复发的危险因素。
这项 7 年的前瞻性研究于 2000 年开始，2007 年结束，包括 73 例患者，他们在成功治疗甲真菌病后定期随访，其中特比萘芬 250mg 每日（59 例）或伊曲康唑 400mg 每日，每月治疗 1 周（14 例）。患者每 6 个月评估一次，进行临床和真菌学评估。
73 例患者中有 12 例（16.4%）在成功治疗后平均 36 个月出现甲真菌病复发。其中 5 例（35.7%）接受 I 治疗，7 例（11.9%）接受 T 治疗（P=0.046）。
接受 T 治疗的患者（59 例）多于接受 I 治疗的患者（14 例）。
在完全应答的患者中，特比萘芬系统治疗首次发作甲真菌病可能比伊曲康唑提供更好的长期成功率。其他因素，包括潜在因素、使用指甲油作为预防治疗以及分离的真菌菌株，与复发无显著相关性。
