The successful treatment of finger Trichophyton rubrum onychomycosis with oral terbinafine.

Eleven patients with distal subungal onychomycosis of the fingers by Trichophyton rubrum infection were treated with daily doses of oral terbinafine, a new allylamine derivative. A 125-mg capsule was given twice daily. Each patient's nailplate was marked appropriately following the Zaias and Drachman method for the determination of antifungal efficacy in onychomycosis. Patients were monitored monthly for the antifungal effect of the drug, as well as side-effects, including laboratory values for liver and kidney function tests and a full blood count. At the end of 6 months, all 11 patients were clinically and mycologically normal. It can be concluded that 250 mg (125 mg b.i.d.) oral terbinafine is the most appropriate drug for the treatment of finger onychomycosis. No side-effects of any kind were noted in this 6-month period. Onychomycosis is a common disease of the toenails. No topical treatments have yet been found to be satisfactory. In a very motivated patient-doctor relationship, the use of topically applied thiabendazole has proved effective, particularly after nailplate avulsion. Systemic antifungal treatment is possible with griseofulvin and ketoconazole. Griseofulvin may cause enzyme induction in the liver, which requires a higher dose intake to achieve results. This has been demonstrated using the Zaias and Drachman method of judging successful antifungal clinical effects in onychomycosis. Ketoconazole is a very effective drug which must be carefully monitored. Its difficulties are with liver function, anti-androgenic dysfunction in males, and adrenal dysfunction. There is a great need for an effective and safe oral systemic drug. Terbinafine is an allylamine derivative which is highly antifungal.(ABSTRACT TRUNCATED AT 250 WORDS)