Tosti A, Piraccini B M, Stinchi C, Colombo M D
Department of Dermatology, University of Bologna, Italy.
Dermatology. 1998;197(2):162-6. doi: 10.1159/000017990.
Data about relapses of onychomycosis after treatment with the new systemic antifungals vary among the different studies, with figures ranging from 3 to 20% for terbinafine and from 21 to 27% for itraconazole, depending on the follow-up duration.
To determine the prevalence of relapses of onychomycosis cured by terbinafine compared with that of onychomycosis cured by itraconazole.
We followed up 47 patients whose toenail onychomycosis had been mycologically cured in an open randomized study comparing intermittent itraconazole treatment with continuous terbinafine treatment and intermittent terbinafine therapy. Patients were examined every 3 months for up to 3 years after the end of therapy. At each visit clinical and mycologic (direct microscopy and cultures) evaluations were performed.
Eight of the 36 patients (22.2%) who completed the study had a relapse of onychomycosis during the follow-up period, including 2 patients of the terbinafine 250 mg group, 2 patients of the terbinafine 500 mg group and 4 patients in the itraconazole 400 mg group. As the original infection, the relapse was caused in all cases by Trichophyton rubrum.
This study shows that 22.2% of patients with onychomycosis successfully treated with systemic antifungals experienced a relapse. The relapse rate increased from 8. 3% at month 12 to 19.4% at month 24 and to 22.2% at month 36. Relapses were more common in patients treated with pulse itraconazole (4/11) than in patients treated with continuous (2/12) or intermittent (2/13) terbinafine. Statistical analysis did not reveal any significant difference between relapse rates in the three groups.
关于新型全身性抗真菌药治疗甲真菌病后复发的数据在不同研究中有所不同，根据随访时间长短，特比萘芬的复发率在3%至20%之间，伊曲康唑的复发率在21%至27%之间。
确定特比萘芬治愈的甲真菌病复发率与伊曲康唑治愈的甲真菌病复发率相比情况如何。
在一项开放性随机研究中，我们对47例趾甲甲真菌病经真菌学治愈的患者进行了随访，该研究比较了间歇性伊曲康唑治疗与连续性特比萘芬治疗及间歇性特比萘芬治疗。治疗结束后，对患者进行长达3年的随访，每3个月检查一次。每次就诊时进行临床和真菌学（直接显微镜检查和培养）评估。
完成研究的36例患者中有8例（22.2%）在随访期间甲真菌病复发，其中特比萘芬250mg组2例，特比萘芬500mg组2例，伊曲康唑400mg组4例。与原感染一样，所有病例的复发均由红色毛癣菌引起。
本研究表明，22.2%经全身性抗真菌药成功治疗的甲真菌病患者出现复发。复发率从第12个月的8.3%增至第24个月的19.4%，并在第36个月达到22.2%。脉冲式伊曲康唑治疗的患者（4/11）比连续性（2/12）或间歇性（2/13）特比萘芬治疗的患者复发更常见。统计学分析未显示三组复发率之间有任何显著差异。
