Tratamento da Tinea Unguium dos pododáctilos com terbinafina oral administrada de forma intermitente associada à onicoabrasão

Abstract

Onychomycosis constitutes up to 50% of all nail disorders and its prevalence ranges between 2-8%. The toenails are frequently affected, mostly due to dermatophytes (tinea unguium). Terbinafine is the only systemic fungicidal agent and the most potent antifungal agent in vitro against dermatophytes. However there are few randomized controlled trials using a non-continuous dose of terbinafine. The aim of this study was to compare the safety and effectiveness of two different intermittent regimens with terbinafine and nail abrasion to treat dermatophyte toenail onychomycosis. We selected 41 patients diagnosed with onychomycosis caused by dermatophytes, divided them in two groups, each receiving one of the following treatments, besides mechanical nail abrasion: Group I: oral terbinafine 250mg/day, 7 days, montly; Group II: oral terbinafine 500mg/day, 7 days, every two months. Both groups were treated for six months. The parameters used to evaluate the efficacy were clinical and mycological at the end of the treatment, six months and one year after termination. We used the following criteria: total cure, partial cure, clinical improvement, treatment failure and recurrence. Thirty-six patients completed the study. There was no statistical difference between groups in the various parameters used to evaluate therapeutic response. The evaluation of the therapeutic result reveals that after 18 months, eight patients (44.4%) of each group met the criteria for total cure, and five (27.8%) patients of group I and four (22.2%) of group II displayed partial healing. Only one patient of each group ended without any clinical improvement during the whole study. The presence of fungi in the nail plate was reducing progresively during the visits, and at the end of the study, all patients staged negative culture for dermatophytes. Despite the small number of patients of our study, there was no statistical difference between the outcomes (clinical and mycological) of each group. Both intermittent regimens were safe, without serious adverse effects, or abnormal findings in the laboratory tests performed. Significant cure rates were achieved (total and partial) in group I and II (66.6% and 72.2%, respectively, in 18 months). Eight patients (44.4%) of each group achieved the total cure (disease-free nail). The intermittent regimen of terbinafine with nail abrasion was an efficient, safe and low-cost treatment for dermatophyte toenail onychomycosis, indifferent to the regimen used.