Combined treatment with surgery and short duration oral antifungal therapy in patients with limited dermatophyte toenail infection

BACKGROUND: Localized nail infection with dermatophyte fungi occurs both as a primary presentation of fungal disease and as a pattern of failure of previous treatment, even with modern antifungal agents. METHODS: Twelve patients (six treatment failures and six previously untreated) were confirmed to have dermatophyte infection of their toenails, and were then treated with surgical removal of the affected area of nail, followed by 28 days of oral terbinafine (250 mg/day). RESULTS: Repeat mycology 12 months after the oral treatment confirmed mycological cure in all patients, and all treated nails were clinically normal. Histology of excised nail showed appearances compatible with a dermatophytoma. CONCLUSIONS: Combined modality treatment is successful and well tolerated for localized nail disease, and provides a useful means of dealing with treatment failure after conventional oral treatment as well as primary therapy of limited nail disease. (J Dermatol Treat (2000) 11: 259-262)