Preventing long term relapsing tinea unguium with topical anti-fungal cream: a case report

Bruce Arroll,Amanda Oakley

doi:10.1186/1757-1626-2-70

Abstract

BackgroundThe patient was aged 34 when he consulted a dermatologist in Vancouver BC with onychomycosis affecting the right great toenail.Case presentationTrichophyton rubrum was cultured from nail clippings. Griseofulvin was taken for 6 months, resulting in clinical and mycological cure. Over the next 27 years there were multiple relapses. Each course of treatment with oral terbinafine (for up to 18 months) or itraconazole resulted in clinical and mycological cure. A dermatological colleague suggested the reason for relapse was likely to be self re-infection.ConclusionNo clinical relapse has occurred with once-weekly miconazole cream applied to the toenail and webspaces of the right foot over the last four years.

Highlights

The patient was aged 34 when he consulted a dermatologist in Vancouver BC with onychomycosis affecting the right great toenail.Case presentation: Trichophyton rubrum was cultured from nail clippings
No clinical relapse has occurred with once-weekly miconazole cream applied to the toenail and webspaces of the right foot over the last four years
Tinea unguium is the term used when a dermatophyte has been identified on culture

Summary

Background

Onychomycosis is fungal infection affecting fingernails or toenails, and may be due to dermatophyte, yeast or mould. Oral medication is recommended for extensive or symptomatic tinea unguium, and is appropriate in diabetics at risk of secondary bacterial infection. Topical antifungal agents are often prescribed for tinea unguium. They have impressive in vitro cure rates. A Medline search of tinea unguium and recurrence revealed few references and little evidence regarding the use of topical medication in preventing relapse.[4]. Medical history (At the time of diagnosis, hand eczema and recurrent tinea pedis; subsequently hypertension (1994), currently treated with chlorthalidone, lisinopril and metoprolol.). There has been no recurrence of tinea unguium since starting prophylactic topical miconazole (figure 2). She had recurrent melanoma on one leg. Mycological testing of the nail revealed fungal elements on microscopy and Trichophyton rubrum on culture

Discussion

Conclusion

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