Recalcitrant Onychomycosis of the Toenails Successfully Treated With Fluconazole

Abstract

REPORT OF CASES CASE 1.— A 40-year-old male physician presented with onychomycosis of several toenails of many years' duration. He was treated several years ago with 660 mg/d of ultramicrosized griseofulvin for 5 months. No response to treatment was noted, and the patient found the mild headaches induced by griseofulvin therapy annoying. He discontinued the therapy and was not interested in further therapy at that time. Recently, he became interested in treatment of his onychomycotic toenails. Findings from his physical examination showed moderate-to-severe involvement with yellowing and destruction of the toenails and absence of the small toenails bilaterally. Culture of nail clippings and curettings yielded Trichophyton rubrum . CASE 2.— A 29-year-old physician's wife presented with onychomycosis of the left great toenail. This was previously treated with griseofulvin for over a year with concurrent removal of the nail. The nail grew normally while she received griseofulvin, but the infection recurred within