Document Detail

Efficacy of debridement alone versus debridement combined with topical antifungal nail lacquer for the treatment of pedal onychomycosis: a randomized, controlled trial.
MedLine Citation:
PMID:  19423029     Owner:  NLM     Status:  MEDLINE    
Pedal onychomycosis is a common malady caused by dermatophytes, saprophytes, and yeasts. Traditional treatment options for this condition include toenail debridement, and pharmacological therapies that range from the application of topical agents to the oral administration of antifungal medications. In this study, 55 patients (289 toenails) were randomly allocated to either nail debridement (27 [49.09%] patients) or debridement plus application of topical antifungal nail lacquer (28 [50.91%] patients). The primary outcome was mycological cure, and secondary outcomes included foot-related quality of life, and a number of clinically important toenail characteristics. After a median follow-up of 10.5 months (range, 3.25-14.25) months), patients in the antifungal nail lacquer group improved statistically significantly more than did those in the debridement alone group, and displayed a 76.74% rate of mycological cure. None of the patients in the debridement-only group experienced mycological cure. Variables that statistically significantly decreased the likelihood of cure included yeast on culture, pedal hyperhidrosis, cigarette smoking, involvement of the lunula, and involvement of >50% of the transverse width of the nail. Variables statistically significantly associated with an increased likelihood of cure included intervention before 6 months' duration, treatment at a large, urban practice, black race, and loss of protective sensation. Level of Clinical Evidence: 1.
D Scot Malay; Sang Yi; Pamela Borowsky; Michael S Downey; Alan J Mlodzienski
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons     Volume:  48     ISSN:  1542-2224     ISO Abbreviation:  J Foot Ankle Surg     Publication Date:    2009 May-Jun
Date Detail:
Created Date:  2009-05-08     Completed Date:  2009-08-05     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9308427     Medline TA:  J Foot Ankle Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  294-308     Citation Subset:  IM    
Penn Presbyterian Medical Center, Philadelphia, PA, USA.
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MeSH Terms
Administration, Topical
African Continental Ancestry Group
Antifungal Agents / therapeutic use*
Foot Dermatoses / microbiology,  pathology,  therapy*
Hyperhidrosis / complications
Middle Aged
Onychomycosis / pathology,  therapy*
Pyridones / therapeutic use*
Risk Factors
Single-Blind Method
Smoking / adverse effects
Time Factors
Treatment Outcome
Urban Health Services
Reg. No./Substance:
0/Antifungal Agents; 0/Pyridones; 29342-05-0/ciclopirox

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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