Document Detail


Topical steroids versus systemic antifungals in the treatment of chronic paronychia: an open, randomized double-blind and double dummy study.
MedLine Citation:
PMID:  12077585     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The involvement of Candida in the pathogenesis of chronic paronychia (CP) has never been proven, even though this condition is commonly considered a type of Candida onychomycosis.
OBJECTIVE: The purpose of this study was to compare the efficacy of systemic antifungals (itraconazole or terbinafine) with a topical corticosteroid (methylprednisolone aceponate) in the treatment of patients with CP.
METHODS: The study involved 45 adult patients with CP. Medication was given in a randomized, double-blind and double dummy manner over 3 weeks. Patients were then followed for 6 weeks. Clinical and mycologic evaluations were performed at baseline, and at weeks 3 and 9. The efficacy measures included clinical and photographic evaluation.
RESULTS: Of 48 nails treated with methylprednisolone aceponate, 41 were improved or cured at the end of the follow-up period. The statistical analysis showed a significant difference between the number of nails improved or cured by methylprednisolone aceponate and that of nails improved or cured with terbinafine (30 out of 57) or itraconazole (29 out of 64). Presence of Candida was not strictly linked to disease activity, and Candida eradication was associated with clinical cure in only 2 of the 18 patients who carried Candida at the beginning of the study.
CONCLUSION: This study shows that topical steroids are more effective than systemic antifungals in the treatment of CP, and supports the view that CP is not a type of onychomycosis but a variety of hand dermatitis caused by environmental exposure.
Authors:
Antonella Tosti; Bianca Maria Piraccini; Emanuela Ghetti; Maria Delia Colombo
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American Academy of Dermatology     Volume:  47     ISSN:  0190-9622     ISO Abbreviation:  J. Am. Acad. Dermatol.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-06-21     Completed Date:  2002-07-22     Revised Date:  2011-12-20    
Medline Journal Info:
Nlm Unique ID:  7907132     Medline TA:  J Am Acad Dermatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  73-6     Citation Subset:  IM    
Affiliation:
Department of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy. tosti@almadns.unibo.it
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Administration, Topical
Adult
Aged
Antifungal Agents / administration & dosage*
Chronic Disease
Double-Blind Method
Drug Administration Schedule
Female
Follow-Up Studies
Humans
Itraconazole / administration & dosage
Male
Methylprednisolone / administration & dosage*
Middle Aged
Naphthalenes / administration & dosage
Paronychia / diagnosis,  drug therapy*
Probability
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Naphthalenes; 83-43-2/Methylprednisolone; 84625-61-6/Itraconazole; 91161-71-6/terbinafine
Comments/Corrections
Comment In:
J Am Acad Dermatol. 2011 Dec;65(6):1219-27   [PMID:  21501889 ]
Summary for patients in:
J Fam Pract. 2002 Oct;51(10):824   [PMID:  12401149 ]

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


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