Avner Shemer
Tel-Aviv University
Israel
Title: Treatment of onychomycosis with a new topical drug delivery drilling of the nail plate
Biography
Biography: Avner Shemer
Abstract
Introduction: Onychomycosis is a fungal infection of the nail plate and nail bed. Onychomycosis treatment options include oral and topical antifungal agents, devices and mechanical treatments such as nail avulsion or debridement. Methods: Participants were allocated into one of three treatment arms: Holes with combined oral and topical terbinafine, holes with topical terbinafine and topical terbinafine. An automatic device was used to drill two horizontal lines of holes just proximal to the border between the diseased and healthy portions of the nail with a diameter of 1.8-2 mm apart. Participants in Group-1 were instructed to take 250 mg of terbinafine per day for two weeks and participants in Groups-1, 2 and 3 were instructed apply terbinafine 1% spray. At each visit, nail specimens were collected and the percentage of infected nail that appeared healthy and clear was measured by a trained dermatologist. Results: A total of 98 people participated in this study (106 infected nails). Approximately 61% of the sample had 50% involvement and 38.7% had 75% involvement. There were no significant differences in baseline characteristics between treatment groups (Ps>0.05). The holes with topical terbinafine arm (Group-2) had the highest compliance rate, 95.6%, compared to 73.9% in the holes with oral and topical terbinafine (Group-1) and 73.7% in the topical terbinafine only arm (Group-3) and this difference was significant (P=0.013). The average percent clear nail in each treatment was well tolerated. Overall, nail drilling appears to be a safe and effective addition to onychomycosis treatment.