경구항진균제, Nail Lacquer 국소도포와 함께 손발톱 밑으로 항진균제를 직접 주입하여 완치를 보인 피부사상균종 (Dermatophytoma)를 동반한 손발톱진균증

Abstract

Systemic antifungal therapy is essential to cure onychomycosis but when used alone, its complete cure rate is less than 50%. Therefore, combination therapy is preferred to achieve higher cure rate of onychomycosis, especially severely infected onychomycosis. For effective treatment of onychomycosis,it is important how antifungal agents reach causative fungi in the nail lesion. If there are dermatophytoma or onycholysis, biofilms and space may disturb antifungal agent to reach the fungi in the nail lesion. If direct antifungal solution is applied to the space, it can be spread with capillary action to the space and fungi. A 57-year old male patient presented onychomycosis with infected nail matrix and dermatophytoma,which had recurred after combination therapy of oral and topical antifungal agents before. He had been treated with subungual antifungal solution added to systemic terbinafine (250 mg/day) and amorolfine nail lacquer for initial 3 months, and with subungual antifungal solution and nail lacquer for the next 4months, and nail lacquer only for the rest period. After 3 months treatment, totally involved left great toe nail showed 50% of normal healthy nail growing from the proximal nail fold. His infected nails eventually showed complete normal nails 1 year after the initial treatment.