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COMBINATION ANTIFUNGAL THERAPY FOR ONYCHOMYCOSIS
Author(s) -
Nur Khamidah,
Evy Ervianti
Publication year - 2018
Publication title -
indonesian journal of tropical and infectious disease/indonesian journal of tropical an infectious disease
Language(s) - English
Resource type - Journals
eISSN - 2356-0991
pISSN - 2085-1103
DOI - 10.20473/ijtid.v7i1.6235
Subject(s) - terbinafine , itraconazole , griseofulvin , medicine , dermatophyte , antifungal , combination therapy , fluconazole , dermatology , nail plate , nail (fastener) , nail disease , pharmacology , paronychia , materials science , metallurgy
Onychomycosis is a fungal infection of the nail unit including the nail matrix, the nail bed and the nail plate by both dermatophyte and non-dermatophyte agents. It is disturbs not only cosmetic disfigurement, but also it may have an impact on patients’ emotional, social and occupational functioning, finally affecting the overall quality of life. The incidence rate tends to increase, management of onychomycosis is still challenging. Important problems regarding antifungal monotherapy have experienced many failures and recurrences. In general, pharmacological approaches for onychomycosis can be topical or oral antifungal. Antifungal monotherapies often lead to failure treatment, also high incidence of recurrence. One strategy for this problem is a combination antifungal therapy. In vitro studies show the synergistic effect of using combination two antifungals (both oral antifungal or combination topical and oral antifungal), hence it is mycologically or clinically expected to increase the success rate of onychomycosis therapy. This review tries to evaluate the previous study exploring the effectiveness of antifungal combination therapies on onychomycosis. Two oral antifungals usually used are terbinafine as fungicidal agent and itraconazole as fungistatic agent. There is combination between topical and oral antifungal such as itraconazole or terbinafine with amorolfine or ciclopirox, also other combination like griseofulvin and amorolfone or tioconazole. All the combination therapies show better result than monotherapy alone, but it is still difficult to conclude whether antifungal combinations in onychomycosis will increase effectiveness due to variations in therapeutic duration, result definition, and statistical evaluation on existing studies. Further research is required with longer duration of observation, uniform patient criteria and definition of success, random control and blinding to minimize bias.

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