A QUESTIONNAIRE STUDY ON THE MANAGEMENT OF ONYCHOMYCOSIS - A CANADIANPERSPECTIVE

Background Onychomycosis of the toenails is a condition that responds poorly to griseofulvin. The introduction of terbinafine in Canada in M ay 1993 resulted in a marked shift in the choice of treatment for peda l onychomycosis. Methods A questionnaire survey was carried out in 199 6 among Canadian dermatologists regarding the management of onychomyco sis. Results There were 160 respondents from the roughly 350 practicin g dermatologists. The dermatologists saw 8 +/- 0.6 patients per week ( average +/- standard error (SE)) with suspected or diagnosed onychomyc osis, with 5 +/- 0.5 patients per week consulting the dermatologists f or the first time. Most dermatologists performed mycological testing p rior to starting treatment for onychomycosis. The management options f or onychomycosis (mean +/- SE) were oral systemic antifungal therapy 5 1 +/- 3%, no therapy 31 +/- 3%, and nondrug therapy 9 +/- 2%, The majo rity of dermatologists (83%) used terbinafine as first-line therapy if , indeed, they used oral antifungal agents. In contrast, griseofulvin and ketoconazole were used as first-line therapy in 5% and 1% of cases , respectively. In Canada, there are no monitoring requirements when u sing oral terbinafine for onychomycosis. Therefore, it is not surprisi ng that only 30% of dermatologists performed monitoring with terbinafi ne. In contrast, the frequency of monitoring with griseofulvin and ket oconazole was 40% and 80%, respectively. The subset of dermatologists who reported monitoring carried it out in only a fraction of their pat ients: 47%, 53%, and 83% for terbinafine, griseofulvin, and ketoconazo le, respectively. Therefore, the overall number of patients in whom re gular monitoring was performed was 14.1%, 21,2%, and 71.4% for terbina fine, griseofulvin, and ketoconazole, respectively. The perceived cure rates with terbinafine and griseofulvin (mean +/- SE) were 83.7 +/- 1 % and 41 +/- 3.1%, respectively. Conclusions In May 1996, within three years of the introduction of terbinafine to Canada, this agent has be come the drug of choice for the treatment of pedal onychomycosis (at t he time of the survey neither itraconazole or fluconazole were approve d for onychomycosis). Terbinafine has been found to be very effective and safe, and only a minority of dermatologists perform regular monito ring with this drug.