Combined treatment with surgery and short duration oral antifungal therapyin patients with limited dermatophyte toenail infection

BACKGROUND: Localized nail infection with dermatophyte fungi occurs both as a primary presentation of fungal disease and as a pattern of failure of pr evious treatment, even with modern antifungal agents. METHODS: Twelve patients (six treatment failures and six previously untreat ed) were confirmed to have dermatophyte infection of their toenails, and we re then treated with surgical removal of the affected area of nail, followe d by 28 days of oral terbinafine (250 mg/day), RESULTS: Repeat mycology 12 months after the oral treatment confirmed mycol ogical cure in all patients, and all treated nails were clinically normal. Histology of excised nail showed appearances compatible with a dermatophyto ma, CONCLUSIONS: Combined modality treatment is successful and well tolerated f or localized nail disease, and provides a useful means of dealing with trea tment failure after conventional oral treatment as well as primary therapy of limited nail disease.