Combination therapy for onychomycosis with amorolfine nail lacquer and oral antifungal agents

Introduction: A combined approach to onychomycosis management is becoming more and more popular. The complementarity of both antifungal activity and topical and oral administration of antifungal agents seems to be the most rational. Objective: Assessment of the efficacy, tolerability and patent satisfaction of amorolfine 5% nail lacquer (Loceryl) combined with an oral antifungal in patients with toenail onychomycosis with matrix involvement. Patients and methods: A multicentre study of 243 patients was conducted for 12 months. All patients received both amorolfine lacquer once weekly for 12 months and an oral antifungal of researcher's choice: either terbinafine 250 mg once per day for 3 months (AT group), itraconazole 200 mg twice per day in pulse therapy for 3 months (Al group) or fluconazole 300 mg once per week for 6 months (AF group). Oral pentoxiphyline 400 mg twice per day for three months was optional. Global cure has been defined as remaining of maximum 10% of initial lesions and negative culture examination. Tolerability was assessed for the topical and oral antifungal separate. Patient's satisfaction score was based on the opinion of the individual patients. Results: There was a 79.4% of global cure independently of the oral antifungal used (78.2% in the AT group, 83.3% in the Al group and 71.4% in the AF group). There was on higher efficacy noted in patients receiving pentoxiphyline. Both topical amorolfine and the oral antifungals were very well tolerated. The most importantly, the majority of patients were satisfied of the treatment. Conclusions: The combination of topical amorolfine with oral antifungal (terbinafine, itraconazole or fluconazole) is an effective and very well tolerated onychomycosis therapy.