Comparison of two topical preparations for the treatment of onychomycosis: Melaleuca alternifolia oil and clotrimazole - tea tree

Journal of Family Practice, June, 1994 by David S. Buck, David M. Nidorf, John G. Addino

Three additional interventions may have improved the outcome: simultaneous use of multiple oral and topical agents, longer treatment times, and a keratolytic agent, such as DMSO, or other agents that improve nail penetration of the medication.

One potential reason for the poor long-term benefits of any therapy is that it may be treating only a manifestation of underlying disease(s), such as generalized immune suppression or peripheral micro- or macrovascular disease. In a study of 400 patients, Forck(53) looked at the "relationship between blood circulation of the skin and the development of fungus disease" and found a greater than 50% reduction in blood flow in patients with tinea pedis and onychomycosis as compared with patients without these disorders. If onychomycosis is a symptom of an underlying process, then treatment aimed at eradication of a pathogen(54) may be unrealistic. A more appropriate goal may be the amelioration of symptoms and the improvement of nail appearance.

Topical and oral therapies have high recurrence rates. Oral therapy has the added disadvantages of high cost and potentially adverse side effects. Topical therapies, including the two preparations presented in this paper, provide significant improvement in nail appearance and symptomatology for over one half of all subjects. The use of a topical preparation in conjunction with debridement is an appropriate initial treatment strategy.

Acknowledgments

Schering-Plough Corp in Liberty Corner, New Jersey, and Thursday Plantation Inc, in Montecito, California, provided technical and financial support.

We are indebted also to Dr Peter Franks for technical advice, multiple reviews, and assistance with study design; to Dr Peter Broderick and Dr Jay N.M.I. Hegde for reviewing the manuscript; and to Sally Rousseau, for her assistance with data entry and evaluation.

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