Terbinafine in chronic paronychia and candida onychomycosis

This study was designed as a double-blind, stratified, randomized parallel-group study to compare the efficacy and safety of terbinafine (Lamisil®), given for 12 weeks in a dose of 250 mg/day, and placebo in chronic candidal paronychia and candidal onychomycosis. Non-responders at the end of the 12-week treatment were allowed to receive a further 12 weeks of therapy. The results at 12 weeks showed no statistically significant difference in efficacy between terbinafine and placebo in the treatment of these conditions. A few patients were mycologically cured: three patients taking terbinafine remained negative whereas one taking placebo was positive again at the subsequent clinical visit. Some patients responded well to therapy, mainly those with Candida parapsilosis infection. It is known that terbinafine is fungicidal against this species, but fungistatic against Candida albicans. Where more than one Candida species was involved in the infection, and their distribution was more widespread with various species cultured from several sample sites, terbinafine was less effective. The overall tolerability of the drug was very good: No adverse events were reported nor changes noted on routine haematology and biochemistry screening.