Orit Markowitz1,2, Cynthia X Chan1,2. 1. Dr. Markowitz is with the Department of Dermatology, Mount Sinai in New York, New York. 2. Ms. Chan is with the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire.
Abstract
BACKGROUND: Onychomycosis affects 43 million people in the United States and Europe. Topical therapies can be effective but require lengthy and costly regimens without an established method for predicting the treatment outcome. OBJECTIVE: We studied the role of optical coherence tomography (OCT), a noninvasive imaging device approved by the United States Food and Drug Administration, in evaluating onychomycosis treatment outcomes. METHODS: This investigator-initiated prospective clinical study recruited subjects from two urban medical centers. A total of 34 subjects with mild-to-moderate onychomycosis, confirmed using periodic acid-Schiff (PAS) staining, were treated with topical efinaconazole for 48 weeks, at which time a final PAS result was obtained. RESULTS: A positive final PAS result was associated with fungal findings on OCT and with nonclearance of fungal findings by week 12. A negative final PAS was associated with the absence of fungal findings by week 12. OCT findings at Week 8 may suggest a 77% chance of mycological nonclearance or 82% chance of clearance. These predictive values are higher than the currently documented mycological cure rate of 54%. Clinical examination data had no predictive value alone or in concert with OCT. CONCLUSION: We recommend OCT imaging be performed at the end of the second month of treatment to inform shared decision-making regarding whether or not to continue efinaconazole for nine additional months. OCT's ability to evaluate onychomycosis outcome in patients on topical efinaconazole both earlier and more reliably than nonimaging variables may improve the care given to and reduce the cost of onychomycosis for millions of patients.
BACKGROUND: Onychomycosis affects 43 million people in the United States and Europe. Topical therapies can be effective but require lengthy and costly regimens without an established method for predicting the treatment outcome. OBJECTIVE: We studied the role of optical coherence tomography (OCT), a noninvasive imaging device approved by the United States Food and Drug Administration, in evaluating onychomycosis treatment outcomes. METHODS: This investigator-initiated prospective clinical study recruited subjects from two urban medical centers. A total of 34 subjects with mild-to-moderate onychomycosis, confirmed using periodic acid-Schiff (PAS) staining, were treated with topical efinaconazole for 48 weeks, at which time a final PAS result was obtained. RESULTS: A positive final PAS result was associated with fungal findings on OCT and with nonclearance of fungal findings by week 12. A negative final PAS was associated with the absence of fungal findings by week 12. OCT findings at Week 8 may suggest a 77% chance of mycological nonclearance or 82% chance of clearance. These predictive values are higher than the currently documented mycological cure rate of 54%. Clinical examination data had no predictive value alone or in concert with OCT. CONCLUSION: We recommend OCT imaging be performed at the end of the second month of treatment to inform shared decision-making regarding whether or not to continue efinaconazole for nine additional months. OCT's ability to evaluate onychomycosis outcome in patients on topical efinaconazole both earlier and more reliably than nonimaging variables may improve the care given to and reduce the cost of onychomycosis for millions of patients.
Authors: Faris Abuzahra; Felix Spöler; Michael Först; Richard Brans; Stefan Erdmann; Hans F Merk; Daniela Hoeller Obrigkeit Journal: Mycoses Date: 2009-09-28 Impact factor: 4.377
Authors: Boni E Elewski; Phoebe Rich; Richard Pollak; David M Pariser; Shinichi Watanabe; Hisato Senda; Chikara Ieda; Kathleen Smith; Radhakrishnan Pillai; Tage Ramakrishna; Jason T Olin Journal: J Am Acad Dermatol Date: 2012-11-20 Impact factor: 11.527