الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 166 |  |  |
| | | from | 166 | | |
Abstract
Background: Onychomycosis is a fungal infection of nail plate. It is a common disease and studies have shown prevalence of between 2 % and 8%. Onychomycosis contributes to 40%-50% of all nail disorders and appears to be increasing in frequency. It is usually caused by dermatophytes, yeasts and nondermatophyte moulds. Most cases of the toenail onychomycosis are caused by dermatophytes. Also, it is predominantly caused by Trichophyton rubrum. Onychomycosis is classified clinically as distal and lateral subungual onychomycosis (DLSO), superficial white onychomycosis (SWO), proximal subungual onychomycosis (PSO), candidal onychomycosis and total dystrophic onychomycosis. Patients and Methods: All selected patients were subjected to the following:- Full dermatological examination.- Mycological examination of the nail samples.- Trichophytin prick test and trichophytin ID test.- Oral treatment with Terbinafine or Itraconazole.- Repeated examination of the patients after one month.- Repeated mycological examination of samples.- Reevaluation of skin prick test and Trichophytin intradermal test. Results: In patients who received Terbinafine 8 patients changed from trichophytin prick test +ve to–ve after treatment, 7 patients changed from trichophytin intradermal test –ve to +ve after treatment and 10 patients changed from direct KOH examination +ve to –ve after treatment. In patients who received Itraconazole 6 patients changed from trichophytin prick test +ve to–ve after treatment, 5 patients changed from trichophytin intradermal test –ve to +ve after treatment and 9 patients changed from direct KOH examination +ve to–ve after treatment.There was no statistical significant difference between the Itraconazole treated and the Terbinafine treated groups as regards the results of Trichophytin prick test, Trichophytin intradermal test and direct KOH examination of the scrap. There was significant increase in –ve culture after treatment in Itraconazole treated group and highly significant increase in –ve culture after treatment in Terbinafine treated group. There was no statistical difference between Itraconazole treated group and Terbinafine treated group as regards results of culture before and after treatment and the percentage of clinically improved patients after treatment. There was no significant relation between duration of infection and culture results before or after treatment. The correlation between duration of infection with both positivity of Trichophytin prick test and Trichophytin ID test was insignificant but a significant persistent positivity of Trichophytin prick test and negativity of Trichophytin ID after treatment with increase duration of onychomycosis was noticed. There was a significant relation between positivity of the scrap and positivity of Trichophytin prick test & negativity of Trichophytin intradermal test before treatment. There was a highly significant increase in with negativity of KOH examination of scrap after treatment and a highly significant increase in negativity of trichophytin prick test with negativity of KOH examination of scrap and persistence of positivity of trichophytin prick test with persistence of positivity of KOH examination of scrap after treatment. Conclusion: Successful treatment of onychomycosis with systemic antifungal treatment (Terbinafine and Itraconazole) was associated with changes in trichophytin skin tests. -Restoring normal immune response towards the fungal elements was associated with changing trichophytin prick test from positive to negative and changing trichophytin intradermal test from negative to positive. -Patients treated with Terbinafine showed better results than patients treated with Itraconazole but not with a statistically significant level.