BROAD SPECTRUM WAY FORWARD IN ANTIFUNGALS

A broader spectrum antifungal agent is needed in the treatment of onychomycosis, and Janssen's Sporanox (itraconazole) is the best agent available at the moment for the eradication of the disease, said a number of speakers at a Janssen-sponsored conference in Monte Carlo, Monaco, entitled Issues in the Management of Onychomycosis - New Approaches to Diagnosis and Therapy.

Onychomycosis occurs when dermatophytes, yeasts and moulds infect nails and metabolize nail proteins. The problem is much more common than previously thought and is more than just a cosmetic disease, said Donald Greer from the School of Medicine, New Orleans University, USA. Two studies from the UK and the USA, presented at the meeting by Dr Greer, show that the prevelance of the disease is about 2.2% in the general population, about half of which present with clinical symptoms.

The underlying thrust of the presentations was that the disorder is caused by a number of pathogens, not just dermatophytes, as is traditionally held. This point is clearly contentious as a number of the delegates, Dr Zaias, a dermatologist from Miami, USA, in particular, argued that the studies presented showed little clear evidence of this fact and from the data it was impossible to say whether or not the other yeasts and moulds were the primary pathogens or opportunistic infections. A dermatologist from Glasgow told the Marketletter that in clinical practice there has been little evidence to show that much more than 10% of onychomycosis infections are caused by anything other than dermatophyte infections.