Table 1.
Demographics, clinical history, physical examination findings, diagnostic tests, and treatments of patients that underwent terbinafine resistance testing.
| # | Age/Sex | Race | Past Medical History | Nails Affected | Duration | Prior Treatment(s) | Physical Examination | Repeat Pathology | PCR | Culture | Terbinafine Resistance | Treatment (Outcome) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 54/F | White | None | R toenails | Multiple years | Itraconazole Terbinafine 250 mg × 3 months |
Thickening, yellow discoloration | Not collected | Trichophyton rubrum | Trichophyton rubrum | Susceptible | Efinaconazole 10% |
| 2 | 72/M | White | HTN, atrial fibrillation, BPH, Waldenstrom’s macroglobulinemia | All toenails | Multiple years | Terbinafine 250 mg × 3 months | Thickening, yellow discoloration | Not collected | Trichophyton rubrum | No fungus isolated | Resistant (3 mutated populations: Phe397Leu, Phe415Ser, Phe415Ile) | Efinaconazole 10% |
| 3 | 41/M | White | Melanoma | R1/L1 toenails | Multiple years | Terbinafine 250 mg × 3 months 2 × Fluconazole 150 mg × 12 months |
Onycholysis, subungual debris | Hyphae | Trichophyton rubrum | Not performed | Resistant (1 mutated population: Phe397Leu) | Itraconazole 200 mg × 3 months (improved) |
| 4 | 45/F | White Hispanic |
None | R1 toenail | 1 year | Terbinafine 250 mg × 3 months | Yellow streak extending to lunula | Hyphae | Aspergillus | Aspergillus | Susceptible | Fluconazole 150 mg × 3 months (failed) Efinaconazole 10% |
| 5 | 56/M | White | Essential tremor, migraines, Sjogren’s, sleep apnea | R1 toenail | Multiple years | Terbinafine 250 mg × 3 months | Onycholysis, yellow discoloration, onycholysis, white patch | Hyphae | Trichophyton rubrum | Not performed | Susceptible | Efinaconazole 10% |
| 6 | 25/M | White | None | All toenails | 2 years | Terbinafine × 8 months | Xanthonychia, onycholysis, subungual debris, crumbling | Hyphae | Trichophyton rubrum | Trichophyton rubrum | Susceptible | Terbinafine 250 mg × 3 months |
| 7 | 51/M | White | HTN, obesity, sleep apnea | R1/L1 fingernails; R4 toenail | 6 years | Terbinafine | Onycholysis, thickening of fingernails, yellow streak of R4 toenail | Dermatophytoma | Trichophyton rubrum | Trichophyton rubrum | Susceptible | Terbinafine 250 mg × 3 months (improved) |
| 8 | 53/F | White | GDM, Grave’s disease, prothrombin mutation | L1 toenail | 2 years | Terbinafine 250 mg × 3 months | Onychomadesis | Hyphae | Fusarium | No fungus isolated | Susceptible | Lost to follow-up |
| 9 | 31/M | White | IBS, depression, asthma | L toenails | 10 years | 4 × Terbinafine 250 mg × 3 months | Hyperkeratotic nail bed, subungual debris, yellow discoloration | Dermatophytoma | Trichophyton rubrum | No fungus isolated | Susceptible | Efinaconazole 10% |
| 10 | 60/M | White | None | L1 toenail | 10 years | Terbinafine Multiple × Itraconazole Multiple × Fluconazole Efinaconazole 10% × 2 months |
Proximal white streak | Hyphae | Trichophyton rubrum | No fungus isolated | Susceptible | Efinaconazole 10% |
| 11 | 76/M | White Hispanic |
HTN, CAD, DM, obesity, BPH, PUD, aortic dissection, kidney stones, sleep apnea, arrhythmia | R1 fingernail | 15 years | Terbinafine 250 mg × 6 weeks | Thickening, onycholysis, subungual debris | Not collected |
Scytalidum,
Candida guilliermondii |
Scytalidium dimidiatum | Susceptible | Efinaconazole 10% |
| 12 | 37/M | White | None | R3 fingernail | Multiple years | 2 × Terbinafine 250 mg × 2 months Ciclopirox 8% × 1 year |
Severe onycholysis, hyperkeratotic nail bed, nail fold fluctuance without tenderness | Hyphae | Fusarium | Fusarium | Susceptible | Efinaconazole 10% |
| 13 | 68/M | White | Raynaud’s | All toenails | Multiple years | Multiple × Terbinafine | Xanthonychia, onycholysis, subungual debris | Hyphae | Trichophyton rubrum | Fusarium, Trichophyton rubrum | Susceptible | Efinaconazole 10% |
| 14 | 61/M | White | Kidney stones, allergic rhinitis | R1/R2 toenails | 10 years | Terbinafine | Xanthonychia, thickening, subungual debris | Hyphae | Trichophyton rubrum | No fungus isolated | Susceptible | Terbinafine 250 mg × 3 months |
| 15 | 68/M | Asian | HTN | R1/L1 fingernails | 5 years | Terbinafine × 6 weeks Ciclopirox × 7 months |
Onycholysis | Hyphae | Trichophyton rubrum | No fungus isolated | Susceptible | Terbinafine 250 mg × 6 weeks |
| 16 | 63/F | White | Osteoporosis | L1 toenail | 2 years | Ciclopirox × 1 month Terbinafine × 3 months |
Severe onycholysis, subungual debris | Hyphae | Aspergillus | Aspergillus | Susceptible | Lost to follow-up |
| 17 | 31/F | White | None | L1 toenail | 3 years | Terbinafine × 3 months | Severe onycholysis | Dermatophytoma | Fusarium | Fusarium | Susceptible | Efinaconazole 10% |
Abbreviations: PCR: polymerase chain reaction testing, HTN: hypertension, BPH: benign prostate hyperplasia, GDM: gestational diabetes mellitus, IBS: irritable bowel syndrome, CAD: coronary artery disease, DM: diabetes mellitus, PUD: peptic ulcer disease.