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I read with great interest the results of your analysis of published data, "How Often Does Oral Treatment of Toenail Onychomycosis Produce a Disease-Free Nail,"¹ in the December 1998 ARCHIVES. Unfortunately, your conclusions did not take into full consideration the complexity of treating mycotic diseases of the nail. The assumption that the purpose of treating onychomycosis is to obtain a normal-appearing nail may be logical, but this result is not necessarily obtainable in some patients. The situation with clearing fungal infections of the nail is in some ways similar to isotretinoin therapy in acne: the treated patients may have no acne cysts after a course of therapy, but facial scars are unchanged. Similarly, totally normal nails may be impossible to obtain after a chronic nail infection because of scarring that may result from fungal infection.

Local factors affecting treatment success include thickened, slow-growing, or traumatized nails; systemic factors include compromised . . . [Full Text of this Article]

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