Resumen

Objectives: The objective of this case is to discuss various treatment options for patients with recalcitrant difficult-to-treat trachyonychia from onychomycosis and verruca. And to discuss the challenges experienced during the treatment course. Introduction: Initially, onychomycosis was treated with pulse dosing Itraconazole (400 mg daily for 7 days, repeated monthly for 3 months). Post-resolution, ND-YAG 1064 Long Pulse Laser (Fluence - 150J, Frequency - 15ms, spot size – 4mm) was done monthly for 3 sessions, alongside oral zinc gluconate (280 mg daily for 3 months). The patient received the Nonavalent HPV vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58) in three doses (week 0, month 2, and month 6), resulting in significant clearance. For recurrence, topical imiquimod 5% cream was applied thrice weekly for 4 weeks, followed by betamethasone 0.0 Materials / method: Onychomycosis was treated with Itraconazole 400 mg daily for 7 days, monthly for 3 months. Post-resolution, ND-YAG 1064nm Long Pulse Laser (Fluence -150J, Frequency -15ms, spot size –4mm) was done monthly for 3 sessions, with oral zinc gluconate (280 mg daily for 3 months). Nonavalent HPV vaccine (6, 11, 16, 18, 31, 33, 45, 52, and 58) was then given in three doses (week 0, month 2, and month 6), resulting in significant clearance. For recurrence, imiquimod 5% cream was applied thrice weekly for 4 weeks, followed by betamethasone 0.05% + calcipotriol 0.005% ointment twice weekly for 4 weeks. Results: After the course of treatment, there is significant improvement to almost complete resolution of the dystrophic nails. Patient expressed significant satisfaction on her daily life after the treatment course. Conclusion: Trachyonychia is a difficult condition to manage, often requiring a multimodal treatment approach and regular follow-up to address recurrences and ensure patient well-being.