Insulin dependent diabetes mellitus in twins

numerical data suggest a plateauing or even slight decrease in the length of unaffected nail in the itraconazole group.In contrast to Buck, however, we think that there is a continuous increase in the terbinafine group.We are confident that our opinion will be supported by the statistical evalua- tion of an additional, blinded 24 week follow up that we have performed in patients with clinical cure or continuous clinical improvement at 52 weeks.Buck's letter gives us the opportunity to com- ment on rates of relapse.De Cuyper recently reported that after 16 weeks' treatment with terbinafine and 32 weeks' follow up 17 patients who had been treated effectively were observed for a further two years; relapse occurred in only three.'This result accords with the 18% recurrence rate 12 months after clinical and mycological cure of the toenails with terbinafine reported by Villars and Jones.2The relatively high proportion of patients with adverse events in our study (40%) should not be overemphasised.In another study of onychomycosis with similar methodological conditions adverse events occurred in 41% of the patients taking placebo for 12 weeks.3In our study more than 90% of the patients and doctors stated that the tolerability of both drugs was good or excellent.We believe that terbinafine provides more than short term benefit for most patients.