The study of Orlov et al. (2001) was dedicated to evaluation of efficacy of special nail avulsion device in combination with pulsed itraconazole and amorolfine nail lacquer. 25 patients aged 58 to 70 were examined, 17 of them having peripheric vascular disease and 8 with diabetes. Initial SCIO values were calculated in addidition to clinical evaluation, 14 patients had SCIO range 13-24 and others with SCIO 16-30. The reported efficacy of combination therapy was 86%.

We think that this study may underscore the possibility and efficacy of combination therapy with nail avulsion in extreme valuesof SCIO.