Recent advances in therapies for Onychomycosis and its management

PubMed Central: Published June, 2019

Onychomycosis is a fungal infection occurring in the nails and may affect the adjacent skin. Typically, it manifests as discoloration of the nail, nail plate thickening, and onycholysis. It is the most common nail pathology and accounts for about 90% of toenail infections worldwide.

At present, there are several oral, topical, and physical therapies broadening the treatment options available to patients. Additionally, combination therapy with several drug classes/modalities can be considered.

TAKE HOME MESSAGE

Traditionally, oral therapeutics have been the preferred treatment because of their accessibility and efficacy. Terbinafine and Itraconazole are US Food and Drug Administration (FDA)–approved oral antifungal medications.

Owing to its chemical composition, the nail is a formidable barrier to the permeation of drugs, and diffusion into the nail is poor relative to the skin. This, coupled with slow toenail growth, requires that topicals be used for 12 months or longer, ideally until a healthy nail has regrown.

Topical therapies Efinaconazole, Tavaborole can effectively treat onychomycosis, particularly when patients adhere to treatment instructions. 

Despite significant advances in the effectiveness of topical treatments, mycological and complete cure rates remain relatively lower than those of some of the oral agents.

Typically, oral therapeutics are reserved for severe infections because of their safety issues and drug–drug interactions.

US Food and Drug Administration–approved drugs and respective cure rates at week 48.

Drug

Mycological cure

Complete cure

Oral medications

Terbinafine 

70%

38%

Itraconazole 

54%

14%

 

Topical medications

Tavaborole 

31.1%

6.5%

Efinaconazole 

53.4–55.2%

15.2–17.8%

Ciclopirox

29–36%

5.5–8.5%


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Molloy debnath , 17 Jan, 2024 Reply
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600855/

This is for informational purposes only. You should consult your clinical textbook for advising your patients.