Ciclopirox nail lacquer in the treatment of onychomycosis

Abstract

Ciclopirox nail lacquer solution 8% is the first and only topical lacquer approved in the US for the treatment of mild to moderate onychomycosis, without lunula involvement, due to Trichophyton rubrum. This antifungal agent is broad-spectrum with activity against dermatophytes, Candida species and some non-dermatophyte molds. In vitro data suggests that a synergy exists between ciclopirox and terbinafine; hence, the combination of these two agents may be more effective than terbinafine alone when treating severe onychomycosis (e.g., nail matrix involvement). Ciclopirox nail lacquer may also be a consideration in children where the nail plate is thinner and the rate of nail outgrowth is faster compared to adults. It should be noted that neither ciclopirox nor the newer antifungal agents, terbinafine and itraconazole, are approved in the US for the treatment of onychomycosis in children. The topical nail lacquer may be preferred to an oral antifungal agent when treating the elderly, diabetics, and those who are immunocompromised since these patients may have limited renal or hepatic reserve, or be taking several drugs, some of which may interact or be contraindicated with one or more of the oral antifungal agents. Ciclopirox nail lacquer may also be of value in prophylactic therapy, helping to prevent relapse of successfully treated onychomycosis especially among diabetics, immunocompromised individuals, and patients with a family history of onychomycosis or chronic fungal infections (e.g., tinea pedis) since these patients are more likely to redevelop onychomycosis following mycological cure.