Abstract
Onychomycosis is the most common affliction of the nail. It may be caused by dermatophytes, yeasts, and non-dermatophyte molds. Traditionally, oral antifungal treatments have been used to treat the fungus, although they can be accompanied by side effects and drug interactions. Topical treatments provide an alternative modality, bypassing the systemic effects of oral drugs; recent research has centered on topical drug improvement and development. Physical and laser treatments are being used in conjunction with topicals, which may help penetrate the thick nail plate. In this review, techniques from all categories are outlined: both novel experimental approaches and progress and effectiveness of recently developed treatments. More long-term studies are required to determine the efficacy of various treatments, but cure rates are improved when patients adhere to treatments and follow preventative measures to avoid disease recurrence.
Highlights
Onychomycosis is a fungal infection occurring in the nails and may affect the adjacent skin
Most onychomycoses are caused by the dermatophytes Trichophyton, Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton[3]
Infections often initiate from tinea pedis, a fungal infection on the surrounding skin of the feet[3]
Summary
Onychomycosis is a fungal infection occurring in the nails and may affect the adjacent skin. In separate phase IIb/III clinical trials, nail samples were isolated from patients to compare the activity of 10% luliconazole with amorolfine, ciclopirox, and terbinafine against distal subungual onychomycosis[26]. It showed a mean minimum inhibitory concentration of 0.00022 μg/mL, which was lower than that of the other three antifungals. After 48 weeks, complete cure (0% clinical involvement of the nail and negative direct microscopy) rate was significantly higher in luliconazole groups (14.9%) compared with vehicle (5.1%, P = 0.012). 13 patients 33 to 74 years of age with 25 to 50% nail involvement completed the trial, and 15.4% achieved mycological cure (negative KOH and culture). It is important to treat tinea pedis, and any affected family members, early and effectively
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