Abstract
Onychomycosis is a fungal infection of nails that is widespread and difficult to treat because of the impermeable nature of human nails. Topically applied anti-fungal agents cannot penetrate this structure, and treatment regimens often resort to systemic antifungals with concomitant side effects. One recent clinical study suggested that mechanical fenestration of the nail using an intelligent nail drill might be a possible solution to this problem. In this work, an in vitro model of the transungual delivery of antifungal agents is presented, which utilizes real nail tissue and an inline flow system. This system was deployed to measure transungual delivery of ciclopirox and determined that nail fenestration improved drug delivery by 3–4-fold after 42 days. This study bolsters the argument that nail fenestration should be accepted as a pretreatment for onychomycosis and offers a way of evaluating new drugs or formulations designed to combat this condition.
Highlights
Onychomycosis is a fungal infection of toenails and fingernails [1]
It most commonly affects the nails of the hallux and is more prevalent in men than women, which is possibly because the male hallux nail is generally thicker than the female nail (1.68 mm versus 1.38 mm) [2]. Both systemic and topical antifungal agents are used as treatments for onychomycosis [1,2,3]
When a drug is applied topically to human nails, compounds may accumulate in the dorsal nail surface layer and this impedes its penetration to the deep ventral layer and the bed [3,5,14]
Summary
Onychomycosis is a fungal infection of toenails and fingernails [1] It most commonly affects the nails of the hallux and is more prevalent in men than women, which is possibly because the male hallux nail is generally thicker than the female nail (1.68 mm versus 1.38 mm) [2]. Both systemic and topical antifungal agents are used as treatments for onychomycosis [1,2,3]. The concentration of an applied drug can drop ~1000-fold across the width of the nail and fail to reach the minimum inhibitory concentration (MIC) needed to arrest fungal growth [5]
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