Onychomycosis: Practical Approaches to Minimize Relapse and Recurrence

Abstract

Introduction: Toenail onychomycosis is a common disease in which treatment options are limited and treatment failures and disease recurrence are frequently encountered. It usually requires many months of treatment, and recurrence may occur in more than half of the patients within 1 year or more after the infection has been eradicated. Data on long-term treatment, follow-up and recurrence are limited. Objective: Our objective is to interpret these data and recommend practical approaches that should minimize recurrence based on our clinical experience. Results: Several factors have been suggested to play a role in the high incidence of recurrence, but only the extent of nail involvement and co-existing diabetes mellitus have been shown to have a significant impact. Conclusion: The use of topical antifungals to prevent recurrences after complete cure was achieved has been suggested by various workers and used successfully in our practice. However, it has never been validated through clinical studies. Topical prophylaxis once weekly or twice monthly would seem appropriate in those patients most at risk. Prompt treatment of tinea pedis is essential, as is ensuring family members are free from disease. Patient education and pharmacologic intervention are equally important, and there are a number of simple strategies patients can employ. Managing onychomycosis is a significant long-term commitment for any patient, and minimizing recurrence is critical to meet their expectations.

Early Visible Improvements during K101-03 Treatment: An Open-Label Multicenter Clinical Investigation in Patients with Onychomycosis and/or Nail Psoriasis

“…It mainly occurs in older adults, and in Europe its prevalence has been estimated to be as high as 23% [1,2] . Onychomycosis is not dangerous as such, but it does not resolve without treatment, can be transmitted from nail to nail and even between individuals [3] , and negatively affects quality of life in long-term sufferers [4] . Curing the causative infection is a challenge.…”

Rapid Visible Improvements in Onychomycosis: An Open-Label Clinical Investigation of Kerasal Nail<sup>TM</sup>

“…Onychomycosis does not resolve spontaneously and if left untreated it can be transmitted to family members [4]. While not dangerous per se, it often causes pain and discomfort and can worsen health-related quality of life, particularly in patients with persistent symptoms [5].…”

Challenges and Opportunities in the Management of Onychomycosis

“…Achieving complete cure can take as long as 18 months [ 16 ] and cure is not achieved at all in 20–25% of treated patients [ 17 ]. Furthermore, the disease is associated with very high recurrence rates due to the presence of residual fungal spores or hyphae, with relapse occurring in 6.5–53% of patients [ 18 ]. The efficacy of current treatments is limited by the slow growth of toenails, nail keratin thickness preventing penetration of topical and systemic drugs, and survival of fungi in surrounding environments (such as footwear) for long periods.…”