Strategies for the enhancement of nail plate permeation of drugs to treat onychomycosis

Abstract

Onychomycosis is caused by dermatophytes, non‐dermatophytes and yeasts. It has a global prevalence of 5.5%, requires long treatment periods, and has high relapse rates following therapy. Oral antifungals are generally the most common treatment. While effective, they have limitations such as drug–drug interactions, hepatotoxicity and adverse side effects; thus, they cannot be used in several populations. Topical antifungals do not have the safety limitations but are typically not as effective. The primary challenge of topical treatment is the permeation of drug molecules across the nail plate barrier, which is a highly cross‐linked keratin network. The use of drugs and formulations with favourable characteristics such as small size, absence of lipophilicity, hydrophilic nature, hydrating properties and appropriate pH can greatly improve permeation. Here, we review physical, nanoparticle‐based, formulation‐based, mechanical and chemical drug delivery strategies to improve the permeation of drugs across the nail plate.

The Plant Defensin Ppdef1 Is a Novel Topical Treatment for Onychomycosis

“…Onychomycosis is a persistent fungal infection of the nail, distinguished by nail discolouration, thickening, and distortion, and affects about 5-10% of the population globally [1][2][3]. These infections are hard to treat, can be painful, and have a cosmetic impact on the patient.…”

Contemporary Techniques and Potential Transungual Drug Delivery Nanosystems for The Treatment of Onychomycosis

“…Oral therapy is effective and at a low cost; however, hepatotoxicity, cardiac disturbances, and drug interactions are chief drawbacks that lead to patient nonadherence and adverse events [5]. On the other side, topical treatment is associated with fewer side effects and high patient compliance, while poor drug diffusion into the rigid nail structure is the main barrier [17]. In the last few years, different physical and chemical approaches emerged along with topically applied treatments including nail solutions and lacquers.…”