The diagnosis and treatment of nail disorders: systemic antifungal therapy

Abstract

Systemic antifungals have been used in the treatment of fungal infections since the introduction of griseofulvin in 1958. Since then, new antifungal medications have been introduced, broadening the spectrum of therapies available. Onychomycosis is one of the most common complaints presented to the dermatologist. Fungal infection of the nails, though usually not an urgent medical condition, can be extremely distressing to the patient. Since current topical antifungal medications have little or no efficacy in the treatment of fungal infections of the nail, it is incumbent upon the dermatologist to be familiar with the use of systemic antifungals in the treatment of onychomycosis. In this article, the treatment of fungal infections of the nail with systemic antifungals is discussed. A brief review of the most common types of nail fungal infection is presented and the use of systemic antifungals relevant to dermatology is addressed.

Onychomycosis in Inflammatory Bowel Diseases

“…Onychomycosis is a common chronic fungal infection of the nail apparatus and is responsible for 40% to 50% of all onychopathies. 1,2 It is highly prevalent, affecting from 2% to 8% of world population, although these numbers are undoubtedly underestimated due to the low frequency of diagnosis. [2][3][4][5] Onychomycosis do not resolve without appropriated treatment and lead to esthetics nail disturbances in great deal of patients.…”

“…8 In general population affected by onychomycosis, the dermatophytes are the most prevalent pathogens. 1 The antropophilics fungus such as Trichophyton rubrum (71%) and Trichophyton mentagrophytes (20%) are responsible for over 90% of cases. [9][10][11] Several immunological disturbs have been reported in onychomycosis.…”

Onychomycosis: beyond cosmetic distress

“…The newer antifungals have a high affinity for the nail plate, 35 allowing numerous people to show their nails again. For safety and efficiency reasons, griseofulvin and ketoconazole should be consigned to the past 36,37 . The newer antifungal drugs (itraconazole, terbinafine, and fluconazole) have an acceptable adverse effect profile.…”

“…Patients taking acid suppressants or proton pump inhibitors must take it with an acidic drink (cola beverage), or take the antacid at least 2 h after the triazole. Terbinafine and fluconazole are not influenced by a meal. Drug interaction may reduce the concentration of the antifungal 37 . In some cases, sequential therapy 40 with itraconazole (two pulses) followed by one pulse of terbinafine (250 mg b.i.d.…”

“…Drug interaction may reduce the concentration of the antifungal 37 . In some cases, sequential therapy 40 with itraconazole (two pulses) followed by one pulse of terbinafine (250 mg b.i.d.…”