Toenail onychomycosis: current and future treatment options

Abstract

Onychomycosis is a common disease affecting as much as 8% of the general population. Treatment of onychomycosis is challenging, complicated by low cure rates and relatively high relapse rates. This paper reviews the efficacy of current oral, topical, and surgical treatment options. Currently, the treatment of choice for toenail onychomycosis is oral terbinafine because of its high efficacy, low relapse rates, and cost-effectiveness. Oral itraconazole or fluconazole could be considered for infections caused by Candida. Topical therapies may be a useful adjunct to these systemic therapies, but are less effective when used alone. More research is needed to determine the best measures for preventing reinfection.

Chemical method to enhance transungual transport and iontophoresis efficiency

“…The current methods of treatment for onychomycosis have encountered only limited success, require long treatment duration, and risk systemic side effects (Rodgers and Bassler, 2001;Repka et al, 2002;Ajit et al, 2003). Approximately one-third of the patients cannot be completely cured after six or more weeks of oral medication due to treatment failure and relapse (Gupta and Shear, 1999;Gupta et al, 2001;Finch and Warshaw, 2007). Recently, iontophoresis has been demonstrated as a promising method for enhancing drug delivery through the human nail plate (James et al, 1986;Murthy et al, 2007a;Murthy et al, 2007b).…”

Ação Do Laser De Baixa Intensidade Na Produção De Metabólitos Secundários Do Dermatófito Trichophyton Rubrum

“…Essas opções de tratamento nem sempre são satisfatórias devido ao alto custo e eficácia (FINCH;WARSHAW, 2007). Os efeitos colaterais das medicações e a dificuldade de aplicação de medicações tópicas são fatores que comprometem o tratamento (LESHER, 1999;KOEHLER;MAIBACH, 2001).…”

Safety and Tolerability of Luliconazole Solution 10-Percent in Patients with Moderate to Severe Distal Subungual Onychomycosis

“…On each of these days, blood was collected immediately prior to dosing and then at 1,3,6,9,12,16,20, and 24 h after dosing. Additional blood draws were conducted prior to dosing on days 3, 4, 5, 11, 18, 22, and 25 and following the cessation of treatment on days 31, 32, 33, and 36 (the last study visit, which occurred 7 days after the last treatment application).…”

“…The PK parameters were calculated using noncompartmental methods and summarized for days 1,8,15, and 29 using descriptive statistics (sample size [n], mean, standard deviation [SD], median, and range). Actual sampling times were used for the PK analyses, while nominal sampling times were used in all data tabulations and in the graphical presentations of the results.…”

“…This condition is usually caused by dermatophytes, either Trichophyton rubrum or Trichophyton mentagrophytes, although it may also occur due to nondermatophyte molds or Candida albicans (1)(2)(3)(4). It is estimated that 10% of the general population has onychomycosis, with higher rates in the range of 20% to 50% reported among individuals over the age of 60 years (5).…”