Topical and device-based treatments for fungal infections of the toenails

Foley, Kelly A.; Gupta, Aditya K.; Versteeg, Sarah G.; Mays, Rachel; Villanueva, Elmer Virgil; John, Denny

doi:10.1002/14651858.cd012093.pub2

Cited by 34 publications

(67 citation statements)

References 114 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These treatments do not have definitive guidelines and efficacy results show the greatest variation among all the available options. [76][77][78] Topical antifungals target the fungus from the outside, penetrating from the dorsal nail plate, while systemic medications work from the inside, penetrating the ventral nail plate. Tables 2-5 summarize relevant drug information.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…28,[156][157][158] There is limited evidence that lasers eradicate pathogenic fungi because reporting is incomplete, and there is a lack of randomized clinical trials. [76][77][78] Clinical studies have demonstrated the safety and effectiveness of the lasers, but clinical trial data released for lasers are incompletethey do not include the types of infections, details of treatment protocols, mycological or complete cure rates, or relapse rates with follow-up at 12 months post-treatment. In one review, a temporary improvement in nail appearance was seen in 78% of patients during treatment and follow-up.…”

Section: Novel Topical Therapiesmentioning

confidence: 99%

See 1 more Smart Citation

Onychomycosis: a review

Gupta

Stec

Summerbell

et al. 2020

Acad Dermatol Venereol

186

245

View full text Add to dashboard Cite

Onychomycosis is a fungal infection of the nail, causing discoloration and thickening of the affected nail plate, and is the most common nail infection worldwide. Onychomycosis was initially thought to be predominantly caused by dermatophytes; however, new research has revealed that mixed infections and those caused by non‐dermatophyte moulds (NDMs) are more prevalent than previously thought, especially in warmer climates. Microscopy and fungal culture are the gold standard techniques for onychomycosis diagnosis, but high false‐negative rates have pushed for more accurate methods, such as histology and PCR. As NDMs are skin and laboratory contaminants, their presence as an infectious agent requires multiple confirmations and repeated sampling. There are several treatment options available, including oral antifungals, topicals and devices. Oral antifungals have higher cure rates and shorter treatment periods than topical treatments, but have adverse side effects such as hepatotoxicity and drug interactions. Terbinafine, itraconazole and fluconazole are most commonly used, with new oral antifungals such as fosravuconazole being evaluated. Topical treatments, such as efinaconazole, tavaborole, ciclopirox and amorolfine have less serious side effects, but also have generally lower cure rates and much longer treatment regimens. New topical formulations are being investigated as faster‐acting alternatives to the currently available topical treatments. Devices such as lasers have shown promise in improving the cosmetic appearance of the nail, but due to a high variation of study methods and definitions of cure, their effectiveness for onychomycosis has yet to be sufficiently proven. Recurrence rates for onychomycosis are high; once infected, patients should seek medical treatment as soon as possible and sanitize their shoes and socks. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurrence.

show abstract

Section: Treatment Optionsmentioning

confidence: 99%

Section: Novel Topical Therapiesmentioning

confidence: 99%

Onychomycosis: a review

Gupta

Stec

Summerbell

et al. 2020

Acad Dermatol Venereol

186

245

View full text Add to dashboard Cite

show abstract

“…Two systematic reviews of treatments for fungal nail infections have been published in recent years [32,33]. In the first of these, Ferrari reported that, although benefits are modest, topical ciclopirox was the best topical preparation for treating toenail infections, concluding that no clinically important results were found from randomized controlled trials of other topical agents such as amorolfine, butenafine, fluconazole, ketoconazole, terbinafine and tioconazole [32].…”

Section: Systematic Reviewsmentioning

confidence: 99%

“…In the most recent systematic review, the Cochrane Skin Group evaluated topical drugs (ciclopirox, efinaconazole, luliconazole and tavaborole) in individuals with toenail onychomycosis [33]. In the case of amorolfine, and although this drug was used as a comparator in some of the included trials, the systematic review was unable to assess the quality of the evidence due to the lack of any randomized controlled trials conducted or published that included amorolfine as the intervention of interest [33]. The authors concluded that while the overall evidence supports the use of topical therapies, complete cure rates were relatively low.…”

Section: Systematic Reviewsmentioning

confidence: 99%

“…The authors concluded that while the overall evidence supports the use of topical therapies, complete cure rates were relatively low. In the case of ciclopirox 8% HPCH, there was moderate-quality evidence (GRADE category) from two studies (n = 490) showing that it was probably more effective than comparators such as amorolfine 5% and water-insoluble ciclopirox 8% in producing a complete cure [relative risk (RR) 2.43, 95% CI 1.32-4.48), but there was probably little or no difference between the treatments with respect to mycological cure (RR 1.08, 95% CI 0.85 to 1.37) [33].…”

Section: Systematic Reviewsmentioning

confidence: 99%

See 1 more Smart Citation