Onychomycosis and Medical Treatment

kozder ozel 13-3 kapak

Ulaş GÜVENÇa, Koray ÖZKANa, Tamer İrfan KAYAb

aVM Medical Park Mersin Hastanesi, Deri ve Zührevi Hastalıkları Kliniği Mersin, TÜRKİYE
bMersin Üniversitesi Tıp Fakültesi, Deri ve Zührevi Hastalıkları ABD, Mersin, TÜRKİYE

ABSTRACT
Onychomycosis is a chronic fungal infection of the nail, contributes to 40% of all nail disorders. Different types of fungi can cause this disease. The most frequent are the dermatophytes (approximately 90% in toenails), with Trichophyton rubrum being the most prevalent. Candida and nondermatophytic molds are less common agents. Tinea unguium is a term which describes chronic fungal infections by dermatophytes only. Onychomycosis is a difficult to treat infection, cure is not always possible and relapses are very common, which makes it difficult to eradicate. Among the treatment options, oral treatments have shorter treatment periods and better cure rates. Oral treatments approved by the FDA are terbinafine, itraconazole for the treatment of dermatophyte onychomycosis. Griseofulvin is rarely used today. Terbinafine may be preferred as first choice of pharmacotherapy due to good cure rates and limited drug-drug interactions. Topical treatments approved by the FDA are ciclopirox 8% nail lacquer, efinaconazole 10% solution and tavaborole 5% solution. Amorolfine %5 nail lacquer is approved in Europe.
Keywords: Onychomycosis; nails; tinea; candida; therapy

Referanslar

  1. Shemer A. Update: Medical treatment of onychomycosis. Dermatologic therapy. 2012;25: 582-93. [Crossref]  [PubMed]
  2. Leung AKc, Lam MJ, Leong KF, Hon KL, et. al. Onychomycosis: An Updated Review. Recent Pat ınflamm Allergy Drug Discov. 2019:25. [Epub ahead of print]
  3. Gupta AK, Versteeg SG, Shear NH. Onychomycosis in the 21st century: An Update on Diagnosis, Epidemiology, and Treatment. nJ cutan Med Surg. 2017;21:525-39. [Crossref]  [PubMed]
  4. Lipner SR. Pharmacotherapy for onychomycosis: new and emerging treatments. Expert Opin Pharmacother. 2019;20:725-35. [Crossref]  [PubMed]
  5. Christenson JK, Peterson GM, Naunton M, Bushell M, et. al. challenges and Opportunities in the Management of Onychomycosis. J Fungi (Basel). 2018; 4:87. [Crossref]  [PubMed]
  6. Szepietowski Jc, Reich A, Garlowska E, Kulig M, Baran E. Factors influencing coexistence of toenail onychomycosis with tinea pedis and other dermatomycoses: A survey of 2761 patients. Arch. Dermatol. 2006;142,1279-84. [Crossref]  [PubMed]
  7. Hay RJ, Ashbee HR. chapter 32: Fungal infections. ın: Griffiths c, Barker J, Bleiker T, chalmers R, creamer D (Editors). Rook's Textbook of Dermatology, 9th edition, Oxford, John Wiley & Sons, 2016: p32.1-96.
  8. Gupta.A.K, Paquet M, Simpson F. Therapies fort he treatment of onychomycosis. clinics in Dermatology. 2013;31:544-54. [Crossref]  [PubMed]
  9. Wilsmann-Theis D, Sareika F, Bieber T, Schmid-Wendtner M-H, Wenzel J. New reasons for histopathological nail-clipping examination in the diagnosis of onychomycosis. J Eur Acad Dermatol Venereol. 2011;25:235-7. [Crossref]  [PubMed]
  10. Gupta AK, Versteeg SG, Shear NH, Piguet V, Tosti A, Piraccini BM. A Practical Guide to curing Onychomycosis: How to Maximize cure at the Patient, Organism, Treatment, and Environmental Level. Am J clin Dermatol. 2019;20:123-33. [Crossref]  [PubMed]
  11. Kreijkamp-Kaspers S, Hawke K, Guo L, Kerin G, et al. Oral antifungal medication for toenail onychomycosis. cochrane Database Syst Rev. 2017;7:cD010031. [Crossref]  [PubMed]
  12. Lamisil (terbinafine hydrochloride) tablets [package insert]. East Hanover, NJ: Novartis Pharmaceuticals corporation. Available at: Accessed April 30, 2018. [Link]
  13. Balfour JA, Faulds D. Terbinafine. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in superficial mycoses. Drugs. 1992;43:259-84. [Crossref]  [PubMed]
  14. Lipner SR, Scher RK. Onychomycosis: Treatment and prevention of recurrence. J Am Acad Dermatol. 2019;80:853-67. [Crossref]  [PubMed]
  15. Gupta AK, Paquet M, Simpson F, Tavakkol A. Terbinafine in the treatment of dermatophyte toenail onychomycosis: a metaanalysis of efficacy for continuous and intermittent regimens. J Eur Acad Dermatol Venereol.. 2013;27:267-72. [Crossref]  [PubMed]
  16. Alpsoy E, Yilmaz E, Basaran E. ıntermittent therapy with terbinafine for dermatophyte toeonychomycosis: a new approach. J Dermatol. 1996;23:259-62. [Crossref]  [PubMed]
  17. de Sá Dc, Lamas AP, Tosti A. Oral therapy for onychomycosis: an evidence-based review. Am J clin Dermatol. 2014;15:17-36. [Crossref]  [PubMed]
  18. Xu Y, Miao x, Zhou B, Luo D. combined oral terbinafine and long-pulsed 1,064-nm Nd:YAG laser treatment is more effective for onychomycosis than either treatment alone. Dermatol Surg. 2014;40:1201-7. [Crossref]  [PubMed]
  19. Gupta AK, De Doncker P, Haneke E. ıtraconazole pulse therapy for the treatment of candida onychomycosis. J Eur Acad Dermatol Venereol. 2001;15:112-5. [Crossref]  [PubMed]
  20. Mishra M, Panda P, Tripathy S, Sengupta S, Mishra K. An open randomized comparative study of oral itraconazole pulse and terbinafine pulse in the treatment of onychomycosis. ındian J Dermatol Venereol Leprol. 2005;71: 262-6. [Crossref]  [PubMed]
  21. Scher RK, Breneman D, Rich P, Savin Rc, et al. Once-weekly fluconazole (150, 300, or 450 mg) in the treatment of distal subungual onychomycosis of the toenail. J Am Acad Dermatol. 1998;38(6 Pt 2):77-86. [Crossref]  [PubMed]
  22. Havu V, Heikkila¨ H, Kuokkanen K, Nuutinen M, et al. A double-blind, randomized study to compare the efficacy and safety of terbinafine (Lamisil) with fluconazole (Diflucan) in the treatment of onychomycosis. Br J Dermatol.. 2000;142:97-102. [Crossref]  [PubMed]
  23. Feng x, xiong x, Ran Y. Efficacy and tolerability of amorolfine 5% nail lacquer in combination with systemic antifungal agents for onychomycosis: A meta-analysis and systematic review. Dermatol Ther. 2017;30:3. [Crossref]  [PubMed]
  24. Sigurgeirsson, B, Ghannoum M., OsmanPonchet H, Kerrouche N, Sidou F. Application of cosmetic nail varnish does not affect the antifungal efficacy of amorolfine 5% nail lacquer in the treatment of distal subungual toenail onychomycosis: results of a randomized active-controlled study and in vitro assays. Mycoses. 2019;59:319-26. [Crossref]  [PubMed]
  25. Sigurgeirsson B, Olafsson JH, Steinsson JT, Kerrouche N, Sidou F. Efficacy of amorolfine nail lacquer for the prophylaxis of onychomycosis over 3 years. J Eur Acad Dermatol.. 2010;24:910-5. [Crossref]  [PubMed]
  26. Dars S, Banwell HA, Matricciani L. The use of urea for the treatment of onychomycosis: A systematic review. J Foot Ankle Res. 2019;12:22. [Crossref]  [PubMed]