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J Korean Med Assoc > Volume 62(7); 2019 > Article
Lee: Treatment of onychomycosis

Abstract

Onychomycosis is a fungal nail infection caused by various fungal species, including dermatophytes, non-dermatophytes, and yeast. It is one of most bothersome nail problems, because it may cause permanent deformity of the nail, local pain, paresthesia, and difficulties performing activities of daily living and engaging in social interactions. Additionally, the treatment of onychomycosis is considered to be challenging because of the long duration of treatment, high recurrence and treatment failure rates, and drug interactions. In this article, we review the prognostic factors for onychomycosis treatment, the treatment options that have been approved, and off-label therapies and devices. Furthermore, we describe preventive therapy for recurrence and emerging methods to achieve a high cure rate. For successful treatment of onychomycosis, the risk factors should be clarified according to the patient's status and the clinical characteristics of onychomycosis. Recently, combinations of various treatment options, such as systemic therapy with simultaneous topical antifungal agents and boost therapy, have been reported as effective treatments of onychomycosis. In addition, laser therapy, photodynamic therapy, and plasma therapy have been proposed as emerging curative options. Providing patient-specific treatment based on an understanding of these treatments plays a pivotal role in achieving better treatment results. This article suggested the updated treatment options for onychomycosis to help clinicians make proper plans and achieve better results.

REFERENCES

1. Elewski BE, Hay RJ. Novel treatment strategies for superficial mycoses: introduction. J Am Acad Dermatol 1999;40(6 Pt 2):S1-S2.
crossref pmid
2. English MP. Trichophyton rubrum infection in families. Br Med J 1957;1:744-746.
crossref pmid pmc
3. Piraccini BM, Alessandrini A. Onychomycosis: a review. J Fungi (Basel) 2015;1:30-43.
crossref pmid pmc
4. Gupta AK. Onychomycosis in the elderly. Drugs Aging 2000;16:397-407.
crossref pmid
5. Gupta AK, Drummond-Main C, Cooper EA, Brintnell W, Piraccini BM, Tosti A. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502.
crossref pmid
6. Baran R, Faergemann J, Hay RJ. Superficial white onychomycosis: a syndrome with different fungal causes and paths of infection. J Am Acad Dermatol 2007;57:879-882.
crossref pmid
7. Hay RJ, Baran R. Onychomycosis: a proposed revision of the clinical classification. J Am Acad Dermatol 2011;65:1219-1227.
crossref pmid
8. Carney C, Tosti A, Daniel R, Scher R, Rich P, DeCoster J, Elewski B. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-1282.
crossref pmid
9. Scher RK, Tavakkol A, Sigurgeirsson B, Hay RJ, Joseph WS, Tosti A, Fleckman P, Ghannoum M, Armstrong DG, Markin-son BC, Elewski BE. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56:939-944.
crossref pmid
10. Roberts DT. Onychomycosis: current treatment and future challenges. Br J Dermatol 1999;141(Suppl 56):1-4.
crossref pmid
11. Tosti A, Piraccini BM, Stinchi C, Colombo MD. Relapses of onychomycosis after successful treatment with systemic antifungals: a three-year followup. Dermatology 1998;197:162-166.
crossref pmid pdf
12. Gupta AK, Studholme C. How do we measure efficacy of therapy in onychomycosis: patient, physician, and regulatory perspectives. J Dermatolog Treat 2016;27:498-504.
crossref pmid
13. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol 2014;7:10-18.

14. Gupta AK, Ryder JE, Baran R. The use of topical therapies to treat onychomycosis. Dermatol Clin 2003;21:481-489.
crossref pmid
15. Tabara K, Szewczyk AE, Bienias W, Wojciechowska A, Pastus-zka M, Oszukowska M, Kaszuba A. Amorolfine vs. ciclopirox: lacquers for the treatment of onychomycosis. Postepy Dermatol Alergol 2015;32:40-45.
crossref pmid pmc
16. Elewski BE, Ghannoum MA, Mayser P, Gupta AK, Korting HC, Shouey RJ, Baker DR, Rich PA, Ling M, Hugot S, Damaj B, Nyirady J, Thangavelu K, Notter M, Parneix-Spake A, Sigurgeirsson B. Efficacy, safety and tolerability of topical terbinafine nail solution in patients with mild-to-moderate toenail onychomycosis: results from three randomized studies using double-blind vehicle-controlled and open-label active-controlled designs. J Eur Acad Dermatol Venereol 2013;27:287-294.
crossref pmid
17. Ruiz-Lopez P, Moreno-Coutino G, Fernandez-Martinez R, Espinoza-Hernandez J, Rodriguez-Zulueta P, Reyes-Teran G. Evaluation of improvement of onychomycosis in HIV-infected patients after initiation of combined antiretroviral therapy without antifungal treatment. Mycoses 2015;58:516-521.
crossref pmid
18. Gupta AK, Fleckman P, Baran R. Ciclopirox nail lacquer topical solution 8% in the treatment of toenail onychomycosis. J Am Acad Dermatol 2000;43(4 Suppl):S70-S80.
crossref pmid
19. Elewski BE, Rich P, Pollak R, Pariser DM, Watanabe S, Senda H, Ieda C, Smith K, Pillai R, Ramakrishna T, Olin JT. Efinaconazole 10% solution in the treatment of toenail onychomycosis: two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol 2013;68:600-608.
crossref pmid
20. Scher RK, Nakamura N, Tavakkol A. Luliconazole: a review of a new antifungal agent for the topical treatment of onychomycosis. Mycoses 2014;57:389-393.
crossref pmid
21. Watanabe S, Kishida H, Okubo A. Efficacy and safety of luliconazole 5% nail solution for the treatment of onychomycosis: A multicenter, double-blind, randomized phase III study. J Dermatol 2017;44:753-759.
crossref pmid pdf
22. Elewski BE, Aly R, Baldwin SL, Gonzalez Soto RF, Rich P, Weisfeld M, Wiltz H, Zane LT, Pollak R. Efficacy and safety of tavaborole topical solution, 5%, a novel boron-based antifungal agent, for the treatment of toenail onychomycosis: results from 2 randomized phase-III studies. J Am Acad Dermatol 2015;73:62-69.
crossref pmid
23. Gupta AK, Sauder DN, Shear NH. Antifungal agents: an overview. Part II. J Am Acad Dermatol 1994;30:911-933.
crossref pmid
24. Breckenridge A. Clinical significance of interactions with antifungal agents. Br J Dermatol 1992;126(Suppl 39):19-22.
crossref
25. Van Cauteren H. The toxicological properties of itraconazole. Recent Trends Discov Dev Eval Antifung Agents 1987;263-271.

26. Munoz P, Moreno S, Berenguer J, Bernaldo de Quiros JC, Bouza E. Fluconazole-related hepatotoxicity in patients with acquired immunodeficiency syndrome. Arch Intern Med 1991;151:1020-1021.
crossref pmid
27. Sigurgeirsson B, Paul C, Curran D, Evans EG. Prognostic factors of mycological cure following treatment of onychomycosis with oral antifungal agents. Br J Dermatol 2002;147:1241-1243.
crossref pmid
28. Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013;69:416-425.
crossref pmid
29. Moore JN, Healy JR, Kraft WK. Pharmacologic and clinical evaluation of posaconazole. Expert Rev Clin Pharmacol 2015;8:321-334.
crossref pmid pmc
30. Watanabe S, Tsubouchi I, Okubo A. Efficacy and safety of fosravuconazole L-lysine ethanolate, a novel oral triazole antifungal agent, for the treatment of onychomycosis: a multicenter, double-blind, randomized phase III study. J Dermatol 2018;45:1151-1159.
crossref pmid pmc pdf
31. Gupta AK, Versteeg SG. A critical review of improvement rates for laser therapy used to treat toenail onychomycosis. J Eur Acad Dermatol Venereol 2017;31:1111-1118.
crossref pmid pdf
32. Hashimoto T, Blumenthal HJ. Survival and resistance of Trichophyton mentagrophytes arthrospores. Appl Environ Microbiol 1978;35:274-277.
crossref pmid pmc pdf
33. Gupta AK, Ahmad I, Borst I, Summerbell RC. Detection of xanthomegnin in epidermal materials infected with Trichophyton rubrum. J Invest Dermatol 2000;115:901-905.
crossref pmid
34. Sotiriou E, Koussidou-Eremonti T, Chaidemenos G, Apalla Z, Ioannides D. Photodynamic therapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: preliminary results of a single-centre open trial. Acta Derm Venereol 2010;90:216-217.
crossref pmid
35. Heinlin J, Maisch T, Zimmermann JL, Shimizu T, Holzmann T, Simon M, Heider J, Landthaler M, Morfill G, Karrer S. Contact-free inactivation of Trichophyton rubrum and Microsporum canis by cold atmospheric plasma treatment. Future Microbiol 2013;8:1097-1106.
crossref pmid
36. Arrese JE, Pierard GE. Treatment failures and relapses in onychomycosis: a stubborn clinical problem. Dermatology 2003;207:255-260.
crossref pmid pdf
37. Pierard GE, Pierard-Franchimont C, Arrese JE. The boosted oral antifungal treatment for onychomycosis beyond the regular itraconazole pulse dosing regimen. Dermatology 2000;200:185-187.
crossref pmid pdf
38. Lipner SR, Scher RK. Onychomycosis: treatment and prevention of recurrence. J Am Acad Dermatol 2019;80:853-867.
pmid


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