A Paradigm Shift in the Treatment and Management of Onychomycosis

Gupta, Aditya K.; Venkataraman, Maanasa; Renaud, Helen J.; Summerbell, Richard C.; Shear, Neil H.; Piguet, Vincent

doi:10.1159/000516112

Cited by 27 publications

(22 citation statements)

References 98 publications

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“…Onychomycosis caused by nondermatophyte molds and mixed infections are difficult to treat and may be contributing to growing antifungal resistance [51, 52]. Some nondermatophytes and Candida species have demonstrated resistance to terbinafine [50].…”

Section: Discussionmentioning

confidence: 99%

Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence

Nickles¹,

Lio²,

Mervak³

2022

Skin Appendage Disord

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Introduction: Onychomycosis is notoriously difficult to treat. While oral antifungals are the most efficacious treatment for onychomycosis, they are contraindicated in certain patient populations, and patients may desire lower risk and accessible alternatives to systemic agents. In this study, we examine the clinical evidence supporting the use of complementary and alternative therapies in the treatment of onychomycosis. Methods: PubMed, Embase, and Cochrane Library were searched for clinical trials, observational studies, and case reports/case series, examining the efficacy of a complementary or alternative therapy for the treatment of onychomycosis. Results: We identified 17 articles studying a complementary and alternative therapy for onychomycosis, including tea tree oil (n = 5), Ageratina pichinchensis (n = 3), Arthrospira maxima (n = 2), natural coniferous resin lacquer (n = 2), Vicks VapoRub® (n = 2), propolis extract (n = 2), and ozonized sunflower oil (n = 1). Conclusion: Given the rise of antifungal resistance, complementary and alternative therapies should continue to be studied as adjunctive or alternative therapy for onychomycosis. While preliminary evidence exists for several complementary and alternative therapies in the treatment of onychomycosis, large-scale, randomized, placebo-controlled trials are needed prior to endorsing their use to patients.

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Section: Discussionmentioning

confidence: 99%

Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence

Nickles¹,

Lio²,

Mervak³

2022

Skin Appendage Disord

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“…The finding that side effects were more common in the HCP-treated group vs. self-treated group might be because the HCP group were prescribed oral antifungals in some cases. Lastly, we were unable to investigate fungal species with this survey, which is a key factor informing testing and treatment strategies, as antifungal resistance is a concern in both dermatophyte and non-dermatophyte infections [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

High Frequency of Self-Diagnosis and Self-Treatment in a Nationally Representative Survey about Superficial Fungal Infections in Adults—United States, 2022

Benedict

Gold

et al. 2022

JoF

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Data about the prevalence, diagnosis, treatment, and public knowledge of superficial fungal infections in the United States are scarce. These infections are a growing concern given the emergence of antifungal drug resistance. We analyzed data from a national survey of nearly 6000 U.S. adults. Overall, 114 (2.7%) participants reported having ringworm and 415 (10.0%) reported a fungal nail infection in the past 12 months; 61.4% of participants with any superficial fungal infection were self-diagnosed. Most patients (55.5%) used over-the-counter antifungals. The common nature of superficial fungal infections and the high rates of self-diagnosis and treatment indicate that community education about these infections should be considered a public health priority.

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“…The incidence of onychomycosis is increasing year on year, accounting for 90% of toenail infections and at least 50% of fingernail infections, and the incidence of onychomycosis varies slightly between age groups. The incidence is 10% in the general population, 20% in those aged 60 years and older, and over 50% in those aged 70 years and older ( 16 – 18 ). Onychomycosis mainly manifests as changes in the color and shape of the nail plate, similar to psoriasis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Clinical Diagnosis of Onychomycosis by Dermoscopy

Cen

et al. 2022

Front. Surg.

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BackgroundAs a common clinical superficial fungal infection, the diagnosis of onychomycosis relies on clinical features, traditional KOH direct microscopy and fungal culture. In recent years, dermoscopy has been widely used in the diagnosis and treatment of infectious diseases and has provided new options for the diagnosis of onychomycosis.ObjectiveTo evaluate the value of dermoscopy in the clinical diagnosis of onychomycosis and to explore the relationship between each clinical subtype and the dermoscopic pattern.MethodsA retrospective study of 114 cases of clinically suspected onychomycosis was conducted to compare the differences between dermoscopy and fungal pathogenic examination (microscopy and culture) in the diagnostic sensitivity of onychomycosis and to analyze the relationship between nine common dermoscopic modalities and clinical subtypes of onychomycosis.ResultsAmong the 114 proposed patients, 87 nails with positive fluorescent staining microscopy and/or positive fungal cultures were diagnosed as onychomycosis. The sensitivity and specificity of dermatoscopy, using the mycological findings as a reference, were 86.21 and 33.33%, respectively. The incidence of common dermatoscopic patterns in the 87 nails with confirmed onychomycosis was as follows: white flocculation in 76 cases (87.35%), longitudinal nail pattern in 72 cases (82.76%), jagged changes in the distal nail plate in 69 cases (79.31%) and yellow staining in 46 cases (52.87%), these four patterns were more commonly seen in the distal lateral subungual onychomycosis and total dystrophic onychomycosis, but there was no statistical difference in the positive dermatoscopic pattern between these two types (P > 0.05).ConclusionDermoscopy can be an important aid in the diagnosis of onychomycosis, especially when fungal microscopy or culture is not appropriate, but this method is still not a substitute for fungal microscopy and culture.

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A Paradigm Shift in the Treatment and Management of Onychomycosis

Cited by 27 publications

References 98 publications

Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence

Complementary and Alternative Therapies for Onychomycosis: A Systematic Review of the Clinical Evidence

High Frequency of Self-Diagnosis and Self-Treatment in a Nationally Representative Survey about Superficial Fungal Infections in Adults—United States, 2022

Assessment of the Clinical Diagnosis of Onychomycosis by Dermoscopy

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