Improving Cure Rates in Onychomycosis

Lam

et al. 2020

IAD

Background : Onychomycosis is a common fungal infection of the nail. Objective: The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis. Methods: A PubMed search was completed in Clinical Queries using the key term “onychomycosis”. The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term “onychomycosis” in www.freepatentsonline.com. Results : Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed. Conclusion: Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.

Section: Epidemiologymentioning

confidence: 99%

Onychomycosis: An Updated Review

Lam

et al. 2020

IAD

“…Sin embargo, existen factores que predisponen a la recurrencia. Dentro de estos se encuentran: inmunosupresión, presencia de tiña pedis, historia familiar de OM, humedad, calzado oclusivo, higiene deficiente, trauma ungueal, tratamiento incorrecto de la infección original y baja adherencia al tratamiento 41 .…”

Section: Prevención De Recurrenciasunclassified

“…Se debe lavar el calzado con agua > 60°C por más de 45 minutos, opción disponible al utilizar máquinas lavadoras 40 . Mención especial merece el tratamiento de familiares con OM, dado a que serían la fuente de reinfección en un 86% de los casos 29,41 .…”

Section: Prevención De Recurrenciasunclassified

Onicomicosis en pediatría: Actualización y tratamiento

2020

Rev Chil Pediatr

La onicomicosis (OM) es una infección fúngica de las uñas, cuyo principal agente causal es el Tricophytum rubrum. Si bien es una patología infrecuente en niños, se ha observado un aumento en la prevalencia en el último tiempo. Hasta la fecha, existen diversos estudios y guías clínicas de OM en adultos. Sin embargo, la literatura en edad pediátrica es escasa, lo que dificulta el tratamiento en pediatría. En el presente articulo se revisa la literatura actual, los métodos diagnosticos de OM, datos epidemiológicos locales y globales, y se presentan las opciones de tratamiento disponibles considerando su eficacia y perfil de seguridad en población pediátrica.

“…Combining onychomycosis treatment options can increase their efficacy and improve patient outcomes, possibly due to synergy, differing mechanisms of action and restricting the effect of fungal resistance [ 52 ]. In their 2017 review, Gupta and colleagues [ 52 ] summarised studies combining oral and/or topical drugs for onychomycosis, revealing that combination therapy is sometimes (though not always) more effective than monotherapy. Most studies combined oral terbinafine or itraconazole with topical amorolfine 5%, ciclopirox 8% or terbinafine.…”

Section: Combination Therapymentioning

confidence: 99%

“…Many combination therapies for onychomycosis are based on improving drug delivery to the infected nail via adjunct physical, mechanical or chemical treatments, including nail filing, nail trimming, debridement, chemical avulsion and the drilling of small holes into the nail plate (microporation) [ 52 ]. A promising emerging adjunct treatment is iontophoresis, which may be combined with topical therapies to improve their effectiveness.…”

Section: Combination Therapymentioning

confidence: 99%

Challenges and Opportunities in the Management of Onychomycosis

Christenson

Peterson

Naunton

et al. 2018

JoF

Onychomycosis is an increasingly common fungal nail infection, chiefly caused by dermatophyte fungi. The disease is notoriously difficult to treat due to the deep-seated nature of fungi within the nail plate, prolonged treatment requirements, poor patient adherence and frequent recurrences. Given the poor efficacy of currently available topical and systemic therapies, there is a renewed interest in exploring alternative treatment modalities for onychomycosis. Natural therapies, physical treatments and various combination therapies have all shown potential for the management of onychomycosis, though research on many of these methods is still in preliminary stages. Further large, well-designed, randomised controlled trials are necessary to confirm the efficacy of these novel treatments in order to make formal recommendations regarding their use in the management of onychomycosis.