Review of antifungal therapy and the severity index for assessing onychomycosis: Part I

Abstract

This review outlines recent data on treatment modalities and outcomes with antifungal therapy in onychomycosis. Included are topical, mechanical, chemical and systemic treatments or a combination thereof. Topical treatments, or transungual drug delivery systems (TUDDS), including ciclopirox and amorolfine were shown to be effective if used alone for mild-moderate nail involvement. Specifically, superficial white onychomycosis (SWO) restricted to the dorsum of the nail plate and moderate distal lateral subungual onychomycosis (DLSO). Mechanical treatments were mostly effective as adjuncts to topical therapy which include nail avulsion and abrasion. In particular, partial nail avulsion aids topical therapy in DLSO and partial subungual onychomycosis for a more effective therapy. Chemical avulsion is a painless method of debridement which uses a keratinolysis formula that is effective only in limited and early disease. Systemic therapies have been shown to be effective with terbinafine and itraconazole is suggested as being the most cost-effective therapy. Systemic therapies require consideration of side effects and monitoring by both patient and physician prior to treatment application. An effective suggestion is the use of a topical with debridement for mild-moderate onychomycosis and systemic (terbinafine) plus topical for severe onychomycosis. Most treatment modalities will require long-term use from 3 to 9 months to be most effective, with strategies presented in Part II of this review.

Prognostic Factors in Onychomycosis Treatment

“…0001) [20]. While trauma has been also cited as a sign of poor prognosis [12,15], there have been no large-scale studies evaluating the association of trauma with response to treatment.…”

“…These are shown in Table 1 [11][12][13][14][15][16][17]. Patient characteristics include older age, prior trauma to the affected nail, and previous history of onychomycosis; patient morbidities include immunosuppression, poor peripheral circulation, and uncontrolled diabetes mellitus.…”

How I treat leukemia during pregnancy

“…53,54 Exposure up to 23 weeks' gestation can cause severe neonatal dysmorphic features including craniosynostosis, cleft palate, humeral-radial fusion, bowed tibia and femur, hypoplasia of the nasal bones, and short thumbs and toes in women receiving fluconazole at doses of $400 mg daily during the first trimester of pregnancy. A number of studies have reported a lack of congenital defects among infants delivered by women exposed to short courses of lower doses of fluconazole, including when given during the first trimester.…”

Effects of itraconazole on the pharmacokinetics and pharmacodynamics of intravenously and orally administered oxycodone

“…Itraconazole is widely used in the treatment of superficial and invasive fungal infections [11,12]. It is a potent and specific inhibitor of CYP3A and it has been the cause of clinically significant drug-drug interactions with many substrates of CYP3A [13][14][15][16].…”