Therapeutic strategies in onychomycosis

Epidemiology and clinical classification of onychomycosis

“…The treatment of onychomycosis has improved in recent years, which means that a complete and durable cure can be expected in most cases. However, because of the multifactorial aetiology of onychomycosis, correct diagnosis is essential to allow appropriate treatment 12 . Misdiagnosis will obviously have a negative impact on treatment outcome.…”

Trans-Ungual Iontophoretic Delivery of Terbinafine

“…Current treatment involves prolonged, daily administration of drugs through oral and topical routes. Unfortunately, oral therapy is associated with severe systemic and GI side effects 4. In particular, oral therapy with terbinafine hydrochloride (Lamisil) is associated with several limitations which include drug interactions, severe side effects, toxicity and a high rate of recurrence 5–7.…”

A randomized trial of amorolfine 5% solution nail lacquer in association with itraconazole pulse therapy compared with itraconazole alone in the treatment of Candida fingernail onychomycosis

“…Griseofulvin has no activity against Candida species. Ketoconazole is active against Candida , including onychomycosis, but the risk for hepatitis limits its use 9 . Data regarding the effectiveness of terbinafine against Candida nail infection are few and variable.…”

“…Itraconazole is an orally active synthetic triazole with broad‐spectrum antimycotic activity. It interferes with the cytochrome P450‐dependent enzyme lanosterol 14‐demethylase, which results in 14‐methylsterol accumulation and ergosterol depletion in fungal cells 9 . Itraconazole continuous or pulse therapy has been shown to be effective in the management of onychomycosis associated with dermatophytes, Candida species and moulds 10 …”