Treatment of Onychomycosis: Pros and Cons of Antifungal Agents

Abstract

The treatment modality of onychomycosis in special patient populations should take into account the clinical presentation of the onychomycosis, the causative organism, patient and physician preference, the concomitant medications that the patient is on, and the potential for adverse events for that patient if antifungal therapy is undertaken.

New Concepts in Median Nail Dystrophy, Onychomycosis, and Hand, Foot, and Mouth Disease Nail Pathology

“…Terbinafine has long been the most effective oral antifungal medication for dermatophytic infections. Studies have shown clearance rates of 76% over 12 weeks [13], but terbinafine remains a non-ideal modality due to its potential for hepatotoxicity, drug interactions, and ineffectiveness against nondermatophytes [14]. …”

Combination of oral terbinafine and topical ciclopirox compared to oral terbinafine for the treatment of onychomycosis

“…Therapeutic options for the treatment of onychomycosis include palliative care, mechanical or chemical debridement, topical and systemic antifungal agents, or a combination of two or more of these modalities (4)(5)(6). Factors that influence the choice of therapy include the presentation and severity of the disease, the current medications the patient is taking, previous therapies for onychomycosis and their response, physician and patient preference, and the cost of therapy (3,7).…”

Intermittent therapy with terbinafine and nail abrasion for dermatophyte toe onychomycosis: a pilot study

“…Pharmacokinetic studies support that terbinafine maintains a fungicidal level for several weeks even after the administration has stopped 12 . In this way, intermittent use may be an effective regimen for treating dermatophyte toenail onychomycosis, however, there are few randomised controlled trials using a non‐continuous dose of terbinafine 12–14 …”