Ciclopirox nail lacquer for the treatment of onychomycosis: an open non-comparative study.
Shemer A, Nathansohn N, Trau H, Amichai B, Grunwald MH. J Dermatol. 2010 Feb;37(2):137-9.
The standard treatment course for ciclopirox is daily treatment for 9-12 months, not 48 months.
Most patients show good improvement in nail appearance in my clinical experience.
67% of patients showed mild improvement to complete cure in this study which is about what I have gotten in my patients.
Down the street from me, a podiatrist charges $1200.00 for "laser fungal toenail treatment" using a non-FDA approved laser and no peer-reviewed scientific studies to back up his amazing claims of "curing nail fungus".
Graham,
I am interested....what do you tell your patients you can do for their mycotic nails.....other than trimming them?
Very interesting article but the results are less impressive than I thought. It seems to be an expensive option for a possible cure.
I still prefer the Terbinafine tablets, or if that is not possible the Amorolfine varnish which is applied twice a week, not every day.
Since I can't read the whole article can anyone please confirm that the suggested use of ciclopirox in the study is with or without deep nail debridement?
I find that the combination of the two (ciclopirox and debridement) has more than 66% success rate (complete resolution of infection) in my patients given they are reviewed every 4-8 weeks.
Surprised to hear this.
Used in my clinic for years with excellent results.
Is the patient applying twice daily for four weeks and then once on retiring?
A multicenter, randomized, open-label, controlled study comparing the efficacy, safety and cost-effectiveness of a sequential therapy with RV4104A ointment, ciclopiroxolamine cream and ciclopirox film-forming solution with amorolfine nail lacquer alone in dermatophytic onychomycosis.
Paul C, Coustou D, Lahfa M, Bulai-Livideanu C, Doss N, Mokthar I, Turki H, Nouira R, Fazaa B, Ben Osman A, Zourabichvili O, Cazeau C, Coubetergues H, Picot S, Bienvenu AL, Voisard JJ. Dermatology. 2013;227(2):157-64.
Hmm, so the amorolfine group did not receive mechanical debridemnet, (imperative for efficacy) nor chemical avulsion...
The jury is still out on whether ciclopirox is classified as fungistatic or fungicidal. Sure, it demonstrates fungistatic behaviour in vitro and in treatment for tinea versicolour - which is a yeast, not a dermatophyte! So, it`s efficacy in treatment for T-rubrum, the most frequent fungus found in OM is questionable, IMO.
Comparison of the antifungal efficacy of terbinafine hydrochloride and ciclopirox olamine containing formulations against the dermatophyte Trichophyton rubrum in an infected nail plate model.
Tauber A et al Mol Pharm. 2014 Jul 7;11(7):1991-6
Patient-reported outcomes from two randomised studies comparing once-weekly application of amorolfine 5% nail lacquer to other methods of topical treatment in distal and lateral subungual onychomycosis.
Schaller M et al Mycoses. 2017 Dec;60(12):800-807.
Efficacy and safety of a new medicated nail hydrolacquer in the treatment of adults with toenail onychomycosis: A randomized clinical trial
Antonio J Zalacain-Vicuña et al Mycoses. 2022 Nov 7