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ToeMate claims there are eight barriers to effectively treating onychomycosis with topical antimycotics. Here's their science. Any comments?
1 - Water Solubility - Kobayashi 1999 found that water soluble antimycotics penetrate nail keratin (hydrophilic) in much higher concentrations than water insoluble ones and exhibit fungicidal activity when the active ingredient solubility exceeds the MFC for the antimycotic and the infection.
2 - Energy - Gutchup 2000 determined the energy necessary for water (18g/mole) to absorb into normal nail keratin is 7.2 kcal/mole. Larger molecule antimycotics ( > 100 g/mole) require more energy to penetrate both nail and keratin debris - energy which is not available at room temperature.
3 - Nail Thickness - Quintanar 1999 discovered that applying a keratolytic to the nail before the antimycotic reduces its thickness and allows larger molecule antimycotics to absorb into the nail.
4 - Modes of Action - Baran 2005 found that using antimycotics with multiple modes of action decreased the overall MIC value for the treatment. Over 90% of topical antimycotics used to treat onychomycosis exhibit one mode of action none of which are sporicidal.
5 - Electrostatic Repulsion - Kobayashi 2004 discovered electrostatic repulsion between antimycotics and the nail surface that prevents medication from penetrating the nail Adding a surfactant to neutralize this barrier increases the absorption of the antimycotic into the nail.
6 - Antifungal Potency - Favre 2003 and Nenoff 1996 calculated MFC and MIC values respectively for topical antimycotics and suggest that lower values improve cure rates given the penetration limitations imposed by the nail and keratin debris.
7 - Molecular Weight and Orientation - Kobayashi 2004 suggested that smaller molecular weight antimycotics accumulate in higher concentrations subungually provided the molecular orientation between the antimycotic and nail plate can align to favor penetration (Askeland 1984).
8 - Alternate Host - Antimycotic shoe spray to prevent reinfection.