Topical Treatment for Onychomycosis: Is it More Effective than the Clinical Data Suggests?

NewsBot · Feb 18, 2017

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Topical Treatment for Onychomycosis: Is it More Effective than the Clinical Data Suggests?
Elewski BE, Vlahovic TC, Korotzer A
J Clin Aesthet Dermatol. 2016 Nov;9(11):34-39.

Background: The current definition of complete cure is considered too stringent to reflect the true benefit of onychomycosis treatment seen in general practice and may limit the use of newer topical agents in mild-to-moderate disease. In addition, outcomes reported in clinical trials do not consistently report secondary endpoints, making data comparison difficult.
Methods: The authors review the clinical data reported on two new topical antifungals, efinaconazole and tavaborole, in light of the latest thinking of more practical approaches to assess improvement and treatment success.
Results: Almost 20 percent (19.7%) of patients treated with efinaconazole had absence of clinical signs, and almost a third (31.6%) had ≤10 percent affected toenail and mycologic cure at Week 52. Cure rates for tavaborole (<10% affected toenail and mycologic cure) were 15.3 percent and 17.9 percent at week 52. With both topical treatments, cure rates were higher when only negative culture was considered.
Conclusion: These clinical cure rates likely better reflect the efficacy we see in practice. It is probable that efficacy would be further improved with longer treatment courses and/or longer follow-up periods and appropriate prophylactic strategies. This clinical judgment is predicated by any risk of nonadherence or disease recurrence.
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Admin2 · Feb 18, 2017

Related Topics:
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Consensus on a clinical approach to onychomycosis
Onychomycosis: a proposed revision of the clinical classification
Clinical diagnosis of toenail onychomycosis - diagnostic rules
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NewsBot · Jul 6, 2018

Chemical and physical strategies in onychomycosis topical treatment: A review.
Angelo T et al
Med Mycol. 2017 Jul 1;55(5):461-475. doi: 10.1093/mmy/myw084.

Onychomycosis is a fungal infection of the fingernails or toenails caused by dermatophytes, nondermatophytes, moulds, and yeasts. This condition affects around 10-30% people worldwide, negatively influencing patients' quality of life, with severe outcomes in some cases. Since the nail unit acts as a barrier to exogenous substances, its physiological features hampers drug penetration, turning the onychomycosis treatment a challenge. Currently, there are several oral and topical therapies available; nevertheless, cure rates are still low and relapse rates achieves 10-53%. Also, serious side effects may be developed due to long-term treatment. In light of these facts, researchers have focused on improving topical treatments, either by modifying the vehicle or by using some physical technique to improve drug delivery trough the nail plate, hence increasing therapy effectiveness. Therefore, the aim of this paper is to explain these novel alternative approaches. First, the challenges for drug ungual penetration are presented. Then, the chemical and physical strategies developed for overcoming the barriers for drug penetration are discussed. We hope that the information gathered may be useful for the development of safer and more effective treatments for onychomycosis.
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NewsBot · Oct 25, 2020

Putting the fun in fungi: toenail onychomycosis

NewsBot · Jul 17, 2022

Effective Treatments for Onychomycosis
Jonathan Knobel
Source

Background: Onychomycosis is a highly prevalent nail infective disorder. Many treatments, with varied success rates and side
effects, are used.
Objectives: To assess the most recommended treatment for Onychomycosis with the optimal cure rate and least severe side effects.
Search Methods: PubMed, ProQuest, EBSCO Multisearch, and Google Scholar were used to gather information. Search terms such
as “Onychomycosis,” and “Effective treatments for Onychomycosis” etc. were used.
Results: Effective treatments include oral, topical, nail avulsion, and laser treatments. Topical treatments have low cure rates and
minimal side effects. Oral treatments have various side effects but the highest mycological and clinical cure rates. Laser treatments
yield high cure rates and minimal to none side effects, but a small chance of recurrence of the Onychomycosis is possible.
Conclusion: For those who are not susceptible to adverse effects, Oral treatment is the recommended treatment. For individuals
who have pre-existing conditions that may be harmed by adverse effects of medication, Laser should be the sought treatment.
Topical treatments are not recommended due to its low efficacy rate.
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NewsBot · Oct 18, 2022

Poor Antifungal Coverage for Onychomycosis in a Cross-Sectional Analysis of Medicaid Formularies
Julianne M Falotico, Shari R Lipner
J Am Podiatr Med Assoc. 2022 Sep-Oct;112(5):21-221

Background: Onychomycosis is the most common nail disease seen in clinical practice. Medication safety, severity of disease, comorbidities, concomitant medications, patient age, and cost are all important considerations when treating onychomycosis. Because cost may affect treatment decisions, we sought to analyze Medicaid formulary coverage of onychomycosis antifungals.

Methods: Public state Medicaid formularies were searched for coverage of US Food and Drug Administration-approved onychomycosis medications and off-label oral fluconazole. Total drug cost for a single great toenail was calculated using the National Average Drug Acquisition Cost. Pearson correlation coefficients were calculated to compare coverage and cost, mycologic cure rate, and complete cure rate.

Results: Oral terbinafine and off-label fluconazole were widely covered for onychomycosis treatment. There was poor coverage of oral itraconazole and topical ciclopirox, and there was no coverage of topical efinaconazole and tavaborole without step-edits or prior authorization. There was a significant negative correlation between medication coverage and cost (r = -0.758; P = .040). There was no correlation between medication coverage and mycologic (r = 0.548; P = .339) and complete (r = 0.768; P = .130) cure rates.

Conclusions: There is poor Medicaid coverage of antifungals for the treatment of onychomycosis, with step-edits and prior authorization based on cost rather than treatment safety and efficacy. We recommend involving podiatrists and dermatologists in developing criteria for insurance approval of onychomycosis treatments.
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NewsBot · Jan 17, 2024

Efficacy of topical trichloroacetic acid 100% either alone or combined with topical tioconazole 28% versus systemic itraconazole in the treatment of onychomycosis
Al-Shimaa M Ibrahim et al
Mycoses. 2024 Jan;67(1):e13690

Background: Treatment of onychomycosis is still challenging and warrants the development of new treatment strategies. Different trials were conducted to increase the penetration and efficacy of topical antifungals aiming at finding an alternative treatment especially when systemic antifungals are contraindicated.

Objectives: To evaluate the efficacy of trichloroacetic acid (TCA) 100% either alone or combined with topical tioconazole 28% versus itraconazole pulse therapy in the treatment of onychomycosis.

Patients/methods: Forty-five patients with onychomycosis were divided into three groups: group (A) treated by topical TCA 100% for 12 sessions, group (B) treated by TCA 100% for 12 sessions combined with topical tioconazole 28% for 18 weeks and group (C) treated by itraconazole (400 mg/day for 1 week/month for 4 months).

Results: TCA 100% combined with topical tioconazole 28% showed the highest therapeutic response; however, the difference between the groups was statistically insignificant. Mycological cure (negative culture) was reported in 66.7% of group B versus 60% of group A and 40% of group C at the 20 week.

Conclusions: TCA 100% is an effective and safe treatment option for onychomycosis especially when combined with antifungals. This modality is promising in the treatment of onychomycosis especially with the increased resistance to different antifungals.
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