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Onychomycosis: therapeutic update
1Department of Dermatology, Columbia-Presbyterian Medical Center, New York, New York 10032, USA.
Journal of the American Academy of Dermatology
|June 15, 1999
Summary
Onychomycosis, a common nail fungal infection, often caused by Trichophyton species, is now treatable with newer oral antifungals. These systemic therapies offer improved efficacy, shorter treatment durations, and better patient outcomes compared to older treatments.
Area of Science:
- Dermatology
- Mycology
- Pharmacology
Background:
- Onychomycosis is a prevalent nail unit infection, affecting 2-18% of the global population and comprising 50% of nail disorders.
- Dermatophytes, particularly Trichophyton rubrum and Trichophyton mentagrophytes, are responsible for over 80% of onychomycosis cases.
- Traditional therapies for onychomycosis were often limited by low cure rates, high relapse rates, and significant adverse effects.
Purpose of the Study:
- To review the advancements in onychomycosis treatment.
- To highlight the benefits of newer systemic antifungal therapies.
- To discuss factors influencing treatment selection for onychomycosis.
Main Methods:
- Review of current literature on onychomycosis prevalence and causative agents.
- Analysis of pharmacokinetic data influencing nail penetration and efficacy of antifungal drugs.
- Evaluation of systemic antifungal agents like itraconazole, fluconazole, and terbinafine.
Main Results:
- Newer oral antifungal agents demonstrate improved safety profiles and efficacy.
- Systemic therapies like itraconazole, fluconazole, and terbinafine offer shorter treatment durations and potentially better patient compliance.
- Understanding nail pharmacokinetics has enabled the development of more effective treatments.
Conclusions:
- Modern systemic antifungal therapies represent a significant improvement in managing onychomycosis.
- Treatment selection should consider drug spectrum, side effects, interactions, and patient preferences.
- Advances in pharmacokinetics have led to safer and more effective treatments for this common nail disorder.