[Treatment of onychomycosis]

Area of Science:

• Medical Mycology
• Dermatology
• Infectious Diseases

Context:

• Onychomycosis, a common nail infection, is primarily caused by dermatophytes, often linked to athlete's foot or hand fungus.
• Candida onychomycosis is a rare opportunistic infection, while non-dermatophytic mold infections are exceptionally uncommon.
• Accurate mycological diagnosis is a prerequisite for initiating appropriate treatment strategies.

Purpose:

• To outline the diagnostic requirements and treatment modalities for various types of onychomycosis.
• To differentiate between dermatophyte, Candida, and non-dermatophytic mold-induced onychomycosis.
• To discuss the efficacy and limitations of topical and systemic antifungal therapies.

Summary:

• Dermatophyte onychomycosis treatment requires consideration of the infected nail area; topical antifungals are suitable for mild to moderate cases, while systemic agents are necessary for severe infections.
• Nail debridement aids antifungal penetration and recurrence prevention. Candida onychomycosis may respond to topical treatments, but systemic therapy is indicated for treatment failures.
• Non-dermatophytic mold onychomycosis presents a significant treatment challenge, with limited efficacy of current antifungals, except for itraconazole against Aspergillus spp. Emerging therapies are under investigation.

Impact:

• Provides a framework for managing onychomycosis based on etiological diagnosis.
• Highlights the importance of mycological confirmation before treatment initiation.
• Informs clinical practice regarding the selection of antifungal agents and adjunctive therapies for different onychomycosis subtypes.
• Underscores the need for further research into effective treatments for challenging non-dermatophytic mold onychomycosis.