Onychomycosis Diagnosis and Management: Perspectives from a Joint Dermatology-Podiatry Roundtable

Area of Science:

• Dermatology and Podiatry
• Mycology
• Infectious Diseases

Background:

• Onychomycosis prevalence is increasing due to aging populations and rising rates of diabetes and peripheral vascular disease.
• Limited treatment options previously existed due to oral antifungal safety concerns and low topical efficacy.
• Recent FDA approvals of efinaconazole and tavaborole provide new topical treatments for mild-to-moderate onychomycosis.

Framework:

• A joint dermatology-podiatry expert roundtable convened to explore differences in onychomycosis diagnosis and treatment approaches.
• Discussion highlighted the role of debridement as an adjunct therapy, particularly for patients with significant symptoms.
• Specialty differences in incorporating debridement and managing high-risk patients (e.g., those with diabetes, PVD, or elderly) were noted.

Implementation:

• Debridement, while not directly impacting mycologic cure, can be a valuable addition to antifungal therapy.
• Referral to podiatry may be beneficial for dermatologists to manage debridement and complex patient cases.
• Podiatrists are well-suited to manage onychomycosis in patients with comorbidities like diabetes or PVD, and in elderly individuals requiring hygiene assistance.

Implications:

• Optimizing onychomycosis treatment requires understanding and bridging the gap between dermatological and podiatric approaches.
• Integrating debridement and leveraging podiatric expertise can enhance patient outcomes and symptom burden management.
• Post-cure strategies, including lifestyle changes, prophylactic treatment, and addressing tinea pedis in households, are crucial for sustained recovery.