Onychomycosis: Strategies to Minimize Recurrence

Area of Science:

• Dermatology
• Mycology
• Infectious Diseases

Background:

• Onychomycosis recurrence is frequent, with prevalence data limited beyond 12 months.
• Terbinafine may offer lower recurrence than itraconazole due to fungicidal action, though not always significant.
• Recurrence rates increase over time, peaking at 36 months post-treatment.

Purpose of the Study:

• To review the prevalence and influencing factors of onychomycosis recurrence.
• To evaluate the potential of prophylactic antifungal treatments for preventing relapse.
• To identify key considerations for managing onychomycosis in diabetic patients.

Main Methods:

• Literature review of clinical studies on onychomycosis recurrence.
• Analysis of factors impacting relapse rates, including treatment type and patient comorbidities.
• Evaluation of data on topical antifungal prophylaxis efficacy and duration.

Main Results:

• Diabetes is a significant risk factor for onychomycosis recurrence.
• Topical amorolfine prophylaxis may delay recurrence; efinaconazole shows high nail penetration.
• Prophylaxis may require up to three years for optimal effect, particularly in diabetic patients.

Conclusions:

• Long-term topical antifungal prophylaxis, potentially twice monthly, is a viable strategy to reduce onychomycosis recurrence.
• Preventative measures, including treating tinea pedis and family members, are crucial.
• Specific attention to prophylaxis is warranted for diabetic patients due to their increased risk.