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Onychomycosis: An Updated Review.

Alexander K C Leung1, Joseph M Lam2, Kin F Leong3

  • 1Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.

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|November 19, 2019
PubMed
Summary

Onychomycosis, a common nail fungal infection, requires updated evaluation and treatment strategies. Current oral antifungals are effective but have side effects, while topical options show limited efficacy due to poor nail penetration, necessitating safer, more effective alternatives.

Keywords:
Dermatophytesitraconazolenail discolorationonychauxisonycholysissubungual hyperkeratosisterbinafine.

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Area of Science:

  • Dermatology
  • Mycology
  • Infectious Diseases

Background:

  • Onychomycosis is a prevalent fungal infection affecting the nail unit.
  • Dermatophytes, particularly Trichophyton species, are the primary causative agents in most cases.

Purpose of the Study:

  • To provide an updated overview of the evaluation, diagnosis, and treatment of onychomycosis.
  • To review current therapeutic options and identify areas for future research.

Main Methods:

  • Comprehensive literature search of PubMed and patent databases for studies on onychomycosis published within the last 20 years.
  • Inclusion of meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews, and patents.

Main Results:

  • Onychomycosis presents with nail discoloration, hyperkeratosis, onycholysis, and onychauxis.
  • Diagnosis confirmed via microscopy, histopathology, fungal culture, or PCR.
  • Oral terbinafine and itraconazole are first-line treatments; topical monotherapy is suitable for mild cases or when oral agents are contraindicated.
  • Recent patents in onychomycosis management were also reviewed.

Conclusions:

  • Oral antifungal therapies are effective but associated with significant adverse effects.
  • Topical therapies have fewer side effects but limited efficacy due to poor nail penetration.
  • There is a critical need for safer and more effective treatment modalities for onychomycosis.