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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.
Background:
Onychomycosis is a common fungal infection of the nail.
Objective:
The study aimed to provide an update on the evaluation, diagnosis, and treatment of onychomycosis.
Methods:
A PubMed search was completed in Clinical Queries using the key term "onychomycosis". The search was conducted in May 2019. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. The search was restricted to English literature. Patents were searched using the key term "onychomycosis" in www.freepatentsonline.com.
Results:
Onychomycosis is a fungal infection of the nail unit. Approximately 90% of toenail and 75% of fingernail onychomycosis are caused by dermatophytes, notably Trichophyton mentagrophytes and Trichophyton rubrum. Clinical manifestations include discoloration of the nail, subungual hyperkeratosis, onycholysis, and onychauxis. The diagnosis can be confirmed by direct microscopic examination with a potassium hydroxide wet-mount preparation, histopathologic examination of the trimmed affected nail plate with a periodic-acid-Schiff stain, fungal culture, or polymerase chain reaction assays. Laboratory confirmation of onychomycosis before beginning a treatment regimen should be considered. Currently, oral terbinafine is the treatment of choice, followed by oral itraconazole. In general, topical monotherapy can be considered for mild to moderate onychomycosis and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated. Recent patents related to the management of onychomycosis are also discussed.
Conclusion:
Oral antifungal therapies are effective, but significant adverse effects limit their use. Although topical antifungal therapies have minimal adverse events, they are less effective than oral antifungal therapies, due to poor nail penetration. Therefore, there is a need for exploring more effective and/or alternative treatment modalities for the treatment of onychomycosis which are safer and more effective.
Insights
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.
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.
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