Therapeutic Recommendations for the Treatment of Toenail Onychomycosis in the US

Area of Science:

• Dermatology
• Mycology
• Pharmacology

Background:

• Onychomycosis affects 14% of North American and European populations, often undertreated due to challenges like slow nail growth, drug penetration issues, and recurrence.
• Existing national guidelines for onychomycosis diagnosis and treatment are over five years old, necessitating updated medical guidance.

Purpose of the Study:

• To provide updated recommendations for the diagnosis and pharmaceutical treatment of toenail onychomycosis.
• To address the need for current medical guidance in managing this common fungal nail infection.

Main Methods:

• Recommendations were developed following a roundtable discussion.
• Participants included a panel of dermatologists, podiatrists, and a microbiologist specializing in nail disease.
• Consensus was reached on key aspects of diagnosis, laboratory confirmation, and pharmaceutical interventions.

Main Results:

• Clinical assessment combined with laboratory confirmation (microscopy, histology, culture) is recommended for diagnosing onychomycosis.
• Terbinafine is the preferred oral antifungal medication, while efinaconazole 10% is recommended for topical treatment.
• Efinaconazole may be considered for off-label maintenance therapy to prevent recurrence, alongside patient counseling on expectations and follow-up care.

Conclusions:

• This article offers crucial updates to existing guidelines for diagnosing and treating toenail onychomycosis.
• The recommendations aim to assist dermatologists and podiatrists in improving patient outcomes for fungal nail infections.