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Onychomycosis: Rapid Evidence Review.

Winfred Taylor Frazier1, Zuleica M Santiago-Delgado2, Kenneth C Stupka3

  • 1University of Pittsburgh Medical Center, St. Margaret New Kensington Family Health Center and St. Margaret Family Medicine Residency Program, Pittsburgh, PA, USA.

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|October 15, 2021
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Summary

Onychomycosis, a fungal nail infection, causes pain and impairment. Oral terbinafine is generally more effective than topical treatments for this condition.

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Area of Science:

  • Dermatology
  • Mycology
  • Infectious Diseases

Background:

  • Onychomycosis is a chronic fungal infection affecting fingernails and toenails.
  • It leads to nail brittleness, discoloration, thickening, and can cause pain and physical impairment, impacting quality of life.
  • Suspected in cases of discolored, thickened, separated, or foul-smelling nails.

Purpose of the Study:

  • To review diagnostic approaches for onychomycosis.
  • To discuss current and emerging treatment options.
  • To highlight the importance of preventive measures.

Main Methods:

  • Diagnostic methods include potassium hydroxide preparation, fungal culture, periodic acid-Schiff stain, and polymerase chain reaction.
  • Treatment evaluation considers oral terbinafine, topical agents (ciclopirox, efinaconazole, tavaborole), and adjunctive nail care.
  • Emerging therapies like photodynamic and plasma treatments are noted, requiring further research.

Main Results:

  • Oral terbinafine demonstrates superior effectiveness and shorter treatment duration compared to topical therapies.
  • Topical therapies are suitable for mild to moderate onychomycosis with fewer side effects.
  • Concurrent nail trimming and debridement enhance pharmacologic treatment response.

Conclusions:

  • Accurate diagnosis is crucial due to lengthy treatment and potential adverse effects.
  • Treatment choice depends on severity, patient health, and preferences.
  • Preventive strategies are essential to reduce the significant relapse rate of onychomycosis.