Novel and Investigational Treatments for Onychomycosis

Area of Science:

• Dermatology
• Mycology
• Pharmacology

Background:

• Onychomycosis is a prevalent fungal nail infection often caused by dermatophytes, yeasts, or moulds.
• Recalcitrant cases lead to significant daily life difficulties and emotional distress, with frequent treatment failures and relapses.
• Emerging challenges include antifungal resistance, comorbidities, and polypharmacy in aging populations, necessitating safer therapeutic strategies.

Purpose of the Study:

• To review the current landscape of onychomycosis treatment, focusing on challenges and advancements.
• To highlight the shift towards topical antifungals due to their improved safety profile and reduced drug interactions.
• To discuss novel topical agents and reformulated older drugs aimed at enhancing efficacy and patient outcomes.

Main Methods:

• Literature review of recent advancements in onychomycosis treatment.
• Analysis of new topical antifungal agents and their clinical potential.
• Examination of reformulation strategies for existing antifungal drugs.

Main Results:

• Newer topical antifungals like efinaconazole, tavaborole, and luliconazole offer alternatives, though market availability is limited.
• Drug development pipeline includes novel agents (ME-1111, NP213) and reformulated established drugs (Terbinafine, Amphotericin B) with enhanced properties.
• Reformulation focuses on using penetration enhancers to improve drug delivery and efficacy.

Conclusions:

• There is a clear need for effective topical onychomycosis treatments with prolonged disease-free periods and minimal systemic effects.
• Advancements in topical antifungals and drug delivery systems represent a promising future for managing this common nail condition.
• The development of safer, more effective treatments is crucial for improving patient quality of life and addressing therapeutic challenges.