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New therapies for onychomycosis
1Department of Dermatology, University of California, San Francisco 94143, USA.
Abstract:
Until recently, the treatment of onychomycosis was discouraging because of the relatively low success rate, the need for prolonged therapy, and the laboratory monitoring necessary with the traditional oral antifungal agents, griseofulvin and ketoconazole. The advent of a new generation of oral antifungal drugs, including two triazoles (itraconazole and fluconazole) and an allylamine (terbinafine), has greatly improved the outlook for patients with fungal nail infections, particularly those with toenail involvement. Recently, the broad-spectrum triazole, itraconazole, has been approved for the treatment of onychomycosis in the U.S. Numerous studies have demonstrated its efficacy when administered either continuously for 3 months or in "pulse" dosing. Preliminary findings suggest that fluconazole and terbinafine are also promising, although their spectrum of activity is not as broad as that of itraconazole.
Insights
New oral antifungal drugs like itraconazole offer improved treatment for fungal nail infections (onychomycosis). These medications provide higher success rates and shorter treatment durations compared to older antifungal agents.
Area of Science:
- Dermatology
- Mycology
- Pharmacology
Background:
- Traditional onychomycosis treatments had low success rates and required prolonged therapy.
- Older oral antifungals like griseofulvin and ketoconazole necessitated laboratory monitoring.
Purpose of the Study:
- To review the efficacy of newer oral antifungal agents for onychomycosis.
- To highlight advancements in treating fungal nail infections.
Main Methods:
- Review of clinical studies on newer antifungal drugs.
- Analysis of treatment outcomes for itraconazole, fluconazole, and terbinafine.
Main Results:
- Itraconazole, a broad-spectrum triazole, is approved and effective for onychomycosis, with continuous or pulse dosing options.
- Newer agents like itraconazole, fluconazole, and terbinafine show improved efficacy and patient outlook.
- Itraconazole demonstrates a broader spectrum of activity compared to fluconazole and terbinafine.
Conclusions:
- The new generation of oral antifungals has significantly improved onychomycosis treatment outcomes.
- Itraconazole is a highly effective option for fungal nail infections, including toenail onychomycosis.
- Fluconazole and terbinafine are promising alternatives, though with a narrower spectrum than itraconazole.