Onychomycosis: recognition, diagnosis, and management

Area of Science:

• Dermatology
• Mycology
• Infectious Diseases

Background:

• Fungal nail disease, or onychomycosis, is a common condition affecting approximately 20% of US adults aged 40-60.
• The global incidence of onychomycosis is rising, with dermatophytes being the most frequent cause in the US, though molds and yeasts can also be implicated.

Purpose of the Study:

• To review the diagnostic methods and current therapeutic strategies for onychomycosis.
• To highlight advances in the systemic treatment of fungal nail infections.

Main Methods:

• Diagnosis confirmation involves potassium hydroxide (KOH) examination.
• Fungal culture is essential for identifying the specific pathogen and guiding treatment selection.

Main Results:

• Oral terbinafine, itraconazole, and fluconazole are now preferred systemic treatments worldwide, surpassing older agents like griseofulvin and ketoconazole.
• These newer antifungals demonstrate higher cure rates and a better side effect profile compared to traditional therapies.

Conclusions:

• Intermittent itraconazole dosing (3-4 weekly pulses) represents a significant advancement in onychomycosis treatment.
• This pulsed regimen is as safe and effective as continuous therapy, offering greater flexibility, convenience, and cost-effectiveness.