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Novel and emerging pharmacotherapy and device-based treatments for onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Jose W. Ricardo, Shari R. Lipner
Albaconazole is an investigational triazole that is effective against a broad spectrum of dermatophyte and yeast species. It has a long half-life, which allows for once weekly dosage. In a phase II study, 54% of the patients treated with albaconazole once weekly for 36 weeks had a mycologic cure at week 52 with a favorable safety profile. Therefore, it may be an alternative to existing systemic therapies for distal subungual onychomycosis in the future.
Dermatophytosis
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Mahmoud A. Ghannoum, Iman Salem, Nancy Isham
Distal subungual onychomycosis, in contrast, is the most common clinical presentation comprising more than 90% of all nail infections [1]. Its most frequent etiologic agent is T. rubrum, but is also caused by T. tonsurans, T. mentagrophytes, and E. floccosum. It also preferentially affects the toenails. Fungal hyphae enter distally under the nail plate and spread proximally digesting the stratum corneum of the nail bed and nail plate. As the infection spreads, subungual hyper- keratosis, paronychia, and onycholysis can occur. Splinter hemorrhages can be seen secondary to mild inflammation compressing small vessels, and discoloration of the nail plate may occur as a result of secondary infection with mold or bacteria.
Nail anatomy and physiology
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
The hyponychium is an epithelial area underlying the free edge of the nail plate. Its proximal border is the distal limit of nail bed (the onychodermal band). Distally, it is continuous with normal volar skin and is separated from distal nail groove, with convexity anteriorly. Like any other epidermal areas, hyponychium undergoes normal keratinization and exhibits a granular layer and eccrine glands. The hyponychium is the first site of keratinization in the nail unit and of all epidermis in the embryo. Also, the hyponychium is the initial site of invasion by dermatophytes in the most common type of onychomycosis, distal subungual onychomycosis. In addition, hyponychium and overhanging free nail plate provide a crevice and act as a reservoir for scabies, mites, and microbes.
Combined long-pulsed Nd-Yag laser and itraconazole versus itraconazole alone in the treatment of onychomycosis nails
Published in Journal of Dermatological Treatment, 2020
Mohamed Hamed Khater, Fathia M. Khattab
In Group II (itraconazole and laser therapy), onychomycosis affected six patients in toenails and nine in fingernails. Distal subungual onychomycosis is present in eight cases, total dystrophy in five cases, and Candida onychomycosis in two cases. As regards clinical response, excellent response in 10 (66.6%) cases, good in 3 (20.1%) cases while moderate and mild was present in 1 (6.6%) case for each one, respectively. Mycological improvement’s response was excellent in 2 (13.3%) cases, good in 2 (13.3%) cases, and moderate in 6 (40.1%) cases while mild in 5 (33.3%) cases (Table 1; Figure 2).
Efinaconazole topical solution (10%) for the treatment of onychomycosis in adult and pediatric patients
Published in Expert Review of Anti-infective Therapy, 2022
Tracey C. Vlahovic, Aditya K. Gupta
However, oral antifungals are not appropriate for all patients due to medical history and drug-drug interactions; therefore, topical antifungals were introduced to the onychomycosis market. Monotherapy with topical antifungals is limited to mild to moderate distal subungual onychomycosis [38]. In addition to the limitation of nail plate involvement, developing effective topical treatments for onychomycosis has been complicated by low permeation rates through the nail plate to the site of infection [39,40]. The two lacquer-based topical therapies are ciclopirox 8%, a hydroxypyrimidine antifungal agent, and amorolfine 5%, a morpholine antifungal [41]. These are applied primarily to the exterior nail plate (ventral surface), with the drug reaching the infection site mostly through nail permeation [42,43]. These topical antifungals were the first to appear on the market but have suffered from low clinical and mycological cure rates. As the nail is a water-based hydrogel, it may be more permeable to agents formulated in an aqueous vehicle [40]. Unlike ciclopirox and amorolfine nail lacquers, the new topical antifungal agents, efinaconazole 10% and tavaborole 5%, are available as alcohol-based solutions [11,31]. Efinaconazole is an azole antifungal, and tavaborole is an oxaborole antifungal which inhibits protein synthesis. Both topical agents were approved by the US Food and Drug Administration (FDA) in 2014 for the treatment of toenail onychomycosis caused by Trichophyton rubrum and Trichophyton mentagrophytes [11,31]. Terbinafine transungual lacquer solution (P-3058) has been submitted to the European Medicines Agency for the treatment of onychomycosis but is currently not approved [44]; neither of the phase 3 studies were completed in the US (NCT02549001, NCT02547701). Two phase 3 studies of MOB-015, a topical 10% solution of terbinafine, for the treatment of mild to moderate distal subungual onychomycosis have been published (NCT02866032 [EU], NCT02859519 [US and Canada]) [45].