Abstract
Onychomycosis is a common condition and accounts for 50% of all nail diseases. Dermatophyte organisms are responsible for most cases of toenail onychomycosis, with Trichophyton rubrum and Trichophyton mentagrophytes, representing the first and second most commonly isolated organisms in the United States (US). Nondermatophyte molds, such as Fusarium and Acremonium and yeasts such as Candida parapsilosis are responsible for the remaining cases. This chapter will review treatment options for onychomycosis for adults and children, including nail avulsion, available topical therapies, as well as those in clinical trials. Lasers, photodynamic therapy, devices, such as non-thermal plasma, and over the counter treatments will also be discussed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Scher RK, Rich P, Pariser D, Elewski B. The epidemiology, etiology, and pathophysiology of onychomycosis. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S2–4.
Lecha M, Effendy I, Feuilhade de Chauvin M, Di Chiacchio N, Baran R, Taskforce on Onychomycosis E. Treatment options – development of consensus guidelines. J Eur Acad Dermatol Venereol JEADV. 2005;19(Suppl 1):25–33.
Scher RK, Tosti A, Joseph WS, Vlahovic TC, Plasencia J, Markinson BC, et al. Onychomycosis diagnosis and management: perspectives from a joint dermatology-podiatry roundtable. J Drugs Dermatol JDD. 2015;14(9):1016–21.
Feldstein S, Totri C, Friedlander SF. Antifungal therapy for onychomycosis in children. Clin Dermatol. 2015;33(3):333–9.
Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol. 2014;7(7):10–8.
Stokes JH. Letter to referring physician – 1938. Int J Dermatol. 1999;38(11):827. 9, 40.
Gupta AK, Paquet M, Simpson FC. Therapies for the treatment of onychomycosis. Clin Dermatol. 2013;31(5):544–54.
Pandhi D, Verma P. Nail avulsion: indications and methods (surgical nail avulsion). Indian J Dermatol Venereol Leprol. 2012;78(3):299–308.
Lai WY, Tang WY, Loo SK, Chan Y. Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails. Hong Kong Med J (Xianggang yi xue za zhi/Hong Kong Acad Med). 2011;17(2):127–31.
Elewski B, Pariser D, Rich P, Scher RK. Current and emerging options in the treatment of onychomycosis. Semin Cutan Med Surg. 2013;32(2 Suppl 1):S9–12.
Scher RK, Baran R. Onychomycosis in clinical practice: factors contributing to recurrence. Br J Dermatol. 2003;149(Suppl 65):5–9.
Flagothier C, Pierard-Franchimont C, Pierard GE. New insights into the effect of amorolfine nail lacquer. Mycoses. 2005;48(2):91–4.
Gupta AK, Simpson FC. Routes of drug delivery into the nail apparatus: implications for the efficacy of topical nail solutions in onychomycosis. J Dermatolog Treat. 2015:1–3.
Polak A. Preclinical data and mode of action of amorolfine. Dermatology. 1992;184(Suppl 1):3–7.
Insert AP. Amorolfine 5% W/V Nail Lacquer: Medicines and Healthcare Products Regulatory Agency; 2011. Available from: http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con129125.pdf2011.
Baran R, Sigurgeirsson B, de Berker D, Kaufmann R, Lecha M, Faergemann J, et al. A multicentre, randomized, controlled study of the efficacy, safety and cost-effectiveness of a combination therapy with amorolfine nail lacquer and oral terbinafine compared with oral terbinafine alone for the treatment of onychomycosis with matrix involvement. Br J Dermatol. 2007;157(1):149–57.
Kruk ME, Schwalbe N. The relation between intermittent dosing and adherence: preliminary insights. Clin Ther. 2006;28(12):1989–95.
Bohn M, Kraemer KT. Dermatopharmacology of ciclopirox nail lacquer topical solution 8% in the treatment of onychomycosis. J Am Acad Dermatol. 2000;43(4 Suppl):S57–69.
Penlac. Package insert: Penlac nail lacquer (Ciclopirox) topical solution, 8%: Dermik Laboratories; 2004 [21 June 2014]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/21022s004lbl.pdf2004.
Elewski BE, Rich P, Pollak R, Pariser DM, Watanabe S, Senda H, et al. Efinaconazole 10% solution in the treatment of toenail onychomycosis: two phase III multicenter, randomized, double-blind studies. J Am Acad Dermatol. 2013;68(4):600–8.
Jublia. Package insert: Jublia (efinaconazole 10% solution) [June 26 2015]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203567s000lbl.pdf.
Rock FL, Mao W, Yaremchuk A, Tukalo M, Crepin T, Zhou H, et al. An antifungal agent inhibits an aminoacyl-tRNA synthetase by trapping tRNA in the editing site. Science. 2007;316(5832):1759–61.
Elewski BE, Aly R, Baldwin SL, Gonzalez Soto RF, Rich P, Weisfeld M, et al. Efficacy and safety of tavaborole topical solution, 5%, a novel boron-based antifungal agent, for the treatment of toenail onychomycosis: results from 2 randomized phase-III studies. J Am Acad Dermatol. 2015;73:62–9.
Kerydin. Package insert: Kerydin (tavaborole) topical solution, 5% [June 26 2015]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204427s000lbl.pdf.
Elewski BE, Ghannoum MA, Mayser P, Gupta AK, Korting HC, Shouey RJ, et al. Efficacy, safety and tolerability of topical terbinafine nail solution in patients with mild-to-moderate toenail onychomycosis: results from three randomized studies using double-blind vehicle-controlled and open-label active-controlled designs. J Eur Acad Dermatol Venereol JEADV. 2013;27(3):287–94.
Scher RK, Nakamura N, Tavakkol A. Luliconazole: a review of a new antifungal agent for the topical treatment of onychomycosis. Mycoses. 2014;57:389–93.
Wiederhold NP, Fothergill AW, McCarthy DI, Tavakkol A. Luliconazole demonstrates potent in vitro activity against dermatophytes recovered from patients with onychomycosis. Antimicrob Agents Chemother. 2014;58(6):3553–5.
Trial C. Safety and efficacy of luliconazole solution, 10% in subjects with mild to moderate onychomycosis (SOLUTION): Topica Pharmaceuticals; 2013 [21 June 2014]. Available from: http://clinicaltrials.gov/ct2/show/NCT01431820.
Gupta AK, Sibbald RG, Lynde CW, Hull PR, Prussick R, Shear NH, et al. Onychomycosis in children: prevalence and treatment strategies. J Am Acad Dermatol. 1997;36(3 Pt 1):395–402.
Leibovici V, Evron R, Dunchin M, Westerman M, Ingber A. A population-based study of toenail onychomycosis in Israeli children. Pediatr Dermatol. 2009;26(1):95–7.
Singal A, Khanna D. Onychomycosis: diagnosis and management. Indian J Dermatol Venereol Leprol. 2011;77(6):659–72.
Friedlander SF, Chan YC, Chan YH, Eichenfield LF. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol. 2013;30(3):316–22.
Pena-Penabad C, Garcia-Silva J, Almagro M, del Pozo J, Fonseca E. Superficial white onychomycosis in a 3-year-old human immunodeficiency virus-infected child. J Eur Acad Dermatol Venereol JEADV. 2001;15(1):51–3.
Hsu MM. Rapid response of distal subungual onychomycosis to 5% amorolfine nail lacquer in a 20-month-old healthy infant. Pediatr Dermatol. 2006;23(4):410–1.
Liddell LT, Rosen T. Laser therapy for onychomycosis: fact or fiction? J Fungi. 2015;1(1):44–54.
Choi MJ, Zheng Z, Goo B, Cho SB. Antifungal effects of a 1444-nm neodymium:yttrium-aluminum-garnet laser on onychomycosis: a pilot study. J Dermatolog Treat. 2014;25(4):294–7.
Carney C, Cantrell W, Warner J, Elewski B. Treatment of onychomycosis using a submillisecond 1064-nm neodymium:yttrium-aluminum-garnet laser. J Am Acad Dermatol. 2013;69(4):578–82.
Hochman LG. Laser treatment of onychomycosis using a novel 0.65-millisecond pulsed Nd:YAG 1064-nm laser. J Cosmet Laser Ther. 2011;13(1):2–5.
Kimura U, Takeuchi K, Kinoshita A, Takamori K, Hiruma M, Suga Y. Treating onychomycoses of the toenail: clinical efficacy of the sub-millisecond 1,064 nm Nd: YAG laser using a 5 mm spot diameter. J Drugs Dermatol: JDD. 2012;11(4):496–504.
Waibel J, Wulkan AJ, Rudnick A. Prospective efficacy and safety evaluation of laser treatments with real-time temperature feedback for fungal onychomycosis. J Drugs Dermatol: JDD. 2013;12(11):1237–42.
Hollmig ST, Rahman Z, Henderson MT, Rotatori RM, Gladstone H, Tang JY. Lack of efficacy with 1064-nm neodymium:yttrium-aluminum-garnet laser for the treatment of onychomycosis: a randomized, controlled trial. J Am Acad Dermatol. 2014;70(5):911–7.
Zhang RN, Wang DK, Zhuo FL, Duan XH, Zhang XY, Zhao JY. Long-pulse Nd:YAG 1064-nm laser treatment for onychomycosis. Chin Med J. 2012;125(18):3288–91.
Moon SH, Hur H, Oh YJ, Choi KH, Kim JE, Ko JY, et al. Treatment of onychomycosis with a 1,064-nm long-pulsed Nd:YAG laser. J Cosmet Laser Ther. 2014;16(4):165–70.
Noguchi H, Miyata K, Sugita T, Hiruma M, Hiruma M. Treatment of onychomycosis using a 1064nm Nd:YAG laser. Med Mycol J. 2013;54(4):333–9.
Hees H, Jager MW, Raulin C. Treatment of onychomycosis using the 1 064 nm Nd:YAG laser: a clinical pilot study. J Ger Soc Dermatol JDDG (Journal der Deutschen Dermatologischen Gesellschaft). 2014;12(4):322–9.
Kalokasidis K, Onder M, Trakatelli MG, Richert B, Fritz K. The effect of Q-switched Nd:YAG 1064 nm/532 nm laser in the treatment of onychomycosis in vivo. Dermatol Res Pract. 2013;2013:379725.
Landsman AS, Robbins AH, Angelini PF, Wu CC, Cook J, Oster M, et al. Treatment of mild, moderate, and severe onychomycosis using 870- and 930-nm light exposure. J Am Podiatr Med Assoc. 2010;100(3):166–77.
Lim EH, Kim HR, Park YO, Lee Y, Seo YJ, Kim CD, et al. Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. J Am Acad Dermatol. 2014;70(5):918–23.
Heinemann IU, Jahn M, Jahn D. The biochemistry of heme biosynthesis. Arch Biochem Biophys. 2008;474(2):238–51.
Sotiriou E, Koussidou-Eremonti T, Chaidemenos G, Apalla Z, Ioannides D. Photodynamic therapy for distal and lateral subungual toenail onychomycosis caused by Trichophyton rubrum: preliminary results of a single-centre open trial. Acta Derm Venereol. 2010;90(2):216–7.
Heinlin J, Maisch T, Zimmermann JL, Shimizu T, Holzmann T, Simon M, et al. Contact-free inactivation of Trichophyton rubrum and Microsporum canis by cold atmospheric plasma treatment. Future Microbiol. 2013;8(9):1097–106.
Zemel M, Friedman G, Park S. Personal communication, in vitro nail studies with plasma. 2014.
Ouf SA, El-Adly AA, Mohamed AH. Inhibitory effect of silver nanoparticles mediated by atmospheric pressure air cold plasma jet against dermatophyte fungi. J Med Microbiol. 2015;64:1151–61.
Lipner SR, Friedman G, Scher RK. Pilot study to evaluate a plasma device in the treatment of onychomycosis, submitted. 2015.
Halteh P, Lipner SR, Scher RK. Over the counter and natural remedies for onychomycosis: do they really work? Cutis, Accepted. 2015.
Jo Siu WJ, Tatsumi Y, Senda H, Pillai R, Nakamura T, Sone D, et al. Comparison of in vitro antifungal activities of efinaconazole and currently available antifungal agents against a variety of pathogenic fungi associated with onychomycosis. Antimicrob Agents Chemother. 2013;57(4):1610–6.
Baker SJ, Zhang YK, Akama T, Lau A, Zhou H, Hernandez V, et al. Discovery of a new boron-containing antifungal agent, 5-fluoro-1,3-dihydro-1-hydroxy-2,1- benzoxaborole (AN2690), for the potential treatment of onychomycosis. J Med Chem. 2006;49(15):4447–50.
Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42(2 Pt 1):217–24.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
11.1 Electronic Supplementary Materials
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Lipner, S.R., Scher, R.K. (2018). Onychomycosis: Topical Therapy and Devices. In: Rubin, A.I., Jellinek, N.J., Daniel, C.R., Scher, R.K. (eds) Scher and Daniel’s Nails. Springer, Cham. https://doi.org/10.1007/978-3-319-65649-6_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-65649-6_11
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-65647-2
Online ISBN: 978-3-319-65649-6
eBook Packages: MedicineMedicine (R0)