From the Guidelines
Topical medications for onychomycosis, such as ciclopirox 8% nail lacquer, amorolfine 5% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution, are effective treatment options, with ciclopirox being applied daily for up to 48 weeks, and amorolfine applied 1-2 times weekly for up to 12 months 1.
Key Considerations
- Topical treatments have lower cure rates (5-20%) compared to oral antifungals but offer fewer systemic side effects 1.
- They work best for mild to moderate infections, particularly those limited to the distal nail or lateral edges.
- Mechanical nail debridement before application is recommended to improve drug penetration.
- Patients should continue treatment for the full prescribed duration even if improvement is seen earlier, as premature discontinuation often leads to recurrence.
Treatment Options
- Ciclopirox 8% nail lacquer: applied daily for up to 48 weeks, with nail debridement and removal of previous applications weekly 1.
- Amorolfine 5% nail lacquer: applied 1-2 times weekly for up to 12 months 1.
- Efinaconazole 10% solution: applied once daily for 48 weeks without nail debridement.
- Tavaborole 5% solution: applied once daily for 48 weeks.
Efficacy and Safety
- Ciclopirox has been shown to be effective in treating toenail onychomycosis, with a mycological cure rate of 34% and a clinical cure rate of 8% 1.
- Amorolfine has been shown to be effective in treating distal fingernail and toenail onychomycosis, with a cure rate of around 50% 1.
- Topical treatments are generally well-tolerated, with common side effects including periungual and nail fold erythema, and local burning, pruritus, and erythema 1.
From the FDA Drug Label
Ciclopirox Topical Solution, 8%, (Nail Lacquer), as a component of a comprehensive management program, is indicated as topical treatment in immunocompetent patients with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum The comprehensive management program includes removal of the unattached, infected nails as frequently as monthly, by a health care professional who has special competence in the diagnosis and treatment of nail disorders, including minor nail procedures. Ciclopirox Topical Solution, 8%, (Nail Lacquer), should be applied once daily (preferably at bedtime or eight hours before washing) to all affected nails with the applicator brush provided.
Topical Medications for Onychomycosis:
- Ciclopirox Topical Solution, 8%, (Nail Lacquer) is a topical treatment option for mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum.
- It should be used as part of a comprehensive management program, including removal of the unattached, infected nails and daily application of the medication.
- The medication should be applied once daily to all affected nails, and removed with alcohol every seven days 2, 2.
From the Research
Topical Medications for Onychomycosis
- Onychomycosis is a common condition affecting toenails more than fingernails, caused predominantly by dermatophytes 3.
- Topical medications such as ciclopirox nail lacquer 8% have been shown to be effective in treating onychomycosis, with mycologic cure rates ranging from 29% to 36% in US studies 3, 4.
- Ciclopirox nail lacquer has a broad spectrum of activity, with efficacy against Candida species and some non-dermatophytes in non-US studies 3.
- Amorolfine and ciclopirox are valuable therapeutic options for the treatment of onychomycosis, with proper penetration through the nail plate provided by transungual drug delivery systems 5.
- Combination therapy with oral antifungal agents, such as terbinafine, and topical agents like amorolfine or ciclopirox, may improve efficacy of antifungal therapy 6, 5.
- Newer topical antifungals, such as efinaconazole 10% solution and tavaborole 5% solution, have shown superior mycologic cure rates compared to ciclopirox 8% nail lacquer 7.
- Topical therapy for onychomycosis may provide a viable monotherapy alternative to oral therapy, and may also find a role in combination therapy or as continued therapy after initial clearance to reduce recurrence or re-infection 7.