What is the most effective topical antifungal treatment for onychomycosis (fungal infection of the nails) in Canada?

From the Guidelines

For nail fungal infections in Canada, amorolfine 5% nail lacquer (Loceryl) is the most effective topical antifungal treatment, with a cure rate of around 50% for distal fingernail and toenail onychomycosis, as shown in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1. Apply it once or twice weekly to the affected nail after removal of as much of the diseased areas of the nail as possible by gentle filing, for 6-12 months. Some key points to consider when using topical antifungal treatments include:

• Keeping nails trimmed short to prevent further damage and promote healthy growth
• Drying thoroughly after bathing to reduce moisture that can contribute to fungal growth
• Wearing breathable footwear to reduce sweat and moisture accumulation
• Continuing treatment for the full duration, even if improvement is seen early, as complete nail regrowth can take 6-12 months Other options, such as ciclopirox 8% nail lacquer (Penlac) and efinaconazole 10% solution (Jublia), may also be effective, but amorolfine has been shown to have higher cure rates in some studies 1. It's essential to note that topical treatments generally work best for mild to moderate infections, and severe cases may require oral antifungals prescribed by a healthcare provider 1. In addition to treatment, it's crucial to practice good foot hygiene and take steps to prevent reinfection, such as wearing clean socks and using an antifungal powder or spray on the feet. Overall, while there are various treatment options available, amorolfine 5% nail lacquer (Loceryl) is currently the most effective topical antifungal treatment for nail fungal infections in Canada, according to the most recent and highest quality study 1.

From the FDA Drug Label

INDICATIONS AND USAGE ... 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 results of use of Ciclopirox Topical Solution, 8%, (Nail Lacquer), in treatment of onychomycosis of the toenail without lunula involvement were obtained from two double-blind, placebo-controlled studies conducted in the US At Week 48 (plus Last Observation Carried Forward) for the Intent-to-Treat (ITT) Population ... Complete Cure*6/110 (5.5%)1/109 (0.9%)10/118 (8.5%)0/117 (0%)

The most effective antifungal topical for nails in Canada, based on the provided information, is ciclopirox (TOP), with a complete cure rate of 5.5% and 8.5% in two studies, respectively, at week 48 2.

• Key points:
  • Indicated for mild to moderate onychomycosis
  • Part of a comprehensive management program
  • Should be used under medical supervision
  • Efficacy rates:
    • Complete cure: 5.5% and 8.5%
    • Almost clear: 6.5% and 12%
    • Negative mycology: 29% and 36%

From the Research

Effective Antifungal Topical Treatments for Nails in Canada

The following are some effective antifungal topical treatments for nails in Canada:

• Ciclopirox 8% nail lacquer 3, 4, 5, 6
• Amorolfine 5% nail lacquer 4, 7, 6
• Efinaconazole 10% solution 5
• Tavaborole 5% solution 5

Comparison of Antifungal Topical Treatments

Some studies have compared the efficacy of different antifungal topical treatments:

• A study found that combining terbinafine with amorolfine tended to be more effective than terbinafine in conjunction with ciclopirox 7
• Another study found that efinaconazole 10% solution and tavaborole 5% solution had superior mycologic cure rates compared to ciclopirox 8% nail lacquer 5
• A clinical comparative study found that oral terbinafine pulse therapy plus topical ciclopirox olamine 8% or topical amorolfine hydrochloride 5% did not show any significant difference in efficacy compared to monotherapy with oral terbinafine 6

Efficacy of Antifungal Topical Treatments

The efficacy of antifungal topical treatments can vary:

• Ciclopirox 8% nail lacquer had a mycological cure rate of 56.0% to 70.4% in some studies 3
• Amorolfine 5% nail lacquer had a mycological cure rate of 85.7% in one study 6
• Efinaconazole 10% solution had superior mycologic cure rates compared to ciclopirox 8% nail lacquer 5
• Tavaborole 5% solution had treatment success rates superior to ciclopirox 8% nail lacquer 5