From the Guidelines
Topical treatments for Candida glabrata onychomycosis include ciclopirox 8% nail lacquer and amorolfine 5% nail lacquer, with ciclopirox being potentially more effective due to Candida glabrata's resistance to azoles. The treatment of Candida glabrata onychomycosis can be challenging due to its resistance to various antifungal agents.
- Ciclopirox 8% nail lacquer should be applied daily to affected nails for 6-12 months, with nail debridement recommended before application 1.
- Amorolfine 5% nail lacquer is applied 1-2 times weekly for 6-12 months 1. These treatments work by disrupting fungal cell membranes or inhibiting essential fungal enzymes. However, Candida glabrata often shows resistance to azoles, making ciclopirox potentially more effective. Treatment success is improved by combining topical therapy with mechanical nail debridement or chemical nail avulsion using 40% urea preparations. Complete cure rates with topical treatments alone are modest (20-40%), especially for Candida glabrata infections, which are typically more resistant than other Candida species. For severe or resistant cases, oral antifungals like terbinafine or itraconazole may be necessary in combination with topical therapy 1. Additionally, a study published in 2016 suggested the use of topical 17% flucytosine cream alone or in combination with 3% AmB cream administered daily for 14 days as a third option for C. glabrata infection 1.
From the Research
Topical Treatments for Candida Glabrata Onychomycosis
- Ciclopirox nail lacquer 8% topical solution has been shown to be effective in the treatment of onychomycosis, including cases caused by Candida species 2
- Amorolfine 5% and ciclopirox 8% nail lacquers are commonly used in the topical treatment of onychomycosis, and may be used alone or in combination with oral antifungal agents 3
- Topical monotherapy can be considered for mild to moderate onychomycosis, and is a therapeutic option when oral antifungal agents are contraindicated or cannot be tolerated 4
Mechanism of Action and Efficacy
- Ciclopirox nail lacquer has a broad spectrum of activity, with efficacy against Candida species and some non-dermatophytes 2
- Amorolfine and ciclopirox have a different mode of action, but both exhibit a broad antifungal activity 3
- The use of antifungal nail lacquers in combination with oral agents can improve the efficacy of antifungal therapy 3