From the Guidelines
Popular compounded topical medications for nail fungus include combinations such as terbinafine 1% with itraconazole 1% in a vehicle containing DMSO, ciclopirox 8% combined with urea 40%, and amorolfine 5% with tea tree oil 5%. These medications are often used to enhance penetration and efficacy against fungal infections, with treatment durations typically ranging from 6-12 months. The choice of medication depends on the severity of the infection, patient preferences, and potential side effects. Some key points to consider when using these medications include:
- Terbinafine 1% with itraconazole 1% in DMSO can be applied once or twice daily for 6-12 months 1
- Ciclopirox 8% combined with urea 40% can be applied daily after filing the affected nail, with urea helping to soften the nail plate and enhance medication delivery 1
- Amorolfine 5% with tea tree oil 5% provides both antifungal and natural antimicrobial properties, typically applied twice weekly for 6-12 months 1 It's essential to note that treatment duration is typically long due to the slow growth of nails, and consistent application and patience are crucial for successful treatment outcomes. Additionally, potential side effects and interactions should be considered, such as periungual and nail fold erythema with ciclopirox 1, and headache and gastrointestinal upset with itraconazole 1. Overall, the most effective treatment approach will depend on individual patient needs and circumstances, and may involve a combination of topical and oral medications.
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 FDA drug label does not answer the question.
From the Research
Popular Compounded Topical Medications for Nail Fungus
- Ciclopirox 8% lacquer 2
- Efinaconazole 10% solution 2
- Tavaborole 5% solution 2
- P-3051 (ciclopirox 8% hydrolacquer) 2
- Luliconazole 5% solution 2
- Melaleuca alternifolia (tea tree) oil 3
- Clotrimazole solution 3
- Bifonazole cream 4
- Urea 40% paste followed by bifonazole 1% cream 4
- Amorolfine 5% 5
Key Findings
- Topical treatments have relatively low complete cure rates 2
- Efinaconazole 10% solution and tavaborole 5% solution have high-quality evidence supporting their effectiveness 2
- Ciclopirox 8% lacquer and P-3051 (ciclopirox 8% hydrolacquer) have moderate-quality evidence supporting their effectiveness 2
- Melaleuca alternifolia (tea tree) oil and clotrimazole solution have been shown to be effective in treating onychomycosis 3
- Bifonazole cream has been shown to be effective in treating onychomycosis after nail ablation with urea 40% paste 4
Treatment Considerations
- Topical monotherapy can be considered for mild to moderate onychomycosis 6
- Oral antifungal therapies are effective, but significant adverse effects limit their use 6
- Topical antifungal therapies have minimal adverse events, but are less effective than oral antifungal therapies due to poor nail penetration 6