What is the treatment regimen for fingernail fungal infections using Edfinaconazole (generic name: Edfinaconazole)?

Efinaconazole Treatment Regimen for Fingernail Fungal Infections

For fingernail fungal infections, efinaconazole 10% topical solution should be applied once daily directly to the affected fingernails for approximately 36-40 weeks. 1, 2

Efficacy and Indications

• Efinaconazole 10% topical solution is FDA-approved for onychomycosis in patients aged 6 years and above, with demonstrated efficacy for fingernail infections 3
• Efinaconazole exhibits higher in vitro activity against dermatophytes than other topical antifungals like ciclopirox and itraconazole, with activity comparable to amorolfine and terbinafine 3
• Efinaconazole provides enhanced nail penetration compared to other topical antifungals due to its low surface tension, poor water solubility, and low keratin affinity 3
• In clinical studies, fingernail infections treated with efinaconazole for a mean duration of 38.7 weeks showed significant improvement, with an 80% improvement rate 1

Application Instructions

• Apply efinaconazole 10% solution directly to the affected fingernail(s) once daily 1, 2
• Ensure the nail and surrounding area are clean and dry before application 3
• Use the applicator to apply the solution to the entire nail surface and undersurface of the nail plate where accessible 3
• Allow the solution to dry completely before touching or washing the treated area 3
• Continue treatment until clinical improvement is observed, typically for 36-40 weeks for fingernail infections 1, 2

Patient Selection Considerations

• Efinaconazole is particularly recommended as first-line therapy for:
  • Mild-to-moderate onychomycosis 3
  • Patients with liver or kidney disease who cannot take oral antifungals 3, 2
  • Patients with certain autoimmune conditions like scleroderma where oral antifungals may be contraindicated 2
  • Patients taking medications that interact with oral antifungals 2

Treatment Outcomes and Expectations

• Patients should be informed that complete cure takes time due to the slow growth rate of nails 4
• Factors associated with better response include:
  • Female gender
  • Lower BMI
  • Mild onychomycosis
  • Short disease duration
  • Treatment of concomitant fungal infections 3
• Mycological cure rates are typically about 30% better than clinical cure rates 4

Monitoring and Side Effects

• Monitor for application site reactions, which are the most common side effects:
  • Ingrown nails
  • Dermatitis
  • Vesicles
  • Pain at application site 3
• These side effects are typically mild and resolve upon discontinuation of treatment 5

Important Caveats

• Confirm diagnosis with mycological examination (direct microscopy and culture) before initiating treatment 6, 7
• Treatment failure is common with incorrect diagnosis made on clinical grounds alone 7
• While oral antifungals like terbinafine and itraconazole generally have higher efficacy rates for onychomycosis, topical efinaconazole is a valuable alternative for patients who cannot tolerate or have contraindications to oral therapy 6, 7, 2
• Consider longer treatment durations for elderly patients, those with more severe infections, or mixed infections (dermatophyte plus non-dermatophyte molds) 8