From the Guidelines
This topical antifungal formulation containing diclofenac 3%, fluconazole 3%, itraconazole 3%, and terbinafine 1% is not recommended as a first-line treatment for onychomycosis due to the lack of evidence supporting its efficacy and safety. The British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1 recommend itraconazole and terbinafine as first-line treatments for dermatophyte onychomycosis, with fluconazole as a potential alternative in patients who cannot tolerate these medications. Key points to consider when treating onychomycosis include:
- Itraconazole and terbinafine are preferred due to their high efficacy and relatively favorable safety profiles 1
- Fluconazole may be used as an alternative, but its efficacy and safety profile are not as well-established as itraconazole and terbinafine 1
- Topical treatments, such as amorolfine and ciclopirox, may be useful for superficial and distal onychomycosis, but their efficacy is generally lower than that of systemic treatments 1
- The combination of diclofenac, fluconazole, itraconazole, and terbinafine is not supported by the guidelines and may increase the risk of adverse effects, such as liver toxicity and gastrointestinal upset 1
- When treating onychomycosis, it is essential to monitor liver function tests and complete blood counts, especially in patients with pre-existing liver or renal impairment 1
- The treatment duration and dosage should be individualized based on the severity of the infection, the patient's medical history, and the potential for drug interactions 1
From the Research
Topical Antifungal Treatments
- The study 2 found that terbinafine 1% was effective in achieving clinical cure rates compared to placebo, with a risk ratio of 4.51 and a number needed to treat of 3.
- The same study 2 also found that naftifine 1% was more effective than placebo in achieving mycological and clinical cure rates.
- Another study 3 found that oral fluconazole, itraconazole, and terbinafine were effective in treating tinea corporis and tinea cruris.
Comparison of Antifungal Agents
- The study 2 compared the effectiveness of different antifungal agents, including azoles, benzylamines, and allylamines, and found that there was no significant difference in mycological cure rates between azoles and benzylamines.
- The study 4 found that terbinafine was more effective than griseofulvin in treating tinea pedis, with a pooled risk difference of 52% in favor of terbinafine.
Treatment of Superficial Fungal Infections
- The study 5 discussed the use of topical antifungal-corticosteroid combination therapy for the treatment of superficial mycoses and found that the addition of a corticosteroid to an antifungal agent can attenuate inflammatory symptoms and increase patient compliance.
- The study 6 provided an overview of treatment approaches for fungal infections and discussed the main characteristics, clinical uses, and side effects of different antifungal agents.
Concentrations of Antifungal Agents
- The concentrations of antifungal agents mentioned in the question, such as diclofenac 3%, fluconazole 3%, itraconazole 3%, and terbinafine 1%, are not directly addressed in the studies provided.
- However, the study 2 found that terbinafine 1% was effective in achieving clinical cure rates, and the study 3 found that oral fluconazole and itraconazole were effective in treating tinea corporis and tinea cruris, but the concentrations used in these studies are not specified.