What are the options for topical antifungal treatment for toenail onychomycosis?

From the Guidelines

Topical Antifungal Treatment Options

Topical antifungal treatment for toenail onychomycosis is a viable option for patients with mild to moderate disease.

• Effective topical agents include ciclopirox 8% nail lacquer, applied daily for 48 weeks 1, and amorolfine 5% nail lacquer, applied once or twice weekly for 6-12 months 1.
• Alternatively, efinaconazole 10% solution can be applied daily for 48 weeks, with clinical trials demonstrating significant mycological and clinical cure rates 1.
• Treatment duration and frequency may vary depending on the severity of the infection and patient response.
• It's worth noting that tavaborole 5% solution is also an option, although the provided evidence does not directly mention its use for toenail onychomycosis, it is often considered in the treatment of onychomycosis.
• Other topical treatments like terbinafine, butenafine, bifonazole, and urea ointment have been used, but there are limited data to support their use as monotherapy for onychomycosis 1.
• The choice of treatment should be based on the severity of the disease, patient preferences, and potential side effects, with periungual and nail fold erythema being common side effects of ciclopirox 1 and local burning, pruritus, and erythema being rare side effects of amorolfine 1.

From the FDA Drug Label

1 INDICATIONS AND USAGE JUBLIA (efinaconazole) topical solution, 10% is an azole antifungal indicated for the topical treatment of onychomycosis of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes.

1 INDICATIONS AND USAGE Tavaborole topical solution is an oxaborole antifungal indicated for the treatment of onychomycosis of the toenails due to Trichophyton rubrumor Trichophyton mentagrophytes.

The options for topical antifungal treatment for toenail onychomycosis are:

• Efinaconazole (JUBLIA), an azole antifungal 2
• Tavaborole, an oxaborole antifungal 3

From the Research

Topical Antifungal Treatment Options

The following are some topical antifungal treatment options for toenail onychomycosis:

• Efinaconazole topical solution, 10%: This treatment has been shown to be effective in treating mild to moderate toenail onychomycosis, with mycologic cure rates of 55.2% and 53.4% in two studies 4, 5.
• Ciclopirox nail lacquer, 8%: This treatment has been shown to be effective in treating mild to moderate toenail onychomycosis, with mycologic cure rates of 29% and 36% in two studies 6.
• Tavaborole: This treatment has been shown to be effective in treating mild to moderate toenail onychomycosis, although the exact mycologic cure rates are not specified in the provided studies 7.
• Amorolfine: This treatment has been shown to be effective in treating mild to moderate toenail onychomycosis, although the exact mycologic cure rates are not specified in the provided studies 7.

Treatment Efficacy

The efficacy of these treatments can vary depending on the severity of the disease and the duration of treatment. Studies have shown that longer treatment and follow-up periods can result in better outcomes 7. Additionally, the efficacy of these treatments can be influenced by the type of fungus causing the infection, with some treatments being more effective against certain types of fungi 6, 5.

Treatment Safety

The safety of these treatments has been evaluated in several studies, with most reporting that they are well-tolerated and have a low risk of adverse events 4, 6, 8, 5. Local site reactions, such as erythema and application site reactions, have been reported, but these are generally mild and transient 4, 6, 8.