From the Guidelines
Amorolfine cream is not the preferred formulation for treating onychomycosis, as the 5% nail lacquer is the recommended form, applied once or twice weekly for 6-12 months. The British Association of Dermatologists' guidelines for the management of onychomycosis 2014 recommend amorolfine (strength of recommendation D; level of evidence 3) as a treatment option 1. According to the guidelines, amorolfine nail lacquer has been shown to be effective in around 50% of cases of distal fingernail and toenail onychomycosis. The lacquer is applied to the affected nail after removal of as much of the diseased areas of the nail as possible by gentle filing. It persists in the nail for 14 days after treatment is completed.
Key points to consider when using amorolfine for onychomycosis include:
- The importance of removing as much of the diseased nail as possible before application
- The need for consistent and prolonged treatment, typically 6-12 months
- The potential for clinical improvement without achieving mycological cure, which may be lower by 30%
- The effectiveness of amorolfine as a prophylactic treatment for recurrence of onychomycosis, as noted in the guidelines 1.
It is essential to follow the recommended application and treatment duration to maximize the effectiveness of amorolfine and minimize the risk of side effects. As the guidelines suggest, once-weekly application is as effective as twice-weekly application, providing flexibility in treatment regimens 1.
From the Research
Amorolfine Cream Overview
- Amorolfine is a topically active antifungal agent with both fungistatic and fungicidal activity in vitro 2
- Its spectrum of in vitro activity includes dermatophyte, dimorphic, some dematiaceous and filamentous fungi, and some yeasts 2
Efficacy of Amorolfine Cream
- Application of amorolfine 0.25% cream for up to 6 weeks produced overall cure and improvement in approximately 85 to 90% of patients with superficial dermatomycoses 2
- Amorolfine 5% nail lacquer once or twice weekly for up to 6 months produced mycological and clinical cure in approximately 40 to 55% of patients with mild onychomycosis 3 months after cessation of therapy 2
Combination Therapy with Amorolfine
- Combining terbinafine with amorolfine tended to be more effective than terbinafine in conjunction with ciclopirox, with additive effects observed in most combinations and synergy detected in combinations involving amorolfine in S. brevicaulis 3
- The use of adjuvant topical amorolfine may reduce the need for systemic therapy in patients with severely infected nails, although evidence to date does not clarify this 2
Comparison with Other Antifungal Treatments
- Terbinafine and azoles are effective treatments for the mycological and clinical cure of onychomycosis, with moderate-quality evidence of excess harm 4
- Terbinafine probably leads to better cure rates than azoles with the same risk of adverse events, although the quality of the evidence varied widely from high to very low depending on the outcome and comparison 4