From the Guidelines
Treatment for Onychomycosis
The treatment for onychomycosis typically involves oral antifungal medications, such as terbinafine (250mg daily for 12-16 weeks) or itraconazole (200mg daily for 12 weeks with a 3-week pulse regimen) 1.
- Terbinafine is generally preferred over itraconazole due to its higher efficacy and tolerability 1.
- Itraconazole can be used as an alternative, especially in cases where terbinafine is contraindicated 1. Alternatively, topical treatments like ciclopirox olamine (8% solution applied daily for 48 weeks) or efinaconazole (10% solution applied daily for 48 weeks) may be used, particularly for mild to moderate cases 1. In severe cases, combination therapy with oral and topical agents may be employed, and in some instances, surgical debridement or nail avulsion may be necessary 1. It is essential to note that treatment should not be commenced before mycological confirmation of infection 1. The choice of treatment depends on the severity of the infection, the type of fungus causing the infection, and the patient's overall health 1. Regular follow-up and monitoring are crucial to ensure the effectiveness of the treatment and to prevent relapse 1.
From the FDA Drug Label
Terbinafine tablets, USP are indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium). 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 treatment for onychomycosis includes:
- Terbinafine (PO), an oral antifungal agent, for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes 2
- Ciclopirox (TOP), a topical antifungal agent, as part of a comprehensive management program, for the treatment of mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum 3
From the Research
Treatment Options for Onychomycosis
The treatment for onychomycosis can vary depending on the severity and type of fungal infection. Some of the treatment options include:
- Oral antifungals, such as itraconazole, terbinafine, and fluconazole, which are typically preferred over topicals for moderate to severe onychomycosis due to efficacy and shorter treatment courses 4, 5
- Topical antifungals, such as efinaconazole 10% solution, which may be an effective alternative for patients with fingernail onychomycosis who have contraindications to oral medications 4
- Combination therapy, which involves the use of oral and topical antifungals, and has been shown to be more effective than oral antifungals alone in some cases 6, 7
- Surgical avulsion, which involves the removal of the infected nail, followed by topical antifungal therapy, although this approach has been found to be not very effective in some studies 8
Oral Antifungal Medications
Oral antifungal medications, such as itraconazole, terbinafine, and fluconazole, are commonly used to treat onychomycosis. These medications have been shown to be effective in achieving clinical and mycological cure, with good persistence in nails 5. The treatment duration and dosage of these medications can vary, with pulse therapy being a common approach 7.
Topical Antifungal Medications
Topical antifungal medications, such as ciclopirox olamine 8% and amorolfine hydrochloride 5%, can be used in combination with oral antifungals to enhance treatment efficacy. However, the effectiveness of these medications can vary, and they may not be as effective as oral antifungals alone 6, 7.
Combination Therapy
Combination therapy, which involves the use of oral and topical antifungals, has been shown to be more effective than oral antifungals alone in some cases. For example, a study found that combination therapy with oral terbinafine and topical ciclopirox olamine 8% was more effective than oral terbinafine alone in achieving mycological cure 6. However, another study found that combination therapy with oral terbinafine and topical amorolfine hydrochloride 5% did not show any significant difference in efficacy compared to monotherapy with oral terbinafine 7.