Onychomycosis: Current trends in diagnosis and treatment.

Abstract

Onychomycosis is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed. Onychomycosis occurs in 10% of the general population, 20% of persons older than 60 years, and 50% of those older than 70 years. It is caused by a variety of organisms, but most cases are caused by dermatophytes. Accurate diagnosis involves physical and microscopic examination and culture. Histologic evaluation using periodic acid-Schiff staining increases sensitivity for detecting infection. Treatment is aimed at eradication of the causative organism and return to a normal appearance of the nail. Systemic antifungals are the most effective treatment, with meta-analyses showing mycotic cure rates of 76% for terbinafine, 63% for itraconazole with pulse dosing, 59% for itraconazole with continuous dosing, and 48% for fluconazole. Concomitant nail debridement further increases cure rates. Topical therapy with ciclopirox is less effective; it has a failure rate exceeding 60%. Several nonprescription treatments have also been evaluated. Laser and photodynamic therapies show promise based on in-vitro evaluation, but more clinical studies are needed. Despite treatment, the recurrence rate of onychomycosis is 10% to 50% as a result of reinfection or lack of mycotic cure.

• Authors: Dyanne P Westerberg, Michael J Voyack
• Journal: American family physician (Am Fam Physician) Vol. 88 Issue 11 Pg. 762-70 (Dec 01 2013) ISSN: 1532-0650 [Electronic] United States
• PMID: 24364524 (Publication Type: Journal Article, Review)

Chemical References

• Antifungal Agents
• Nonprescription Drugs

Topics

• Administration, Topical
• Algorithms
• Antifungal Agents (therapeutic use)
• Combined Modality Therapy
• Debridement
• Decision Support Techniques
• Humans
• Lasers, Solid-State (therapeutic use)
• Nonprescription Drugs
• Onychomycosis (classification, diagnosis, microbiology, therapy)
• Photochemotherapy
• Treatment Failure