Updated Perspectives on the Diagnosis and Management of Onychomycosis
Julianne M Falotico,1 Shari R Lipner2 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; 2Weill Cornell Medicine, Department of Dermatology, New York, NY, USACorrespondence: Shari R Lipner, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY, NY, 100...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2022-09-01
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| Series: | Clinical, Cosmetic and Investigational Dermatology |
| Subjects: | |
| Online Access: | https://www.dovepress.com/updated-perspectives-on-the-diagnosis-and-management-of-onychomycosis-peer-reviewed-fulltext-article-CCID |
| _version_ | 1818055099006582784 |
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| author | Falotico JM Lipner SR |
| author_facet | Falotico JM Lipner SR |
| author_sort | Falotico JM |
| collection | DOAJ |
| description | Julianne M Falotico,1 Shari R Lipner2 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; 2Weill Cornell Medicine, Department of Dermatology, New York, NY, USACorrespondence: Shari R Lipner, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY, NY, 10021, USA, Tel +1 646-962-3376, Fax +1 646-962-0033, Email shl9032@med.cornell.eduAbstract: Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.Keywords: onychomycosis, nail disease, fungal nail infection, diagnosis, management, treatment, recurrence |
| first_indexed | 2024-12-10T12:07:33Z |
| format | Article |
| id | doaj.art-fec5ba5baad74ea19db03bd6567c75a1 |
| institution | Directory Open Access Journal |
| issn | 1178-7015 |
| language | English |
| last_indexed | 2024-12-10T12:07:33Z |
| publishDate | 2022-09-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical, Cosmetic and Investigational Dermatology |
| spelling | doaj.art-fec5ba5baad74ea19db03bd6567c75a12022-12-22T01:49:26ZengDove Medical PressClinical, Cosmetic and Investigational Dermatology1178-70152022-09-01Volume 151933195778275Updated Perspectives on the Diagnosis and Management of OnychomycosisFalotico JMLipner SRJulianne M Falotico,1 Shari R Lipner2 1Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA; 2Weill Cornell Medicine, Department of Dermatology, New York, NY, USACorrespondence: Shari R Lipner, Weill Cornell Medicine, Department of Dermatology, 1305 York Avenue, NY, NY, 10021, USA, Tel +1 646-962-3376, Fax +1 646-962-0033, Email shl9032@med.cornell.eduAbstract: Onychomycosis is the most common nail disease encountered in clinical practice and can cause pain, difficulty with ambulation, and psycho-social problems. A thorough history and physical examination, including dermoscopy, should be performed for each patient presenting with nail findings suggestive of onychomycosis. Several approaches are available for definitive diagnostic testing, including potassium hydroxide and microscopy, fungal culture, histopathology, polymerase chain reaction, or a combination of techniques. Confirmatory testing should be performed for each patient prior to initiating any antifungal therapies. There are several different therapeutic options available, including oral and topical medications as well as device-based treatments. Oral antifungals are generally recommended for moderate to severe onychomycosis and have higher cure rates, while topical antifungals are recommended for mild to moderate disease and have more favorable safety profiles. Oral terbinafine, itraconazole, and griseofulvin and topical ciclopirox 8% nail lacquer, efinaconazole 10% solution, and tavaborole 5% solution are approved by the Food and Drug Administration for treatment of onychomycosis in the United States and amorolfine 5% nail lacquer is approved in Europe. Laser treatment is approved in the United States for temporary increases in clear nail, but clinical results are suboptimal. Oral fluconazole is not approved in the United States for onychomycosis treatment, but is frequently used off-label with good efficacy. Several novel oral, topical, and over-the-counter therapies are currently under investigation. Physicians should consider the disease severity, infecting pathogen, medication safety, efficacy and cost, and patient age, comorbidities, medication history, and likelihood of compliance when determining management plans. Onychomycosis is a chronic disease with high recurrence rates and patients should be counseled on an appropriate plan to minimize recurrence risk following effective antifungal therapy.Keywords: onychomycosis, nail disease, fungal nail infection, diagnosis, management, treatment, recurrencehttps://www.dovepress.com/updated-perspectives-on-the-diagnosis-and-management-of-onychomycosis-peer-reviewed-fulltext-article-CCIDonychomycosisnail diseasefungal nail infectiondiagnosismanagementtreatmentrecurrence. |
| spellingShingle | Falotico JM Lipner SR Updated Perspectives on the Diagnosis and Management of Onychomycosis Clinical, Cosmetic and Investigational Dermatology onychomycosis nail disease fungal nail infection diagnosis management treatment recurrence. |
| title | Updated Perspectives on the Diagnosis and Management of Onychomycosis |
| title_full | Updated Perspectives on the Diagnosis and Management of Onychomycosis |
| title_fullStr | Updated Perspectives on the Diagnosis and Management of Onychomycosis |
| title_full_unstemmed | Updated Perspectives on the Diagnosis and Management of Onychomycosis |
| title_short | Updated Perspectives on the Diagnosis and Management of Onychomycosis |
| title_sort | updated perspectives on the diagnosis and management of onychomycosis |
| topic | onychomycosis nail disease fungal nail infection diagnosis management treatment recurrence. |
| url | https://www.dovepress.com/updated-perspectives-on-the-diagnosis-and-management-of-onychomycosis-peer-reviewed-fulltext-article-CCID |
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