Role of topical antifungals in the treatment of onychomycosis
Onychomycosis may involve any component of the nail unit, including the nail matrix, the nail bed, or the nail plate. It is caused by three main classes of fungi: dermatophytes, yeasts, and nondermatophyte molds, but the clinical appearance is indistinguishable based on the species of fungus causing the infection. Based on the morphology, major subtypes include distal lateral subungual, white superficial, proximal subungual, and candidal.
Do the topical antifungals have a role in the treatment of onychomycosis? View images
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posted by Dr. Shahbaz A.Janjua at 9:18 AM
3 Comments:
Dear Shahbaz,
I have never been impressed by the effects of topical therapies in onychomycoses.With the advent of Terbinafine and Itraconazole there is little justification for prescribing topical therapy.
Best wishes
5:10 AM
I agree with you but there are circumstances(pertaining to the medical condition of your patient or other drugs that your patient may be taking) where the oral antifungals may be contraindicated and we have to rely on the topicals. Any experience with amorlofine, ciclopirox oalamine, sod.pyrithione or bifonazole/urea as topicals for onychomycosis.
7:51 PM
Amorolofine is the only one I have used.It is effective in less than 50% of cases,is expensive and requires a fair bit of patient compliance.I suppose it is expensive in Pakistan as well?
I appreciate that certain patient characteristics would make oral treatment impossible and topicals the only alternative.
Best wishes
1:08 AM
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