Integrating Novel Antifungals for Onychomycosis into Your Practice

The presentation discusses the challenges and advancements in treating onychomycosis, focusing on the case of a 45-year-old woman, Sarah, who struggles with persistent fungal nail infections despite undergoing multiple antifungal treatments like terbinafine, itraconazole, and fluconazole. Various antifungal therapies yield varying cure rates due to different definitions of 'complete cure' across studies and the emphasis on the big toenail in clinical trials. The speaker introduces novel antifungals like voriconazole and posaconazole, which are not FDA-approved for onychomycosis but may serve as effective alternatives in resistant cases. A notable point is the identification of a mutation in Sarah's squalene epoxidase gene, leading to resistance to terbinafine, prompting a switch in therapy. After starting voriconazole, Sarah shows significant improvement, highlighting the importance of personalized treatment approaches in patients who are not responsive to standard therapies. The presentation concludes with illustrations depicting the treatment progression of resistant cases and a mention of the side effects and monitoring requirements for these newer antifungal medications.