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- Presentation
Topicals, Dermatophytomas, and Antifungal Resistance: A Practical Approach to the Management of Onychomycosis
Description
The presentation addresses the management of onychomycosis, focusing on topical treatments, dermatophytomas, and antifungal resistance. Despite the prevalence of onychomycosis, only three FDA-approved topical medications exist, the oldest being Cyclopyrox, approved in 1999, followed by Efinaconazole and Tavaborole. Newer treatments show better cure rates compared to Cyclopyrox, particularly in pediatric patients, who may benefit from these as first-line options. Innovative therapies, such as a topical terbinifene solution, have demonstrated promising mycological cure rates but lower complete cure rates, highlighting the need for patient education on application methods. Attention is also given to dermatophytomas, which require different treatment approaches, often responding better to topical therapies than oral medications. Topical vitamins are discussed, although not recommended as primary treatments. The emergence of antifungal resistance, particularly to terbinafine, is noted, with studies revealing increasing mutation rates among common fungal strains. This underscores the necessity for antifungal stewardship to mitigate resistance and ensure effective treatment.
View moreConclusions
- Topical treatments for onychomycosis have remained largely unchanged for 25 years, with only three FDA approved options available.
- Newer topical agents like eficonazole and tavaborole show improved cure rates compared to older treatments like cyclopyrox.
- Topical treatments are shown to be effective for pediatric patients, potentially serving as first-line therapy for onychomycosis in this population.
- Emerging research indicates that topical terbinafine demonstrates promising mycological cure rates, although complete cure rates remain low.
- Topicals appear to be effective for treating dermatophytomas, providing better resolution than previously thought.
- Vitamin E and essential oil combinations show potential in achieving good cure rates, although they are not first-line treatments.
- Antifungal resistance, particularly to terbinafine, is an emerging epidemic that necessitates increased vigilance and stewardship.
- Resistance mutations have been identified in strains of T. rubrum, indicating a need for alternative treatments and careful patient management.
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