Therapeutic Recommendations for the Treatment of Toenail Onychomycosis in the US.

BACKGROUND: Onychomycosis affects around 14% of individuals in North America and Europe and is undertreated. Treatment is challenging as toenail growth can take 12–18 months, the nail plate may prevent drug penetration, and disease recurrence is common. National guidelines/consensus documents on onychomycosis diagnosis and treatment were last published more than 5 years ago and updated medical guidance is needed. METHODS: This document aims to provide recommendations for the diagnosis and pharmaceutical treatment of toenail onychomycosis following a roundtable discussion with a panel of dermatologists, podiatrists, and a microbiologist specializing in nail disease. RESULTS: There was a general consensus on several topics regarding onychomycosis diagnosis, confirmatory laboratory testing, and medications. Onychomycosis should be assessed clinically and confirmed with microscopy, histology, and/or culture. Terbinafine is the primary choice for oral treatment and efinaconazole 10% for topical treatment. Efinaconazole can also be considered for off-label use for maintenance to prevent recurrences. For optimal outcomes, patients should be counseled regarding treatment expectations as well as follow-up care and maintenance post-treatment. CONCLUSIONS: This article provides important updates to previous guidelines/consensus documents to assist dermatologists and podiatrists in the diagnosis and treatment of toenail onychomycosis. J Drugs Dermatol. 2021;20(10):1076-1084. doi:10.36849/JDD.6291.

Deferring Nail Mycological Sampling during the COVID-19 Pandemic: Recommendations from a Multidisciplinary Panel of Nail Specialists.

Onychomycosis is the most common nail condition seen in clinical practice, with significant impact on quality of life. Clinical examination alone is insufficient for accurate diagnosis, but mycological confirmation can be challenging during the COVID-19 pandemic. In this letter, a multidisciplinary panel of dermatologists, a podiatrist, dermatopathologists, and a mycologist, discuss considerations for mycological sampling during the pandemic.

Onychomycosis: Clinical overview and diagnosis.

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily life, and impair social interactions. In this continuing medical education series we review the epidemiology, risk factors, and clinical presentation of onychomycosis and demonstrate current and emerging diagnostic strategies.

Onychomycosis: Treatment and prevention of recurrence.

Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily living, and impair social interactions. The epidemiology, risk factors, and clinical presentation and diagnosis of onychomycosis were discussed in the first article in this continuing medical education series. In this article, we review the prognosis and response to onychomycosis treatment, medications for onychomycosis that have been approved by the US Food and Drug Administration, and off-label therapies and devices. Methods to prevent onychomycosis recurrences and emerging therapies are also described.

Biotin for the treatment of nail disease: what is the evidence?

AIM: To describe the pharmacology, mechanism of action, and clinical reports using biotin to treat nail conditions. METHODS: A review of articles indexed for MEDLINE on PubMed using keywords 'biotin' and 'nail' was performed and applicable articles were selected for review. RESULTS: Clinical trials have shown an improvement in firmness, hardness, and thickness of brittle nails with oral biotin. There are some case reports and series demonstrating that oral biotin may improve triangular worn down nails, trachyonychia, and habit tic nail deformity. CONCLUSIONS: Oral biotin has been used to treat several nail conditions with promising results. Further larger clinical trials with controls are necessary to determine efficacy and optimal dosing.

Onychotillomania: Diagnosis and Management.

Onychotillomania, defined as self-induced trauma to the nail unit, either by picking or pulling at the nails, affects 0.9% of the population. It may lead to severe irreversible nail dystrophy, melanonychia, or infections. Although no large clinical trials have assessed the efficacy of treatments, cognitive-behavioral therapy, physical barrier methods, and pharmacological treatments have shown some benefits in case reports. The objective of this article is to review the prevalence, diagnostic criteria, etiology, historical and physical examination findings, pathological features, and current treatment methods. Onychotillomania remains a clinical challenge to dermatologists, pediatricians, internists, and psychiatrists in practice, as there are no evidence-based treatment methods.

Onychopapilloma Presenting as Leukonychia: Case Report and Review of the Literature.

Onychopapilloma is a benign tumor of the nail bed and distal matrix and is the most common cause of localized longitudinal erythronychia. Here, we describe a case of onychopapilloma presenting as longitudinal leukonychia of the left 4th fingernail in a 71-year-old female. To date, this is only the ninth described case of onychopapilloma presenting as longitudinal leukonychia. We review the literature on the reported cases and provide evidence that longitudinal leukonychia as the presenting sign for onychopapilloma is becoming increasingly recognized in clinical practice.

Onychophagia: A nail-biting conundrum for physicians.

Onychophagia, defined as habitual nail biting, is a common disorder affecting 20-30% of the population and all age groups. It may lead to significant psychosocial problems, have a negative impact on quality of life, and cause complications involving both the nail unit and the oral cavity. The objective of this paper is to review the prevalence, etiology, history, physical examination, complications and management of nail biting. Since onychophagia is a challenging disorder to treat, a multi-disciplinary approach should be taken involving dermatologists, internists, pediatricians, psychiatrists and dentists.

Nail disorders: Kids are not just little people.

Nail disorders comprise an important subset of dermatologic conditions and often pose both diagnostic and therapeutic challenges to the clinician. Presentation and management can differ in adults and children. Proper understanding of these differences is important in delivering optimal patient care. This contribution discusses three common nail disorders in adults and children, onychomycosis, melanonychia striata, and trachyonychia, highlighting distinct features in the adult and pediatric populations.