Onychomycosis therapy: past, present, future.

Methods to treat onychomycosis are varied, using therapies that can be categorized as topical, oral or device-related. Since their development, oral therapies have represented the gold standard for treatment over other methods. However, efficacy with oral therapies remains limited, and safety may be an issue, leaving many patients requiring alternative treatments. With research advances, topical therapies as alternatives for onychomycosis are being investigated with greater interest as new technologies are overcoming previous limitations of topical treatments, such as lack of nail penetration. New device-related topical therapy methods are particularly noteworthy, as they may allow for shorter, more convenient treatments for patients, reducing issues with topical compliance, and, in cases of non-drug light-based therapies, they will avoid potential for drug reactions. Research in these fields is preliminary, and the impact these methods may have on the future of onychomycosis remains to be seen.

Topical treatments for onychomycosis: a historical perspective.

Topical treatment of onychomycosis, in contrast to systemic oral therapy, allows the patient to apply medication directly to the affected area, thereby decreasing the potential for adverse events and drug interactions. Historically, several topical antifungal agents have been used in the treatment of onychomycosis; however, the evidence for their effectiveness is based on very limited data or anecdotal reports. Recently, the development of new, effective topical agents has renewed interest in this form of therapy. As clinical experience with newer topical agents expands, they may be found to be an effective option for the treatment of onychomycosis.

[A medical student discovers onychomycosis]. / Ein Medizinstudent entdeckt die Onychomykose.

When G. Meissner discovered the tactile bodies of the skin, he earned early fame. Yet he made further contributions to dermatology which have been forgotten such as the first description of onychomycosis. This took place when he was still a student in Göttingen. The circumstances of this discovery are told in the context of the medical history of that time, paying special attention to certain epidemiological aspects. Finally, a detailed account is given of Meissner's academic career.

Ciclopirox nail lacquer and podiatric practice.

Ciclopirox 8% nail lacquer has recently been approved by the US Food and Drug Administration (FDA) for the management of mild-to-moderate dermatophytic onychomycosis not involving the lunula. Previously, the agents that were approved for the treatment of dermatophytic pedal onychomycosis--griseofulvin, itraconazole, and terbinafine--were administered orally. When ciclopirox nail lacquer is used, it is recommended that the infected nail undergo debridement by a health-care professional as frequently as monthly. It is important to be aware of the circumstances under which debridement of the mycotic nail may be considered medically necessary and therefore potentially eligible for reimbursement by third-party payers. For many nail presentations, nail debridement is an important component of a treatment protocol involving either the oral medications or the topical lacquer, as it serves to reduce the fungal load and ameliorate symptoms. With the availability of a new FDA-approved topical treatment alternative, it remains to be seen if podiatrists will embrace the definitive treatment of onychomycosis using the newer oral agents, the new nail lacquer, or both in combination with nail debridement to treat the disease.

A ten year survey of onychomycosis in the central region of the Rio Grande do Sul, Brazil

Onicomicoses sao infeccoes comuns da lamina ungueal causadas por fungos filamentosos e leveduras, que representam aproximadamente 50 por cento das alteracoes das unhas e 30 por cento de todas as infeccoes fungicas superficiais. Apresentamos um estudo sobre a frequencia, epidemiologia e aspectos clinicos das onicomicoses na regiao central do Rio Grande do Sul durante o periodo 1988-1997

Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984.

Nail dust particles were analyzed by scanning electron microscopy for size and topography. The percentage of "fines" that could be inhaled and deposited in the alveoli and bronchioles were determined by quantitative particle size analysis. Distribution representing the largest total mass was graphed between 1 and 2 microns. The authors found that 86% of nail dust would reach the bronchioles and alveoli, and 31% could be expected to deposit in these areas.

Nail dust aerosols from onychomycotic toenails. Part II. Clinical and serologic aspects. 1984.

The podiatric procedure of burring hyperkeratotic fungal infected toenails results in large quantities of nail dust aerosols. An extremely large percentage (31%) of podiatrists who were analyzed for immunoglobulin E (IgE) by antibody radioimmunoassay were found to have abnormally high levels. Incidence of precipitin antibodies to Trichophyton rubrum in sera of those in practice from 0 to 15 years was 23%, and those in practice 16 years or more was 29%. In this study, podiatrists who were chronically exposed to nail dust aerosols after years of practice presented with symptoms of conjunctivitis, rhinitis, asthma, coughing, hypersensitivity, and impaired lung function.