Treatment of nail fungus is one of the most difficult tasks of dermatology, which is associated with:
- slow nail growth rate;
- hard access through the nail to the pathogen.
It is in connection with these factors that the treatment of onychomycosis, in addition to local therapy, should include the use of systemic drugs. Each of them has its own advantages and disadvantages, and it is important for a dermatologist to know which type of treatment is suitable for his patient.
On estet-portal.com read about the intricacies of systemic therapy for nail fungus.
The main systemic drugs for the treatment of onychomycosis
The two main systemic drugs used in the treatment of onychomycosis are terbinafine and itraconazole. Reported treatment failures with these two drugs range from 25-40%.
Ketoconazole has been withdrawn from the US, European and UK markets for the treatment of superficial fungal infections due to the risk of hepatotoxicity associated with long-term use.
- Terbinafine
Terbinafine is a fungicidal/fungistatic allylamine that acts by inhibiting squalene epoxidase, an enzyme required for the production of ergosterol in fungal cell walls.
Due to its strong lipophilic properties, terbinafine is well absorbed in the skin and nails, at therapeutic concentrations it is found in the nail plate as early as a week after the start of therapy, and it can persist for six months after stopping reception.
The recommended dose is 250 mg daily (with or without food) for 6 to 12 weeks.
Terbinafine is generally well tolerated, with the most common side effects being nausea, diarrhea and rashb.
- Itraconazole
Itraconazole is predominantly a fungistatic triazole.
Like terbinafine, itraconazole is rapidly absorbed in the nails and persists for several months after the end of treatment.
Itraconazole can be taken as 200mg per day or as a pulse dose – 400 mg per day for one week per month. The recommended duration of treatment is at least 6-12 weeks, or 2-3 pulsed doses.
The most common side effects are gastrointestinal disturbances and headacheb.
- Fluconazole
Fluconazole – it is an oral azole with a long half-life, allowing once-weekly administration.
Common side effects of fluconazole include headache, rash and gastrointestinal upset.
Fluconazole is used in patients who cannot tolerate terbinafine or itraconazole due to side effects or potential drug interactionsth.
- Griseofulvin
Griseofulvin is a weakly fungistatic oral medication that acts by inhibiting nucleic acid synthesis, interfering with fungal cell division and cell wall synthesis.
This drug has lower treatment success rates than terbinafine and itraconazole, but it is the only antifungal drug licensed for the treatment of onychomycosis in children older than one month (10mg/kg per day) ).
For adults, the recommended dose is 500-1000mg per day with a fatty meal for six to nine months for fingernail infections and for 12-18 months for toenail infections.
The most common side effects are nausea and rash.
Modern aspects of diagnosis and treatment of onychomycosis
Terbinafine is generally considered the most effective treatment for onychomycosis caused by dermatophytes.
Itraconazole and fluconazole may be slightly more effective in shorter courses than terbinafine in the treatment of candidal lesions of nailth.
There are several studies suggesting that systemic treatment with terbinafine or itraconazole in combination with nail debridement and/or topical therapy may be more effective.
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Prevention of onychomycosis
Tips for prevention of onychomycosis include:
- keep nails short and clean;
- wearing comfortable shoes;
- avoidance of nail injuries;
- use of safety shoes in wet areas such as swimming pools and gyms.
Anti-fungal powders and sprays may also be helpful.
It is very important to educate patients about the importance of washing socks in hot water and throwing away old"contaminated" shoes to avoid relapse of the disease.
There are many treatment options for onychomycosis, but there is still a high recurrence rate of the disease.Oral therapy is still the mainstay of treatment for most fungal nail infections. Topical antifungals are useful mainly as monotherapy in very early, limited cases of onychomycosis or as an adjuvant or prophylactic treatment.
For more information about the topical therapy of mycosis, read the article:Topical therapy for onychomycosis: varnishes for the treatment of nail fungus
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