Aditya K Gupta1, R Gary Sibbald2, Anneke Andriessen3, Richard Belley4, Alan Boroditsky5, Mariam Botros6, Robert Chelin7, Wayne Gulliver8, David Keast9, Mani Raman10. 1. University of Toronto, Toronto, ON, Canada, & Mediprobe Research Inc, London, ON, Canada agupta@execulink.com. 2. University of Toronto, Mississauga, ON, Canada. 3. Malden and UMC St Radboud Nijmegen, The Netherlands. 4. Département de Médecine Familiale et, Médecine d'urgence, Faculté de Médecine de l'Université Laval, Québec, QC, Canada. 5. Vancouver General Hospital, Vancouver, BC, Canada. 6. Women's College Hospital, Toronto, ON, Canada. 7. FAAFAS, Toronto, ON, Canada. 8. Faculty of Medicine, Memorial University, St John, NF, Canada. 9. General Practitioner, London, ON, Canada. 10. FRCPC, Toronto, ON, Canada.
Abstract
BACKGROUND: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. OBJECTIVE: To define a patient-centred Canadian treatment strategy for onychomycosis. METHODS: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. RESULTS: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. CONCLUSION: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.
BACKGROUND:Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. OBJECTIVE: To define a patient-centred Canadian treatment strategy for onychomycosis. METHODS: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. RESULTS: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. CONCLUSION: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.
Authors: Eduardo Vinicius Grego Uemura; Marcelo Dos Santos Barbosa; Simone Simionatto; Ahmed Al-Harrasi; Abdullah M S Al-Hatmi; Luana Rossato Journal: J Fungi (Basel) Date: 2022-03-31
Authors: Alexander K C Leung; Joseph M Lam; Kin F Leong; Kam L Hon; Benjamin Barankin; Amy A M Leung; Alex H C Wong Journal: Recent Pat Inflamm Allergy Drug Discov Date: 2020