Managing Onychomycosis: New and Emerging Treatments and Recurrence Prevention Strategies

Vol. 34. No. 3


Until relatively recently, onychomycosis generally was not recognized as an infection that warranted serious clinical consideration.
This was due, in part, to the fact that prior to the introduction of oral terbinafine, effective therapy was not available. With the
approval by the US Food and Drug Administration (FDA) of terbinafine in 1996 and the subsequent approval of the topical agent
ciclopirox in 1999, interest in diagnosing and treating onychomycosis increased. However, although these new medications were effective
in many cases, the achievement of a mycologic cure and cosmetic clearance of the infection were elusive goals for many other patients.
Moreover, even after the introduction of these medications, patients typically sought attention for onychomycosis only when pain or
other symptoms had progressed to the point at which the infection could no longer be ignored. Early cases of this fungal infection were
not commonly identified by either patients or clinicians, and the importance of early treatment was not appreciated. Finally, recurrence
was the rule rather than the exception.
Within the past decade, research regarding the pathogenesis of onychomycosis has led to a better understanding of the underlying
infectious organisms, the introduction in 2014 of two new topical agents, and, as a result, a resurgence of interest in the diagnosis and
treatment of both onychomycosis and a commonly related cutaneous infection, tinea pedis.
In this supplement, the faculty provides an overview of the state of the art in onychomycosis diagnosis and treatment, with a particular
focus on the efficacy and safety data from clinical studies of the newer and emerging medications and devices. Also, a discussion of
the mechanisms of action of these modalities is presented, to help clinicians tailor therapy according to individual patient profiles. In
addition, management strategies for challenging patient populations are offered, as well as some practical approaches for improving
treatment results and reducing the risk for recurrence of infection.
The goal of this educational activity is to provide clinicians with up-to-date information on the diagnosis and treatment of
onychomycosis that will support their efforts to work with patients to manage or, when possible, eradicate this infection.