Onychomycosis: Diagnosis, Treatment, and Prevention Strategies

Vol. 35. No. 3


Onychomycosis recently has become more widely recognized as a medical condition having importance well beyond the cosmetic appearance of nails. Failure to diagnose this infection accurately and treat it effectively may lead to medical sequelae such as permanent damage to the nail plate and its attachments, and the potential for secondary bacterial infections, as well as spread of the fungus locally and to other parts of the body and transmission of the infection to others. In addition, quality-of-life and psychosocial consequences cannot be overlooked. However, until the introduction of newer, more effective medications over the past 2 decades, most patients with onychomycosis remained undiagnosed and untreated or ineffectively managed.

The introduction of terbinafine in 1996 marked the beginning of a new era in the diagnosis and treatment of onychomycosis. The approval of the first topical antifungal for the treatment of this infection followed soon afterward; in 1999, the topical antifungal agent, ciclopirox, was approved by the US Food and Drug Administration (FDA).

Research focusing on a clearer understanding of the underlying infectious organisms subsequently led to the introduction of two new topical agents, efinaconazole and tavaborole, both approved by the FDA in 2014.

This educational supplement features highlights of a CME/CE independent satellite symposium, which was held on November 6, 2015, at Skin Disease Education Foundation’s 16th Annual Las Vegas Dermatology Seminar. It reviews the efficacy and safety of onychomycosis treatments, provides an overview of the mechanisms of action of the available antifungal agents, addresses onychomycosis in special patient populations, and discusses strategies for improving patient adherence to recommended therapy and reducing the risk for recurrence of infection.