Onychomycosis: An update
Keywords:
onychomycosis, treatment, diagnosisAbstract
Onychomycosis is a common superficial fungal infection. The infected nail shows nail discoloration, onycholysis, subungual hyperkeratosis, and onychodystrophy. Onychomycosis may cause by dermatophytes, yeasts, and mold. The definite diagnosis is made by visually detection of fungal hyphae by microscopy and fungal culture. Topical treatment show limited efficacy. The gold standard treatment is oral antifungal drugs for several months. Lately, the new modalities of treatment have been introduced in order to improve fungal eradication and minimize the adverse effect of long term drug administration. The definition of improvement and cure are vary from study to study. Even standard oral regimen were started, the resistance, fungal hyphae are found or fungal culture still positive. The treatment option for onychomycosis need further randomised clinical trials.
References
1. Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol 2010;28:197-201.
2. Cozzani E, Agnoletti AF, Speziari S, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy. Geriatr Gerontol Int 2016;16:486-91.
3. Papini M, Piraccini BM, Difonzo E, Brunoro A. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification. Mycoses 2015;58:659-64.
4. Dubljanin E, Dzamic A, Vujcic I, et al. Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification. Mycoses 2016. Jul 29. doi: 10.1111/myc.12537.
5. Gupta AK, Gupta G, Jain HC, et al. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol 2016;30:1567-72.
6. Nenoff P, Kruger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014;12:188-209; quiz 10, 188-211; quiz 2.
7. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000;42:217-24.
8. Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol 2012;66:830-41.
9. Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502.
10. Ungpakorn R, Lohaprathan S, Reangchainam S. Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand. Clin Exp Dermatol 2004;29:87-90.
11. Blake N, Zhu J, Hernandez G, Juliano PJ. A Retrospective Review of Diagnostic Testing for Onychomycosis of the Foot. J Am Podiatr Med Assoc 2015;105:503-8.
12. Bet DL, Reis AL, Di Chiacchio N, Belda Junior W. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples. An Bras Dermatol 2015;90:904-6.
13. Nenoff P, Kruger C, Schaller J, et al. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2014;12:749-77.
14. Petinataud D, Berger S, Contet-Audonneau N, Machouart M. Molecular diagnosis of onychomycosis. J Mycol Med 2014;24:287-95.
15. Bombace F, Iovene MR, Galdiero M, et al. Nondermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses 2016;59:558-65.
16. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56:939-44.
17. Chang A, Wharton J, Tam S, Kovich OI, Kamino H. A modified approach to the histologic diagnosis of onychomycosis. J Am Acad Dermatol 2007;57:849-53.
18. Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol 2004;140:696-701.
19. Allevato MA. Diseases mimicking onychomycosis. Clin Dermatol 2010;28:164-77.
20. Nenoff P, Kruger C, Paasch U, Ginter-Hanselmayer G. Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy. J Dtsch Dermatol Ges 2015;13:387-410; quiz 1.
21. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol 2014;7:10-8.
22. Kushwaha A, Murthy RN, Murthy SN, et al. Emerging therapies for the treatment of ungual onychomycosis. Drug Dev Ind Pharm 2015;41:1575-81.
23. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171:937-58.
24. Auvinen T, Tiihonen R, Soini M, et al. Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial. Br J Dermatol 2015;173:940-8.
25. Gupta AK, Studholme C. Novel investigational therapies for onychomycosis: an update. Expert Opin Investig Drugs 2016;25:297-305.
26. Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:489-502.
27. McAuley WJ, Jones SA, Traynor MJ, et al. An investigation of how fungal infection influences drug penetration through onychomycosis patient's nail plates. Eur J Pharm Biopharm 2016;102:178-84.
28. Vlahovic TC, Joseph WS. Efinaconazole topical, 10% for the treatment of toenail onychomycosis in patients with diabetes. J Drugs Dermatol 2014;13:1186-90.
29. Subissi A, Monti D, Togni G, Mailland F. Ciclopirox: recent nonclinical and clinical data relevant to its use as a topical antimycotic agent. Drugs 2010;70:2133-52.
30. Campione E, Paterno EJ, Costanza G, et al. Tazarotene as alternative topical treatment for onychomycosis. Drug Des Devel Ther 2015;9:879- 86.
31. Stensen W, Turner R, Brown M, et al. Short Cationic Antimicrobial Peptides Display Superior Antifungal Activities toward Candidiasis and Onychomycosis in Comparison with Terbinafine and Amorolfine. Mol Pharm 2016;13:3595-3600
32. Gupta AK, Simpson FC. Medical devices for the treatment of onychomycosis. Dermatol Ther 2012;25:574-81.
33. Bhatta AK, Keyal U, Huang X, Zhao JJ. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol 2016;74:916-23.
34. Zhang J, Lu S, Huang H, et al. Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer. Lasers Med Sci 2016;31:1391-6.
35. Bristow I, Baran R, Score M. Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution. J Drugs Dermatol 2016;15:974-8.
36. de Sa DC, Lamas AP, Tosti A. Oral therapy for onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:17-36.
37. Gupta AK, Simpson FC. New pharmacotherapy for the treatment of onychomycosis: an update. Expert Opin Pharmacother 2015;16:227-36.
38. Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013;69:416-25.
39. Dietz AJ, Barnard JC, van Rossem K. A randomized, double-blind, multiple-dose, placebo-controlled, dose escalation study with a 3-cohort parallel group design to investigate the tolerability and pharmacokinetics of albaconazole in healthy subjects. Clin Pharmacol Drug Dev 2014;3:25-33.
40. Bristow IR. The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res 2014;7:34.
41. Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJ, Landman GW. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015;16:108.
42. Karsai S, Jager M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nmNd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol 2016. Aug 13. doi: 10.1111/jdv.13798.
43. Gupta AK, Simpson FC, Heller DF. The future of lasers in onychomycosis. J Dermatolog Treat 2016;27:167-72.
44. Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis. Dermatol Surg 2016 Jul 25. doi : 10.1097/DSS.0000000000000841
45. Bhatta AK, Keyal U, Wang XL. Photodynamic therapy for onychomycosis: A systematic review. Photodiagnosis Photodyn Ther 2016;15:228-35.
46. Gilaberte Y, Robres MP, Frias MP, et al. Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2016 Aug 12. doi: 10.1111/jdv.13842.
47. Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-82.
48. Ghannoum M, Isham N, Catalano V. A second look at efficacy criteria for onychomycosis: clinical and mycological cure. Br J Dermatol 2014;170:182-7.
49. Yin Z, Xu J, Luo D. A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. J Dermatolog Treat 2012;23:449-52.
50. Feuilhade de Chauvin M. A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%. J Eur Acad Dermatol Venereol 2012;26:875-8.
51. Gupta AK, Brintnell WC. Sanitization of Contaminated Footwear from Onychomycosis Patients Using Ozone Gas: A Novel Adjunct Therapy for Treating Onychomycosis and Tinea Pedis? J Cutan Med Surg 2013;17:243-9.
52. Ghannoum MA, Isham N, Long L. Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 2012;102:309-13.
2. Cozzani E, Agnoletti AF, Speziari S, et al. Epidemiological study of onychomycosis in older adults with onychodystrophy. Geriatr Gerontol Int 2016;16:486-91.
3. Papini M, Piraccini BM, Difonzo E, Brunoro A. Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification. Mycoses 2015;58:659-64.
4. Dubljanin E, Dzamic A, Vujcic I, et al. Epidemiology of onychomycosis in Serbia: a laboratory-based survey and risk factor identification. Mycoses 2016. Jul 29. doi: 10.1111/myc.12537.
5. Gupta AK, Gupta G, Jain HC, et al. The prevalence of unsuspected onychomycosis and its causative organisms in a multicentre Canadian sample of 30 000 patients visiting physicians' offices. J Eur Acad Dermatol Venereol 2016;30:1567-72.
6. Nenoff P, Kruger C, Ginter-Hanselmayer G, Tietz HJ. Mycology - an update. Part 1: Dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges 2014;12:188-209; quiz 10, 188-211; quiz 2.
7. Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol 2000;42:217-24.
8. Finch J, Arenas R, Baran R. Fungal melanonychia. J Am Acad Dermatol 2012;66:830-41.
9. Gupta AK, Drummond-Main C, Cooper EA, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol 2012;66:494-502.
10. Ungpakorn R, Lohaprathan S, Reangchainam S. Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, Thailand. Clin Exp Dermatol 2004;29:87-90.
11. Blake N, Zhu J, Hernandez G, Juliano PJ. A Retrospective Review of Diagnostic Testing for Onychomycosis of the Foot. J Am Podiatr Med Assoc 2015;105:503-8.
12. Bet DL, Reis AL, Di Chiacchio N, Belda Junior W. Dermoscopy and Onychomycosis: guided nail abrasion for mycological samples. An Bras Dermatol 2015;90:904-6.
13. Nenoff P, Kruger C, Schaller J, et al. Mycology - an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges 2014;12:749-77.
14. Petinataud D, Berger S, Contet-Audonneau N, Machouart M. Molecular diagnosis of onychomycosis. J Mycol Med 2014;24:287-95.
15. Bombace F, Iovene MR, Galdiero M, et al. Nondermatophytic onychomycosis diagnostic criteria: an unresolved question. Mycoses 2016;59:558-65.
16. Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007;56:939-44.
17. Chang A, Wharton J, Tam S, Kovich OI, Kamino H. A modified approach to the histologic diagnosis of onychomycosis. J Am Acad Dermatol 2007;57:849-53.
18. Piraccini BM, Tosti A. White superficial onychomycosis: epidemiological, clinical, and pathological study of 79 patients. Arch Dermatol 2004;140:696-701.
19. Allevato MA. Diseases mimicking onychomycosis. Clin Dermatol 2010;28:164-77.
20. Nenoff P, Kruger C, Paasch U, Ginter-Hanselmayer G. Mycology - an update Part 3: Dermatomycoses: topical and systemic therapy. J Dtsch Dermatol Ges 2015;13:387-410; quiz 1.
21. Del Rosso JQ. The role of topical antifungal therapy for onychomycosis and the emergence of newer agents. J Clin Aesthet Dermatol 2014;7:10-8.
22. Kushwaha A, Murthy RN, Murthy SN, et al. Emerging therapies for the treatment of ungual onychomycosis. Drug Dev Ind Pharm 2015;41:1575-81.
23. Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists' guidelines for the management of onychomycosis 2014. Br J Dermatol 2014;171:937-58.
24. Auvinen T, Tiihonen R, Soini M, et al. Efficacy of topical resin lacquer, amorolfine and oral terbinafine for treating toenail onychomycosis: a prospective, randomized, controlled, investigator-blinded, parallel-group clinical trial. Br J Dermatol 2015;173:940-8.
25. Gupta AK, Studholme C. Novel investigational therapies for onychomycosis: an update. Expert Opin Investig Drugs 2016;25:297-305.
26. Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:489-502.
27. McAuley WJ, Jones SA, Traynor MJ, et al. An investigation of how fungal infection influences drug penetration through onychomycosis patient's nail plates. Eur J Pharm Biopharm 2016;102:178-84.
28. Vlahovic TC, Joseph WS. Efinaconazole topical, 10% for the treatment of toenail onychomycosis in patients with diabetes. J Drugs Dermatol 2014;13:1186-90.
29. Subissi A, Monti D, Togni G, Mailland F. Ciclopirox: recent nonclinical and clinical data relevant to its use as a topical antimycotic agent. Drugs 2010;70:2133-52.
30. Campione E, Paterno EJ, Costanza G, et al. Tazarotene as alternative topical treatment for onychomycosis. Drug Des Devel Ther 2015;9:879- 86.
31. Stensen W, Turner R, Brown M, et al. Short Cationic Antimicrobial Peptides Display Superior Antifungal Activities toward Candidiasis and Onychomycosis in Comparison with Terbinafine and Amorolfine. Mol Pharm 2016;13:3595-3600
32. Gupta AK, Simpson FC. Medical devices for the treatment of onychomycosis. Dermatol Ther 2012;25:574-81.
33. Bhatta AK, Keyal U, Huang X, Zhao JJ. Fractional carbon-dioxide (CO2) laser-assisted topical therapy for the treatment of onychomycosis. J Am Acad Dermatol 2016;74:916-23.
34. Zhang J, Lu S, Huang H, et al. Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer. Lasers Med Sci 2016;31:1391-6.
35. Bristow I, Baran R, Score M. Rapid Treatment of Subungual Onychomycosis Using Controlled Micro Nail Penetration and Terbinafine Solution. J Drugs Dermatol 2016;15:974-8.
36. de Sa DC, Lamas AP, Tosti A. Oral therapy for onychomycosis: an evidence-based review. Am J Clin Dermatol 2014;15:17-36.
37. Gupta AK, Simpson FC. New pharmacotherapy for the treatment of onychomycosis: an update. Expert Opin Pharmacother 2015;16:227-36.
38. Sigurgeirsson B, van Rossem K, Malahias S, Raterink K. A phase II, randomized, double-blind, placebo-controlled, parallel group, dose-ranging study to investigate the efficacy and safety of 4 dose regimens of oral albaconazole in patients with distal subungual onychomycosis. J Am Acad Dermatol 2013;69:416-25.
39. Dietz AJ, Barnard JC, van Rossem K. A randomized, double-blind, multiple-dose, placebo-controlled, dose escalation study with a 3-cohort parallel group design to investigate the tolerability and pharmacokinetics of albaconazole in healthy subjects. Clin Pharmacol Drug Dev 2014;3:25-33.
40. Bristow IR. The effectiveness of lasers in the treatment of onychomycosis: a systematic review. J Foot Ankle Res 2014;7:34.
41. Nijenhuis-Rosien L, Kleefstra N, Wolfhagen MJ, Groenier KH, Bilo HJ, Landman GW. Laser therapy for onychomycosis in patients with diabetes at risk for foot complications: study protocol for a randomized, double-blind, controlled trial (LASER-1). Trials 2015;16:108.
42. Karsai S, Jager M, Oesterhelt A, et al. Treating onychomycosis with the short-pulsed 1064-nmNd:YAG laser: results of a prospective randomized controlled trial. J Eur Acad Dermatol Venereol 2016. Aug 13. doi: 10.1111/jdv.13798.
43. Gupta AK, Simpson FC, Heller DF. The future of lasers in onychomycosis. J Dermatolog Treat 2016;27:167-72.
44. Wiznia LE, Quatrano NA, Mu EW, Rieder EA. A Clinical Review of Laser and Light Therapy for Nail Psoriasis and Onychomycosis. Dermatol Surg 2016 Jul 25. doi : 10.1097/DSS.0000000000000841
45. Bhatta AK, Keyal U, Wang XL. Photodynamic therapy for onychomycosis: A systematic review. Photodiagnosis Photodyn Ther 2016;15:228-35.
46. Gilaberte Y, Robres MP, Frias MP, et al. Methyl aminolevulinate photodynamic therapy for onychomycosis: a multicentre, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2016 Aug 12. doi: 10.1111/jdv.13842.
47. Carney C, Tosti A, Daniel R, et al. A new classification system for grading the severity of onychomycosis: Onychomycosis Severity Index. Arch Dermatol 2011;147:1277-82.
48. Ghannoum M, Isham N, Catalano V. A second look at efficacy criteria for onychomycosis: clinical and mycological cure. Br J Dermatol 2014;170:182-7.
49. Yin Z, Xu J, Luo D. A meta-analysis comparing long-term recurrences of toenail onychomycosis after successful treatment with terbinafine versus itraconazole. J Dermatolog Treat 2012;23:449-52.
50. Feuilhade de Chauvin M. A study on the decontamination of insoles colonized by Trichophyton rubrum: effect of terbinafine spray powder 1% and terbinafine spray solution 1%. J Eur Acad Dermatol Venereol 2012;26:875-8.
51. Gupta AK, Brintnell WC. Sanitization of Contaminated Footwear from Onychomycosis Patients Using Ozone Gas: A Novel Adjunct Therapy for Treating Onychomycosis and Tinea Pedis? J Cutan Med Surg 2013;17:243-9.
52. Ghannoum MA, Isham N, Long L. Optimization of an infected shoe model for the evaluation of an ultraviolet shoe sanitizer device. J Am Podiatr Med Assoc 2012;102:309-13.
Downloads
Published
2016-09-01
How to Cite
Smithrithee, R., & Limtanyakul, P. (2016). Onychomycosis: An update. Thai Journal of Dermatology, 32(3), 179–198. Retrieved from https://he02.tci-thaijo.org/index.php/TJD/article/view/159313
Issue
Section
Original articles
License
เนื้อหาและข้อมูลในบทความที่ลงตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นข้อคิดเห็นและความรับผิดชอบของผู้เขียนบทความโดยตรงซึ่งกองบรรณาธิการวารสาร ไม่จำเป็นต้องเห็นด้วย หรือร่วมรับผิดชอบใดๆ
บทความ ข้อมูล เนื้อหา รูปภาพ ฯลฯ ที่ได้รับการตีพิมพ์ในวารสารโรคผิวหนัง ถือเป็นลิขสิทธิ์ของวารสารฯ หากบุคคลหรือหน่วยงานใดต้องการนำทั้งหมดหรือส่วนหนึ่งส่วนใดไปเผยแพร่ต่อหรือเพื่อกระทำการใดๆ จะต้องได้รับอนุญาตเป็นลายลักอักษรจากบรรณาธิการวารสารโรคผิวหนังก่อนเท่านั้น
