Onychomycosis, or nail fungus, is a common dermatologic condition, occurring when fungi infect one or more of the nails. It is estimated that, by the age of 70, up to 50% of individuals will have been infected. Onychomycosis is most often seen in adults, becoming increasingly common with advancing age. While onychomycosis is among the most common fungal infections found in the body, it can be difficult to treat and is prone to recurrence.
Fungal nail infections are unsightly, can be painful, and may cause permanent nail damage. Far more serious complications can occur, however, particularly in people with diabetes, peripheral vascular disease, or weakened immune systems. In such cases, a minor injury or infection can lead to serious complications such as foot ulcers. For these reasons, treatment of the infected nail is important. Symptoms include brittleness, discoloration, thickening of the nail, distortion of the nail's shape, crumbling or ragged nails, dullness, loss of luster or shine, or loosening or detachment of the nail.
Types of Onychomycosis
Onychomycosis is generally classified into 4 subtypes. They are:
Treatment of Nail Fungus
Several approaches are accepted for treating onychomycosis, although some are safer and more cost-effective than others. Systemic treatments are frequently used today but pose a risk of liver toxicity and other significant side effects. Serious drug interactions may occur with the use of systemic antifungal treatments, and full disclosure of all current medications is vital. Most systemic medications can also be made into topical compounds. Commonly used systemic treatments include:
Nonsystemic Treatments and Compounded Medications
For many patients, systemic therapy is contraindicated, and a topical preparation may be more appropriate. Currently, one preparation is commercially available, but other options are available through a compounding pharmacy.
Ciclopirox is available under the trade name Penlac. It is used topically once daily for up to a year, and its side effects are usually minimal.
Compounded preparations provide a valuable resource for the treatment of onychomycosis. A host of options may be considered, as any of the commercially available systemic products mentioned above may be prepared as a topical agent by an experienced compounding pharmacist. Other agents may also be added to enhance the effectiveness of the drug. Some physicians combine topical treatment with oral pulse therapy for maximum effectiveness.
Compounded medications may be less costly than systemic treatments. For this reason, as well as the lower chance of potentially harmful side effects and the ability to individualize treatment, compounded medications for onychomycosis should be considered as a first-line treatment for nail fungus.
Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Services in Edmond, Okla.
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