Onychomycosis, or nail fungus, isa common dermatologic condition,occurring when fungi infectone or more of the nails. It is estimatedthat, by the age of 70, up to 50% of individualswill have been infected. Onychomycosisis most often seen in adults,becoming increasingly common withadvancing age. While onychomycosis isamong the most common fungal infectionsfound in the body, it can be difficultto treat and is prone to recurrence.
Fungal nail infections are unsightly, canbe painful, and may cause permanentnail damage. Far more serious complicationscan occur, however, particularly inpeople with diabetes, peripheral vasculardisease, or weakened immune systems.In such cases, a minor injury or infectioncan lead to serious complications suchas foot ulcers. For these reasons, treatmentof the infected nail is important.Symptoms include brittleness, discoloration,thickening of the nail, distortionof the nail's shape, crumbling or raggednails, dullness, loss of luster or shine, orloosening or detachment of the nail.
Types of Onychomycosis
Onychomycosis is generally classifiedinto 4 subtypes. They are:
Treatment of Nail Fungus
Several approaches are accepted fortreating onychomycosis, although someare safer and more cost-effective thanothers. Systemic treatments are frequentlyused today but pose a risk ofliver toxicity and other significant sideeffects. Serious drug interactions mayoccur with the use of systemic antifungaltreatments, and full disclosure of all currentmedications is vital. Most systemicmedications can also be made into topicalcompounds. Commonly used systemictreatments include:
Nonsystemic Treatments andCompounded Medications
For many patients, systemic therapy iscontraindicated, and a topical preparationmay be more appropriate. Currently,one preparation is commercially available,but other options are availablethrough a compounding pharmacy.
Ciclopirox is available under the tradename Penlac. It is used topically oncedaily for up to a year, and its side effectsare usually minimal.
Compounded preparations provide avaluable resource for the treatment ofonychomycosis. A host of options maybe considered, as any of the commerciallyavailable systemic products mentionedabove may be prepared as a topicalagent by an experienced compoundingpharmacist. Other agents may alsobe added to enhance the effectivenessof the drug. Some physicians combinetopical treatment with oral pulse therapyfor maximum effectiveness.
Compounded medications may beless costly than systemic treatments.For this reason, as well as the lowerchance of potentially harmful sideeffects and the ability to individualizetreatment, compounded medicationsfor onychomycosis should be consideredas a first-line treatment for nailfungus.
Ms. Fields is with the InternationalJournal of PharmaceuticalCompounding and is a pharmacytechnician at Innovative PharmacyServices in Edmond, Okla.
For More InformationThe International Journal ofPharmaceutical Compounding(IJPC) is a bimonthly scientific andprofessional journal emphasizinghigh-quality pharmaceutical compounding.The journal covers topicsrelevant and necessary toempower pharmacists to meet theneeds of today's patients. Formore information, or to subscribeto IJPC, visit www.ijpc.com, or call888-588-4572.