Antifungal Drugs in Onychomycosis Clinical Trial
Official title:
Comparative Study of Systemic Antifungal Drugs Used in Treatment of Onychomycosis
Onychomycosis refers to the fungal infection of the fingernails or toenails, caused by dermatophytes, yeast and non-dermatophyte molds that lead to distortion, discoloration, thickening and detachment from the nail bed
Onychomycosis accounts for up to 30% of all superficial infections of skin and constitutes
about a half of all nail abnormalities; affecting approximately 5% of population worldwide
The prevalence of onychomycosis is determined by age, social class, occupation, climate,
living environment and frequency of travel Despite being common dermatological presentation,
the exact prevalence of onychomycosis remains largely unknown.
Toenails are more commonly affected than fingernails due to slower rate of growth of the
former, reduced blood supply and usual confinement in dark moist environments The infection
is more common in adult males (particularly elderly > 60 yrs of age), diabetics,
immunocompromised individuals (e.g. HIV positive), individuals with peripheral vascular
(arterial) disease, previous tineapedis infection, history of trauma to the nail, or those
with a family history of onychomycosis Dermatophytes whether pathogenic or saprophytes are
the commonest causative nail invaders Dermatophytic onychomycosis can be divided into four
major clinical types on the basis of their presenting clinical features; distal and lateral
subungualonychomycosis (DLSO), proximal subungualonychomycosis (PSO), white superficial
onychomycosis (WSO) and total dystrophic onychomycosis (TDO) , Among these,distal and
lateral subungualonychomycosis( DLSO) is the most common form.
Clinical diagnosis by physical examination alone can be inaccurate as many non infectious
conditions that mimic onychomycosis like lichen planus, psoriasis need to be ruled out .
Various laboratory techniques have been used to accurately diagnose onychomycosis, with
microscopy by KOH and fungal culture being the most frequently used The histopathology of
nail clippings can be utilized for diagnosing onychomycosis, with periodic acid-Schiff (PAS)
stain that allows easy visualization of fungal hyphae . Digital dermoscopy, also called
onychoscopy, is an easy and quick procedure that allows differential diagnosis of
onychomycosis from the common nail dystrophies.
Dystrophic nails can be a social impediment causing significant embarrassment that affects
patient's self-esteem. In addition, thickened nails can be painful, interfere with the
function of the nail unit and may cause discomfort in walking, standing and exercising.
Though initially presenting as a cosmetic problem, it can eventually lead to permanent
disfigurement of the nails and serve as a source of other fungal infections . Due to these
significant effects specific questionnaire was designed and validated to assess quality of
life in patients with onychomycosis
Treatment is chosen depending on the modality of nail invasion, fungus species and the
number of affected nails. Oral treatments are often limited by drug interactions, while
topical antifungal lacquers have less efficacy . Surgery or nail debridement is another
invasive treatment option in limited resistant cases .
The use of griseofulvin and ketoconazole is problematic, as there are typically high relapse
rates of 50-85%. In addition, treatment must be continued for a long duration with risky
systemic side effects.
Fluconazole, itraconazole and terbinafine are relatively safe antifungal drugs that have
been widely used with improved treatment success, producing a mycological cure in more than
90% of fingernail infections and in about 80% of toenail infections
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