ciclopirox olamine 8% (Penlac®)
and amorolfine 5% (Loceryl®).
Ciclopirox is applied to the nail
daily, each layer on top of the
other, without removal. The layers
are removed every 7 days with nail
polish remover or alcohol, and the
daily regimen is continued until the
nail is clear of infection, usually 6
to 9 months. Unfortunately, cure
rates after approximately 1 year are
estimated between 30% and 40%.
There is general consensus that
topical monotherapy should be
used where less than 50% of the
nail surface is affected, without
matrix involvement. In cases where
the nail is so affected that the
topical treatment cannot penetrate
the nail, such as a loosened and
extremely thick nail, chemical or
mechanical thinning or removal
of the nail should be considered.
The most efficacious approach to
treating onychomycosis is using
both oral and topical therapies
when there is greater than 50% of
the nail plate involved.
It is important to advise older
patients who are using topical
agents to avoid discontinuing the
treatment as soon as the nails look
normal. The fungal infection tends
to rapidly reoccur into a fullblown
infection. Patients should be
reminded to continue the treatment
as prescribed, as it is important for
the drug to remain in the nail tissue
for some time after resolution of
symptoms.
Tinea Pedis. Fungal infections of
pedal skin tend to target the skin
where there is contact with the
shoe or between the toes. Interdigit
infections involve the toe web
spaces, appear whitish, and can
have cracks and peel. Pedal skin
infections can mimic dry flaky skin;
however, there is often an element
of peeling and redness. Sometimes
a splotchy, rash-like appearance
and severe itching are present.
Inflammation and open draining
areas are the most severe form.
Topical treatments vary widely.