Are topical and device-based therapies safe and effective in the treatment of toenail onychomycosis?
Topical antifungal drugs, including efinaconazole 10% solution (Jublia), tavaborole 5% solution (Kerydin), and ciclopirox 8% lacquer and hydrolacquer, are beneficial in treating mild to moderate toenail onychomycosis. (1,2) Potential adverse effects are mild and include dermatitis and vesicles. (1) (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)
Onychomycosis, a fungal infection of the nail caused by dermatophytes, nondermatophyte molds, and yeasts, is the most common nail disorder encountered in primary care. (1,3) Aside from its cosmetic impact, toenail onychomycosis may cause pain and discomfort. (1) Oral antifungal medications are considered the most effective treatment; however, they are associated with drug interactions and systemic adverse effects. (1) The authors of this review sought to determine the safety and effectiveness of topical and device-based therapies to treat toenail onychomycosis.
This Cochrane review included 56 randomized controlled trials (published between 1993 and 2019) involving 12,501 participants. (1) The primary outcomes were complete cure rate (defined as mycologic cure and resolution of all clinical symptoms) and treatment-related adverse effects. Secondary outcomes at follow-up included mycologic cure rate (negative mycologic testing) and clinical cure rate (0% nail plate involvement). Ultimately, 12 studies involving 4,269 participants were included...