Current Issues in Global Onychomycosis Management
April 2022 | Volume 21 | Issue 4 | Original Article | 371 | Copyright © April 2022
Published online March 20, 2022
Aditya K. Gupta MD PhD,a,b Elizabeth A. Cooper HBSc BESb and the Global Onychomycosis Survey Group*
*Global Onychomycosis Survey Group Members: Philip Fleckman MD,c Chander Grover MD,d Aditya K. Gupta MD PhD,a,b Eckart Haneke MD,e-h Rod Hay MD,i Matilde Iorizzo MD PhD,j Shari Lipner MD PhD,k Charles W. Lynde MD,a,l Julie E. Mervak MD,m Vincent Piguet MD PhD,n Bianca-Maria Piraccini MD PhD,o Dimitris Rigopoulos MD,p Regina Schechtman MD PhD,q Avner Shemer MD,r,s Michela Starace MD PhDo
aUniversity of Toronto, Toronto, ON, Canada
bMediprobe Research Inc, London ON Canada
cUniversity of Washington, Seattle, WA
dUniversity College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
eInselspital, University of Bern, Bern, Switzerland
fPrivate Dermatology Practice Dermaticum, Freiburg, Germany
gCentro de Dermatología Epidermis, Instituto CUF, Porto, Portugal
hGhent University Hospital, Ghent, Belgium
iInternational Foundation of Dermatology, University of London, London, UK
jPrivate Dermatology Practice, Bellinzona/Lugano, Switzerland
kWeill Cornell Medicine, Department of Dermatology, New York, NY
lLynde Institute of Dermatology, Markham, ON
mDepartment of Dermatology, University of Michigan, Ann Arbor, MI
nDivision of Dermatology, Women’s College Hospital, Toronto, Ontario, Canada
oDermatology Unit - IRCCS Policlinico di Sant’Orsola Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Italy
p1st Department of Dermatology-Venereology, Faculty of Medicine, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
qInstituto de Dermatologia, Pontifical Catholic University Rio de Janeiro, Brazil
rThe Chaim Sheba Medical Center, Tel Hashomer, Israel
sSackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
Abstract
Introduction: Onychomycoses occur worldwide and are complex infections to treat. Diagnosis with standard culture methods has been problematic. Treatment historically used oral monotherapies. A selection of topical agents is now available and can be used in topical/oral combination therapies. Both pharmaceutical and non-pharmaceutical strategies are needed to provide the best efficacy in onychomycosis therapy.
Methods: A 35-question web-based survey of current onychomycosis practice was designed to investigate how onychomycosis diagnosis and treatment is being pursued by physicians from many countries, and what strategies are most frequently implemented to improve onychomycosis outcomes.
Results: Dermatologists (n = 144) indicated that diagnosis is an important factor in treatment success, with most using standard potassium hydroxide (KOH)/culture methods. There appears to be a need to augment diagnosis with newer visualization methods or molecular identification methods such as polymerase chain reaction (PCR). For treatment resistance/failure, dermatologists generally switch antifungals, to either new monotherapy or oral/topical combination therapy. A majority of responders agreed that more effective topical and oral products are needed to improve onychomycosis therapy, and there is a need for more combination therapy data. Patient education and other non-pharmaceutical options are also widely recognized as important factors in improving the results of onychomycosis therapy.
Conclusion: Dermatologists worldwide generally share common concerns about onychomycosis, and particularly about difficulties with obtaining complete disease clearance. This survey confirms that similar pharmaceutical and non-pharmaceutical strategies for success are used across surveyed regions and that more diagnostic and pharmaceutical options are needed to improve onychomycosis outcomes.
J Drugs Dermatol. 2022;21(4):371-375. doi:10.36849/JDD.6746
INTRODUCTION
Onychomycoses occur worldwide and are complex infections to treat. Historically, prescribed treatments have been mainly oral antifungals, with mixed success. Diagnosis has been problematic, as the standard culture methods have a high rate of false negative findings and may not capture the causative agents due to confounding contamination. In the past decade, topical antifungals have progressed to become mainstream and may be used as monotherapy or in combination with oral therapy. Molecular methods of diagnosis have also progressed to become more common, but it remains to be seen how this technology will
