Dermatophytes and humans have coexisted for millennia, and for those thousands of years, humans have suffered the consequences of dermatophyte infections. Only recently have clinicians had access to safe and effective treatments to combat dermatophytoses. In just the past few years, the field of topical antifungal therapy has seen tremendous advancements that are paving the way for better treatment outcomes and enhanced patient adherence.
Of note, the FDA has in recent years approved formulations that feature new antifungal drugs previously not available in the United States. This gives prescribers access to the widest possible range of topical treatment options for onychomycosis and suprficial cutaneous fungal infections. Devising an effective topically applied treatment for toenail onychomycosis had proven an elusive goal. Today, there are two novel topical formulations that show benefit in treating toenail onychomycosis and thus reduce the need for oral antifungal therapy with its associated risks, concerns for drug – drug interactions especially in older patients and required monitoring.
In addition to new chemical entities, several formulation advancements have also emerged recently for both new and established antifungal drugs. These formulation advancements have been demonstrated to provide more patient centric use and in some cases increased efficacy as compared to older formulations of the same active agents. Gels, foams, and other dosage forms now available may be especially suited for application to large body surfaces, hair bearing areas providing ease of spreadibility of the active agent. Additionally, newer formulations allow for less frequent dosing (once daily) or shorter courses of treatment, which may be associated with improved patient satisfaction and better adherence with topical therapy. For example, as discussed ahead, the newest gel formulation of Naftifine 2% for interdigital tinea pedis is applied once daily for 2 weeks. In clinical trials, patients had shown continuous improvement in the signs and symptoms of tinea for up to four weeks after the treatment stopped.
Dermatophyte infections of the nails and skin can have a tremendous impact on patients, effecting not only function but also quality of life. Affected skin can become tender, itchy, and macerated. In patients with certain pre-existing medical conditions, like diabetes, for example, dermatophytoses are a source of potential significant health impairment. Dystrophic nails can become painful and affect gait.
When patients seek treatment, they require accurate diagnosis, education, and a commitment from the prescriber to combat a significant health concern. Many patients may have tried over-the-counter or “alternative” remedies, and may be frustrated with lack of results. They need efficient treatments that can be applied to affected skin and nails without causing additional discomfort and once a day dosing with ease of use. The latest range of topical antifungal therapies in novel formulations provides prescribers many options to meet those patient needs.
The pages ahead explore the microbiology of topical antifungal drugs, the science behind vehicle formulations and delivery systems, and the data on topical treatment efficacy. Armed with this knowledge, clinicians can more effectively target superficial cutaneous fungal infections and ultimately increasing their patients’ quality of life.
Leon H. Kircik MD
Icahn School of Medicine at Mount Sinai, New York, NY
Indiana University School of Medicine, Indianapolis, IN
Physicians Skin Care, PLLC, Louisville, KY
Dr. Kircik has received compensation from the Journal of Drugs in Dermatology for his editorial support.