Individual Article: Updated Review of Topical Pharmaceuticals and Complementary and Alternative Medications for the Treatment of Onychomycosis in Both General and Special Populations in the United States

September 2023 | Volume 22 | Issue 9 | SF378719 | Copyright © September 2023


Published online August 31, 2023

Naiem T. Issa MD PhDa, Leon Kircik MDb

aForefront Dermatology, Vienna, VA; Issa Research and Consulting, LLC, Springfield, VA 
bIcahn School of Medicine at Mount Sinai, New York, NY; Physicians Skin Care, PLLC, Louisville, KY;  
DermResearch, PLLC, Louisville, KY; Skin Sciences, PLLC, Louisville, KY

action and vehicle formulations, their efficacies vary but are also comparable or even superior to oral antifungals while avoiding drug interactions and systemic adverse effects (Figures 1 and 2). Unfortunately, a Medicaid study assessing the relation between medication coverage and complete clinical or mycologic cure rates found no correlation and stressed that there is poor Medicaid coverage of antifungals for the treatment of onychomycosis with decision-making based on cost rather than treatment efficacy, compliance, or safety.11 It is critical for pharmacy benefit managers and insurance companies to revisit topical antifungal coverage and formulary options based on safety and efficacy because cost and comorbidities will decrease in the long run. It is also important to note that antifungal resistance is also a burgeoning problem and has been noted for terbinafine.68 Thus, it is even more imperative that current approved topical antifungals for onychomycosis garner wider patient access through formulary adoption. 

DISCLOSURES

Naiem T. Issa MD PhD has served as a speaker for Ortho Dermatologics. 

Leon Kircik MD has served as an investigator, a consultant, or a speaker for Ortho Dermatologics, Janssen, and Novartis. 

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AUTHOR CORRESPONDENCE

Leon Kircik MD wedoderm@yahoo.com
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