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Ciclopirox nail lacquer for the treatment of onychomycosis: an open non-comparative study.
Shemer A, Nathansohn N, Trau H, Amichai B, Grunwald MH. J Dermatol. 2010 Feb;37(2):137-9.
Quote:
Onychomycosis is a relatively common disease accounting for up to 50% of all nail disorders. Topical treatment, although less effective than systemic, is usually preferred by patients. Topical antifungal nail lacquers have been formulated to provide better delivery of the antifungal agent to the nail unit. The purpose of this research is to evaluate the efficacy and safety of ciclopirox nail lacquer in the treatment of onychomycosis. Patients suffering from distal and lateral subungual toenail onychomycosis (DLSO) and lateral subungual onychomycosis (LSO) were treated by ciclopirox nail lacquer once daily for 9 months. Every week the nail lacquer was removed using acetone. Clinical nail status, KOH examination and mycological culture were recorded by the same investigator at 0, 3, 6 and 9 months. Thirty-six patients completed the 9-month regimen. Trichophyton rubrum was the most common pathogen. At the end of the study, good improvement to complete cure was observed in 13 patients (36%), 12 patients showed only mild to moderate improvement and 11 patients (31%) had no clinical improvement. No adverse effects were noted throughout the treatment period. Ciclopirox nail lacquer seems to be slightly more effective than other topical modalities and could be used in patients who cannot or do not want systemic treatment.
The standard treatment course for ciclopirox is daily treatment for 9-12 months, not 48 months. Most patients show good improvement in nail appearance in my clinical experience. 67% of patients showed mild improvement to complete cure in this study which is about what I have gotten in my patients. Down the street from me, a podiatrist charges $1200.00 for "laser fungal toenail treatment" using a non-FDA approved laser and no peer-reviewed scientific studies to back up his amazing claims of "curing nail fungus".
Graham, I am interested....what do you tell your patients you can do for their mycotic nails.....other than trimming them?
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
The standard treatment course for ciclopirox is daily treatment for 9-12 months, not 48 months. Most patients show good improvement in nail appearance in my clinical experience. 67% of patients showed mild improvement to complete cure in this study which is about what I have gotten in my patients. Down the street from me, a podiatrist charges $1200.00 for "laser fungal toenail treatment" using a non-FDA approved laser and no peer-reviewed scientific studies to back up his amazing claims of "curing nail fungus".
Graham, I am interested....what do you tell your patients you can do for their mycotic nails.....other than trimming them?
Very interesting article but the results are less impressive than I thought. It seems to be an expensive option for a possible cure.
I still prefer the Terbinafine tablets, or if that is not possible the Amorolfine varnish which is applied twice a week, not every day.
Since I can't read the whole article can anyone please confirm that the suggested use of ciclopirox in the study is with or without deep nail debridement?
I find that the combination of the two (ciclopirox and debridement) has more than 66% success rate (complete resolution of infection) in my patients given they are reviewed every 4-8 weeks.
I have not found Phytonail any good for my patients. But then I am not there to supervise its use.
Zsuzsanna
Surprised to hear this. Used in my clinic for years with excellent results. Is the patient applying twice daily for four weeks and then once on retiring?
Ciclopirox for the treatment of onychomycosis
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