Magazine article Drug Topics

How to Help Your Patients Clip Nail Fungus Infections

Magazine article Drug Topics

How to Help Your Patients Clip Nail Fungus Infections

Article excerpt

Guess what lurks in heat and moisture and could become as snug as a bug in a rug beneath your nail? The underachiever happens to be a dermatophyte-the responsible fungus in most cases of onychomycosis, or fungal infection of the nail. The condition typically causes the unlucky nail to endure a variety of symptoms ranging from changes in color and texture to distortion and detachment.

"But not all patients have to be treated," declared Irving Katz, M.D., clinical professor, department of dermatology, University of Minnesota School of Medicine. Some are not bothered by the cosmetic appearance of the infection and feel no discomfort. But for others, "it's not just a cosmetic problem-it's a medical problem."

Patients in whom onychomycosis affects the toenail may have trouble walking because of the pain. And "since the infection compromises the integrity of the skin," those with compromised immune systems or circulatory problems due to diabetes are at risk of developing more serious skin structure infections, Katz noted. Although these types of patients should be considered for therapy, there's no golden rule of who exactly should undergo treatment, he said. Patients may have hepatic impairment or other factors that may preclude the use of systemic antifungals.

And, apparently, systemic therapy are the key words in eradicating a majority of infections. Katz feels that most topical antifungals won't vanquish the bug. "Vehicles such as creams and lotions have difficulty penetrating the hard keratin make-up of the nail plates." And since the viable fungi are underneath the nail (inside the nail bed), application to the affected site may be difficult.

So, which systemic antifungals will eliminate the organism? Griseofulvin, used in the past, "is a wonderful drug for skin fungal disorders-but not for onychomycosis," said Katz. He explained that because griseofulvin is deposited only in the nail matrix (growing cells), the antifungal must be given until the entire nail grows out completely-a process that can take six to 18 months.

The newer systemic antifungals seem to have more bases covered. The drugs are deposited in the nail matrix, as is griseofulvin. But in addition, they manage to diffuse from the nail bed to the nail plate, where they are retained, revealed Katz. As a result, duration of active treatment is shortened. Although other antifungals, such as fluconazole, may be used in the treatment of onychomycosis, Sporanox (itraconazole, Janssen) and Lamisil (terbinafine HCL, Sandoz) are the two agents currently approved for that indication. …

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