Toenail Onychomycosis—A Canadian Approach With a New Transungual Treatment: Development of a Clinical Pathway. Issue 5 (September 2015)

• Record Type: Journal Article
• Authors: Gupta, Aditya K.; Sibbald, R. Gary; Andriessen, Anneke; Belley, Richard; Boroditsky, Alan; Botros, Mariam; Chelin, Robert; Gulliver, Wayne; Keast, David; Raman, Mani
• Is Part Of: Journal of cutaneous medicine and surgery. Volume 19:Issue 5(2015:Sep./Oct.)
• Page Start: 440
• Page End: 449
• Publication Date: 2015-09
• Subjects: toenail onychomycosis -- clinical pathway -- transungual treatment; Dermatology -- Periodicals; Skin -- Diseases -- Treatment -- Periodicals; Skin -- Surgery -- Periodicals; Dermatology -- Canada -- Periodicals; Skin -- Diseases -- Treatment -- Canada -- Periodicals; Skin -- Surgery -- Canada -- Periodicals; 616.5005
• DOI: 10.1177/1203475415581310
• Languages: English
• ISSNs: 1203-4754

Abstract

Background: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. Objective: To define a patient-centred Canadian treatment strategy for onychomycosis. Methods: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. Results: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. Conclusion: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.